A case of endocrine ductal carcinoma of the breast

A case of endocrine ductal carcinoma of the breast is presented. A 65-year-old woman was admitted with complaints of left breast mass and pain. Physical examination, mammography, ultrasonography, and computed tomography showed a mass 5 cm in diameter in the left breast suggestive of breast cancer, and incisional biopsy confirmed ductal carcinoma. Auchincloss's mastectomy was performed. The tumor, 4.0 x 3.8 cm in size, consisted of a relatively uniform proliferation of tumor cells with round nuclei and abundant eosinophilic cytoplasm. Immunohistochemically, tumors cells were positive for chromogranin A, synaptophysin, and neuron-specific enolase. Endocrine ductal carcinoma with invasion was diagnosed. No lymph node metastasis was observed, and estrogen and progesterone receptors were positive.     

A case report of tubular adenoma of the breast

Pure adenoma of the breast was seen in a 34-year-old Japanese woman. On examination, there was a firm, movable, nontender mass, 2.0 cm in diameter, in the upper outer quadrant of the left breast. The xeromammographic and macroscopical diagnosis was fibroadenoma. Histological examination, however, identified pure tubular adenoma of the breast. This was reported herein because of its extreme rarity.     

A case of stromal sarcoma of the breast coexisting with noninvasive ductal carcinoma

This paper describes a very rare case of stromal sarcoma of the breast coexisting with simultaneous noninvasive ductal carcinoma in the same breast. A 75-year-old female was seen at our hospital for a lump in the right breast. On physical examination, a 10 x 8 cm well-difined and movable hard mass with a smooth surface was palpated in the upper outer quadrant of the breast. Aspiration cytology suggested a non-epithelial tumor with marked dysplasia (class 3b). Drill biopsy revealed probable stromal sarcoma. Simple mastectomy and axillary lymphonode sampling was performed. Histologically, the tumor was stromal sarcoma in the upper outer quadrant of the breast. In addition, noninvasive ductal carcinoma was simultaneously detected in the upper inner quadrant of the breast as an independent lesion. No positive axillary nodes were found. To date, as far as we could investigate, there was no preceding case report of both stromal sarcoma and carcinoma in the single patient at the same time.     

Two cases of ductal adenoma of the Breast

We encountered two cases of ductal adenoma of the breast. In the first case, a 32-year-old woman presented with a two-year history of a left breast lump. Previous ultrasonography had demonstrated three tumors which were thought to be most likely fibroadenoma. On excisional biopsy of the largest , intraoperative pathological examination of frozen sections was suspicious for ductal carcinoma with a differential diagnosis of intraductal papilloma or intraductal papillary carcinoma. Ductal adenoma was diagnosed after pathological examination of the permanent sections. The second case was a 64-year-old woman who presented with a hard lump in her left breast. Mammography and ultrasonography demonstrated images typical of carcinoma. Aspiration biopsy cytology (ABC) repeated twice was reported as " indeterminate". Excisional biopsy was later done. Ductal adenoma (sclerosing papilloma) with hemorrhagic infarction was diagnosed. It is noteworthy that ductal adenoma have clinical and histopathological features that should be differentiated from carcinoma, especially when the tumor is accompanied by secondary changes such as hemorrhage or infarction.     

乳腺导管原位癌与浸润性导管癌激素受体及HER-2表达的比较

目的研究乳腺导管原位癌（DCIS）与浸润性导管癌（IDC）患者的激素受体和HER-2表达及分子分型的差异。方法收集2006年3月至2012年9月本院治疗的52例DCIS和224例IDC患者的手术标本,应用免疫组化方法检测其ER、PR、HER-2的表达,并用×2检验综合分析其分子分型构成等特点。结果IDC组ER阳性表达率明显高于DCIS组[67．86％（152／224）比48．08％（25／52）,）（X^2=7．18,P=0．01],IDC组HER-2阳性表达率明显低于DCIS组[54．02％（121／224）比73．08％（38／52）,）（X^2=6．28,P=0．01],而两组的PR表达差异无统计学意义（X^2=1．39,P=0．24）。DCIS组以HER-2阳性型为主要亚型,占44．23％（23／52）,而IDC组以luminalA型为主要亚型,占43．75％（98／224）,两组患者的分子分型构成比差异有统计学意义（X^2=13．11,P=0．00）。结论检测乳腺导管原位癌和浸润性导管癌患者的ER、HER-2表达及其分子分型,可指导临床诊疗及制定个体化综合治疗方案。     

A case of tubular adenoma of the breast preoperatively suspected to be an advanced cancer

A very rare case of a tubular adenoma of the breast is reported. The patient, 59-year-old woman, was admitted to hospital because of a large, left breast tumor. The tumor, 11 cm in diameter, was adhered to the surface skin. Because a malignancy was suspected, an incisional biopsy was first carried out. A pathologic examination revealed it to be a tubular adenoma, and a simple mastectomy was chosen as the operative procedure because a latent malignancy was not ruled out. The removed tumor was grossly cystic and a histological examination supported the finding that it was a non-malignant tubular adenoma.     

A case report of lactating adenoma of the breast and review of the literatures in Japan

We experienced a rare case of lactating adenoma in the mammary gland of a pregnant woman. A 21-year-old pregnant woman visited our clinic with a chief complaint of left mammary gland tumor. Based on palpation, mammograms and echograms, fibroadenoma or phyllodes tumor was diagnosed and enucleation was performed at the time of biopsy. The histopathological diagnosis was lactating adenoma.     

Signet ring cell carcinoma associated with invasive ductal carcinoma of the breast: A case report

A signet ring cell carcinoma (SRCC) associated with invasive ductal carcinoma (IDC) of the breast occurred in a 52-year-old woman. She was admitted in December 1994 for investigation of a palpable right breast mass. On physical examination a tumor measuring 2.5X2.1 cm was palpable in the right upper lateral portion of the breast. Ultrasonography of the breast visualized an irregular-shaped tumor. On January 1995, modified radical mastectomy was performed, and the postoperative course was uneventful. Histological examination revealed a tumor consisting of IDC with a component of SRCC that occupied about 40% of the area of the invasive carcinoma. We reviewed the cases of IDC with SRCC from the Japanese literature with consideration of the characteristics and problems of this rare tumor.     

Influence of lobular development on breast epithelial-cell proliferation and steroid-hormone receptor content

The development of the breast evolves through progressive formation of lobular structures. Lobules type 1 (Lob 1) are the most undifferentiated ones; they evolve to lobules type 2 (Lob 2), and those to type 3 (Lob 3), in response to mainly ovarian hormones. Although estradiol and progesterone act by binding to their specific receptors, their content in these structures and how they correlate with proliferative activity are not known. Normal breast tissues obtained from 40 reduction mammoplasties performed for cosmetic reasons in women free of mammary pathology were processed for light microscopy. Paraffin sections were immunoreacted with antibodies against estrogen receptor (ER), progesterone receptor (PgR), and proliferating cell nuclear antigen (PCNA). The number of cells positively labeled with each one of the three antibodies was quantitated in Lob 1, 2 and 3, and expressed as a percentage of the total number of cells. ER were positive in Lob 1 (21%) and Lob 2 (10%), but negative in Lob 3. PgR were positive in Lob 1 (66%) and 2 (68%), decreasing in Lob 3 (31%). The highest percentage of PCNA positive cells were found in Lob 1 (40%), decreasing in Lob 2 (33%) and Lob 3 (11%). These results indicate that the normal breast epithelium contains ER and PgR, but the former is at higher levels in Lob 1, which also expresses greater proliferative activity as demonstrated with PCNA.     

Histological category and expression of hormone receptors in ductal carcinoma in situ of the breast

BACKGROUND: While the role of estrogen receptor (ER) and progesterone receptor (PR) status in invasive breast cancer has been clinically established, data with respect to their role in ductal carcinoma in situ of the breast (DCIS) are sparse. PATIENTS AND METHODS: We reviewed 120 consecutive patients with DCIS I-III. Detailed histological categorization and immunohistochemical staining for ER and PR were performed and correlated with clinical data. RESULTS: DCIS I, DCIS II, and DCIS III were found in 51, 36 and 33 patients, respectively. Comedo-type tumors (p<0.001), presence of tumor necrosis (p<0.001) and absence of ER (p=0.005) were significantly associated with poorly-differentiated DCIS. No association was ascertained between PR expression and grade of DCIS. Hormone receptor expression was independent of the patients' menopausal status. CONCLUSION: We support the assumption that DCIS I-III is morphologically and biologically heterogeneous. Our results contribute further data on the role of ER and PR in the pathogenesis and progression of DCIS.     

Synchronous bilateral noninvasive ductal carcinoma of the male breast: a case report

A 45-year-old man developed a bloody discharge from his right nipple. Physical examination revealed bloody discharge from his left nipple also but no swelling, breast mass, or axillary lymph nodes. He then underwent bilateral total glandectomy without axillary dissection. Histological examination revealed low-grade ductal carcinoma in situ (DCIS) with a low-papillary and cribriform pattern measuring about 4 mm in diameter in the breast bilaterally. To our knowledge, this is the first report of synchronous bilateral DCIS in a male. Since this patient's hormonal profile showed a relatively high blood level of prolactin, the causative relationship between hyperprolactinemia and male breast cancer is discussed. Including our case, 5 of 6 cases reported thus far have been bilateral, and 4 of the 6 cases have been synchronous. We emphasize that the contralateral breast should also be tested or followed in male breast cancer patients with hyperprolactinemia.     

副乳腺浸润性导管癌1例并文献复习

目的：探讨副乳腺癌的诊断、鉴别诊断以及治疗方法。方法：报道腋窝副乳腺浸润性导管癌1例,结合文献对副乳腺癌的特点、临床表现、诊断、鉴别诊断、治疗以及预后进行探讨。结果：副乳腺癌的发病率较低,结合临床表现、镜下观察及免疫组化方法,可以明确诊断。注意与乳腺腋尾部癌、皮肤附件来源的肿瘤、腋下淋巴结转移癌、腋下淋巴结淋巴瘤等疾病进行鉴别诊断;治疗原则基本等同于乳腺癌的治疗。其预后较差,术后积极放化疗,有可能改善预后。结论：副乳腺癌相对少见。有副乳腺症者应加强自检,做到早期发现早期治疗。新辅助化疗联合手术治疗对提高患者的生存率很重要。     

Pleomorphic adenoma of the human breast

Pleomorphic adenomas of the human breast are histologically identical to those of salivary glands. To date, the literature reports but 15 such benign tumors, all of which occurred in women. The present paper describes clinical and pathologic findings in three further cases, including one man. Considered together, unnecessary mastectomy occurred in 44.4%, indicating the importance of separating this benign entity from malignancies with stromal metaplasia. In case of examination by frozen section, a peripheral portion, if not the entire tumor, should be submitted to the pathologist.