Histological studies of monofilament and multifilament polypropylene mesh implants demonstrate equivalent penetration of macrophages between fibrils

The tissue reaction to implanted monofilamentous and multifilamentous polypropylene mesh was compared in samples removed at operation from the perivaginal area of a 58 year old patient. The fibrils of both were surrounded by collagenous connective tissue, collagen types I and III, and proteoglycans. Smaller, less compacted bundles were seen in the vicinity of the monofilamentous mesh than around the multifilamentous mesh, and in addition, a greater number of inflammatory cells and larger multinucleate giant cells were seen apposed to the monofilamentous mesh.Following this, eight rats were implanted with multifilamentous synthetic polypropylene tape and examined at two, four, six and eight weeks after surgery. Macrophages and multinucleated giant cells were seen in the immediate vicinity of the fibrils, while fibrovascular connective tissue surrounded the implantation site.These observations do not support the prevailing hypotheses that macrophages cannot penetrate between the fibrils of multifilament tape. They do suggest that differences in tensile strength may be present in the artificial neoligaments created by the two tapes.     

Clinicopathological study of migratory lung infiltrates.

Clinical features and the histological appearances of transbronchial lung biopsy specimens were investigated in 11 patients with migratory infiltrates on the chest radiograph. Serum circulating immune complexes were increased at the time that infiltrates were present in all patients and the levels returned to normal as patients recovered clinically and radiologically. The Mantoux test response was negative in most patients. Fifty serial sections were obtained from each paraffin embedded biopsy specimen block and every 10th section was stained (step sectioning) with haematoxylin and eosin. Six patients (group 1) did not have eosinophilic infiltration; four of these had granulation tissue plugs within respiratory bronchioles when the tissue was examined by step sectioning. All had organising pneumonia and interstitial inflammation in the setting of a clinical picture consistent with bronchiolitis obliterans organising pneumonia. In two cases IgG had been deposited in intraalveolar macrophages. Biopsy specimens in five patients (group 2) showed eosinophilic infiltration; four patients had chronic eosinophilic pneumonia and one the Churg-Strauss syndrome. Step sectioning of transbronchial biopsy specimens in patients with migratory pulmonary infiltrates is useful and may support the diagnosis of bronchiolitis obliterans organising pneumonia.     

Local recurrence of breast cancer in the stereotactic core needle biopsy site: case reports and review of the literature

Abstract: Early mammographic detection of nonpalpable breast lesions has led to the increasing use of stereotactic core biopsies for tissue diagnosis. Tumor seeding the needle tract is a theorectical concern; the incidence and clinical significance of this potential complication are unknown. We report three cases of subcutaneous breast cancer recurrence at the stereotactic biopsy site after definitive treatment of the primary breast tumor. Two cases were clinically evident and relevant; the third was detected in the preclinical, microscopic state. All three patients underwent multiple passes during stereotactic large-core biopsies (14 gauge needle) followed by modified radical mastectomy. Two patients developed a subcutaneous recurrence at the site of the previous biopsy 12 and 17 months later; one had excision of the skin and dermis at the time of mastectomy revealing tumor cells locally. In summary, clinically relevant recurrence from tumor cells seeding the needle tract is reported in two patients after definitive surgical therapy (without adjuvant radiation therapy). Often, the biopsy site is outside the boundaries of surgical resection. Since the core needle biopsy exit site represents a potential area of malignant seeding and subsequent tumor recurrence, we recommend excising the stereotactic core biopsy tract at the time of definitive surgical resection of the primary tumor.     

Renal cell carcinoma associated with granulomatous reaction

Granulomatous inflammation is a distinctive pattern of chronic inflammatory reaction characterized by accumulation of epithelioid histiocytes and multinucleate giant cells. The cause of granulomas can be infectious or non-infectious. Granulomas have been described within the stroma of malignancies like carcinomas of the breast and colon, seminoma and Hodgkin's lymphoma, where they represent T-cell-mediated reaction of the tumor stroma to antigens expressed by the tumor. Granulomatous reaction in association with renal cell carcinoma (RCC) is uncommon, with only few published reports in the literature. We describe three cases of conventional (clear cell) RCC associated with epithelioid granulomas within the tumor parenchyma.     

Intraductal papillomas of the breast: diagnosis and management of 151 patients

Introduction

The assessment of papillary lesions continues to be a challenging area in breast radiology and pathology. The management of intraductal papillomas without atypia of the breast remains controversial. The purpose of the present study was to determine diagnostic accuracy of radiographical diagnosis, core biopsy, and surgical excision in papillary breast lesions.

Material and methods

By using files from 1995 to 2010, 151 cases of intraductal papilloma with or without atypia were identified. Patients were stratified as follows: core biopsy followed by surgical excision (n = 61), core biopsy alone (n = 19), and surgical excision alone (n = 71).

Results

The upstage rate of intraductal papillomas without atypia on core biopsy to atypia or malignancy on excision was 8.9%. Excision specimens revealed intraductal papillomas without atypia in 68 out of 71 cases, and atypical papillomas in 3 cases.

Conclusion

Our findings suggest that radiographic and histopathological diagnosis of intraductal papillomas show high accuracy and good concordance. In cases where the radiographic diagnosis reveals suspicious lesions core biopsy represents the first choice.     

钼靶联合超声引导双定位法在乳腺微钙化灶活检中的 临床应用研究

目的:探讨钼靶X线与超声联合定位在乳腺微钙化灶活检中的临床应用价值。方法:在钼靶下对微钙化病灶三维定位,插入双钩定位针,到达病灶后固定位置;以超声探查双钩针,找到病灶的位置后,划出皮肤标记线,再插入单钩定位针;在标记线上作3 cm切口,用特制拉钩显露并固定病灶部位的乳腺组织和单钩针,对微钙化病灶区进行旋切;切下的圆柱体标本,放在带刻度的标本台上摄片,验证钙化灶是否已被完全切除,同时确定钙化灶在标本中的三维位置供病理检查。结果:共108例乳腺微钙化病灶分类为BI-RADS 4A的患者采用以上方法。定位时病灶距双钩针距离平均为4.1 mm(小于传统方法),标本平均重量为8.5 g(小于传统方法),病灶全部被一次性精准切除。108例中阳性20例,包括不典型增生7例,导管原位癌7例,导管原位癌伴局灶浸润性癌3例,浸润性导管癌3例;阴性病例88例。微钙化灶部位及形态与乳腺癌检出无明显关系(均P0.05)。结论:钼靶X线与超声联合定位对病灶定位准确、手术方法合理、切除标本小,并能提供病灶在标本中的精确位置进行病理检查;良性者乳房外形完全没有改变。     

Correction of breast contour deformities using polyurethane breast implant capsule in revisional breast surgery

Surgeons are commonly confronted with breast contour deformities and defects that result from previous surgical interventions. These soft tissue deformities can be corrected by conventional reconstructive flap surgery using autologous tissue, but there can be donor site morbidity. Smaller volume replacement is possible using temporary fillers such as hyaluronic acid or polylactic acid, or by using 'permanent' fillers such as autologous fat, but large defects are notoriously difficult to fill and often the fillers resorb or migrate. The patient described in this case report had an exchange of polyurethane implant (PU) in the left breast and correction of a contralateral breast contour filling deformity. A left breast partial capsulectomy was performed after implant removal and the capsule graft was inserted into a predissected pocket where soft tissue augmentation was required. A biopsy from the PU capsule was reported to show a foreign body type giant cell reaction to PU material in a fibrous capsule, lined by synovial metaplasia. The post-operative result showed satisfactory soft tissue revolumisation. PU breast implant structured capsule has thus been used as filler to correct breast soft tissue deformity and contour defects. Clearly it may have a use in other anatomical sites.     

A prospective study of seeding of the skin after core biopsy of the breast

BACKGROUND: The number of core biopsies done for breast abnormalities is increasing. The risk of skin seeding resulting from core biopsy is unknown. METHODS: Consecutive patients diagnosed with breast cancer were studied. The skin and subcutaneous fat surrounding the site of core needle penetration were excised and studied by routine histologic staining. Findings were correlated with other clinical variables. RESULTS: Eighty-nine consecutive patients were studied. Thirty-one had stereotactic core biopsies, 23 had vacuum-assisted biopsy, 8 had multiple-puncture biopsy, and 58 had ultrasound-guided core biopsy. Two patients who were biopsied using multiple-puncture biopsy were found to have nests of cancer cells in the dermis. One of these patients had recurrence in the skin biopsy site at 34 months. CONCLUSION: Skin seeding may be important in light of increasing use of image-directed biopsy, and particularly for cases in which the biopsy puncture site is outside the index quadrant and in which no radiation is anticipated.     

Paget's disease, workup and monitoring

Paget's disease is a progressive bone disease, characterized by bone hypertrophy and increased bone resorption. The pain and deformity that characterize its clinical course are not simple to assess, but it has a characteristic radiographic appearance. In most cases, treatment can be monitored through biological markers of bone turnover. Total alkaline phosphatase is the best marker and measurement of collagen breakdown products is useful in difficult cases. The goal of treatment is the normalization of these biological markers, to prevent complications of the disease.     

Multicentric Secretory Carcinoma of the Breast in a 35-Year-Old Woman: Mammographic Appearance and the Use of Core Biopsy in Preoperative Management

Abstract: Core biopsy of the breast has been increasingly utilized as a first-line diagnostic approach for mammographic breast lesions, palpable breast lesions, or both. Core biopsy has been shown to be cost-effective in sparing a significant fraction of women an open surgical procedure and, in conjunction with radiologic imaging studies, can allow for planning of definitive therapy in women with malignant lesions ( 1 - 4 ). We present a case of multicentric secretory carcinoma of the breast in which the diagnosis was suggested by core biopsy. This case represents the first reported instance of core biopsy in secretory carcinoma, one of the rarest types of mammary carcinoma. We describe the mammographic appearance of the lesion, the appearance of the tissue core, and the use of core biopsy in the proper preoperative management of this rare, multicentric lesion.     

Endocrine markers in argyrophilic carcinomas of the breast

Argyrophilia in breast carcinomas is of uncertain significance. We tested a series of 20 cases of Grimelius-positive carcinomas with immunocytochemical markers of endocrine or exocrine differentiation. Fifty per cent of these tumors were positive, in a variable percentage of the neoplastic cells, with monoclonal antibodies against chromogranin, a specific marker of neuroendocrine differentiation. All cases were positive for neuron-specific enolase, but the significance and specificity of the reaction remain doubtful. The apparent positivity for alpha-lactalbumin, as found also by Clayton and coworkers, was found to be related to a contaminant, which is in fact also an endocrine marker. As with other types of breast carcinoma, all our cases were positive for epithelial membrane antigen, evidence that argyrophilic breast carcinomas, and specifically the chromogranin-positive subgroup, should be interpreted as endocrine neoplasms displaying multidirectional differentiation.     

超敏反应对假体周围组织炎症反应的影响

目的：建立迟发性超敏反应的新西兰兔动物模型并研究超敏反应对假体周围组织及滑膜炎症反应的影响。方法：通过皮内注射K2Cr2O7和福氏完全佐剂以及波皮相结合的方法在新西兰兔体内建立对Cr^6 产生迟 过敏反应的动物模型，在右侧股骨髁内植入然合金棒，并通过关节腔间断注射Cr^6 ,在要后8周时检测致敏情况并观察膝滑膜和假体周围的炎症反应。结果：有4／6只兔对Cr^6 产生了迟发性过敏反应，在致敏组中，滑膜和假体周围骨髓中炎症细胞浸润明显增加，局部形成典型的肉芽肿性组织，并可见骨髓中破骨细胞数量的增加。结论：在致敏状态下，植入假体后可使假体周围炎症反应明显增加，促进假体周围吸收。     

Lobular carcinoma of the breast metastatic to the epidural space: a potential mimic of giant cell bone tumor

We report the case of a 64-year-old woman with a spinal epidural mass. Tissue from a decompression laminectomy disclosed a tumor with numerous osteoclast-like giant cells separated by small, moderately atypical tumor cells. The osteoclast-like giant cells were immunoreactive for vimentin, but negative for epithelial membrane antigen and broad-pectrum cytokeratin. Subsequent breast biopsy revealed a lobular carcinoma of classic type without osteoclast-like giant cells. This is the first reported case in which metastatic breast carcinoma was accompanied by these giant cells but the giant cells were not present at the primary tumor site.     

On the origin of the osteoclast: The cell surface phenotype of rodent osteoclasts

Summary The origin and development of the osteoclast is not well defined; although it is derived from a bone marrow stem cell, it is not proven whether the osteoclast progenitor comes from the multipotential hemopoietic stem cell or comprises an entirely separate cell lineage. We have studied the cell lineage relationship of osteoclasts isolated from newborn rodent bone to other bone marrow cell types, in particular the monocyte-macrophage cell line, by the use of cell surface phenotyping. In studies in mouse and rat we failed to detect the expression of markers characteristic of mononuclear phagocytes or other bone marrow cell types, including the hemopoietic tissue restricted common leucocyte antigen (T200). Our findings cast further doubt on the view that osteoclasts arise by fusion of mononuclear phagocytes in a similar fashion to the formation of multinucleate inflammatory giant cells.     

Clip placement after sonographically guided percutaneous breast biopsy

A simple and inexpensive technique for deployment of a metallic marker at the site of an ultrasound guided core breast biopsy is described. An illustrative case in which this technique was employed to mark the location of three biopsied lesions is presented.     

Bone lesions in histiocytosis X.

Sixty-two patients with histiocytosis X were followed for an average of 5 years. The patients were classified into three groups: general visceral types (14 cases), multiple eosinophilic granulomas (nine cases), and solitary eosinophilic granulomas (39 cases). One hundred bony lesions were noted in 60 of the 62 patients. The bone lesions showed progressive improvement in single and multiple eosinophilic granulomas independent of treatment type. After biopsy, patients received no treatment unless there was a dangerous extension into the soft tissues because of its site, i.e., in the skull. In the general visceral types, chemotherapy was effective in visceral sites and in extensions of the tumor outside the bone but did not alter the natural history of the bony lesion.     

Tissue marker migration after MRI‐guided breast biopsy: Migration frequency and associated factors

The purpose of this study was to determine the frequency and associated risk factors contributing to immediate tissue marker migration in patients undergoing MRI‐guided breast biopsy and to evaluate how often tissue marker migration altered clinical management. Between July 2010 and May 2015, we retrospectively reviewed all MRI‐guided breast biopsies at our institution for tissue marker migration. Migration was defined as final position of the tissue marker >10 mm from the target site based on the expected location of the MRI finding on postprocedure mammogram. Factors associated with migration were analyzed using Fisher's exact test and Chi‐squared test, with P < .05 considered statistically significant. A total of 278 patients underwent 298 MRI‐guided biopsies. Migration occurred in 42/298 biopsies (14%). Almost entirely fat fibroglandular tissue was identified as an independent risk factor for tissue marker migration, occurring in 6/16 (38%), compared to 36/262 (14%) for the other fibroglandular tissue categories (P = .03). Biopsy target size was significantly associated with clip migration, occurring in 25/114 (22%) lesions <10 mm in size vs 17/184 (9%) for larger lesions (P = .003). Clinical management was affected by clip migration in 6/42 cases (14%) with one requiring ultrasound‐guided biopsy cavity marker placement and five requiring biopsy cavity wire localization. Radiologists must be vigilant in assessing for clip migration as it is not an infrequent complication. Given migration may change clinical management and require altered procedures for localization of the biopsy cavity, the possibility of clip migration should be included in informed consent.     

Use of Hydrogel Breast Biopsy Tissue Markers Reduces the Need for Wire Localization

Background

The purpose of this study was to determine whether breast biopsy tissue markers composed of an ultrasound-visible hydrogel reduced the need for preoperative wire localization (WL) in patients undergoing a partial mastectomy.

Methods

A single-surgeon, single-institution, retrospective chart review was performed on 691 consecutive female patients, with mean age 67 years (range 36–98 years), from 2009 to 2012 undergoing partial mastectomies after percutaneous biopsies by stereotactic or ultrasound guidance.

Results

Overall, the use of WL was more frequent in patients who had standard (other) markers placed during biopsy as opposed to those with hydrogel markers (HydroMARK). For stereotactic biopsy, 75.8 % of patients with a standard marker required WL versus 17.1 % with HydroMARK and for ultrasound biopsy, 22.6 % standard versus 4.3 % HydroMARK (p < .0001, p < .0001). In some cases where hydrogel markers were used, WL was used for “bracketing” because of the presence of microcalcifications. In cases where standard markers were used, WL was not used because of either IOUS visibility of residual lesion or marker visibility. Specimen volume and re-excision rate were comparable between patients with hydrogel and standard markers, showing no significant differences (p = .1673, p = .1813 respectively).

Conclusions

Hydrogel biopsy tissue markers optimize the surgeon’s ability to perform a partial mastectomy without the use of WL. HydroMARK was as effective as a standard marker in terms of partial mastectomy specimen volume and re-excision rate. This yields potential for cost savings, increased efficacy in operating room and radiology scheduling, and patient comfort and convenience.     

Distinguishing papillary endothelial hyperplasia and angiosarcoma on core needle biopsy of the breast: The importance of clinical and radiologic correlation

Papillary endothelial hyperplasia (PEH) is a rare non‐neoplastic exuberant organizing hematoma that can closely mimic angiosarcoma due to a resemblance to malignant anastomosing blood vessels. It could be particularly difficult to distinguish PEH from angiosarcoma in breast core needle biopsies. We identified all cases of these lesions diagnosed on core needle biopsy in order to identify clinical, radiologic, and pathologic features that could prove helpful to arrive at the correct diagnosis. Four cases of PEH and 4 cases of angiosarcoma were identified. The mean age at diagnosis was 62 for PEH and 33 for primary angiosarcoma. All cases of PEH formed small masses with circumscribed or lobulated margins by imaging (mean size 0.9 cm). In 3 cases, the masses were difficult or impossible to identify after the biopsy. Angiosarcomas presented as larger masses with ill‐defined margins (mean size 2.8 cm) that were unchanged in size after biopsy. PEH was surrounded by adipose tissue, whereas angiosarcoma invaded into fibrous stroma and involved lobules. The pseudopapillary structures of PEH were composed mainly of collagen, and thus, additional histologic stains for fibrin were not helpful for diagnosis. The 4 patients with PEH received no further treatment and are alive and disease‐free at 2‐11 years of follow‐up. In contrast, the patients with angiosarcoma underwent mastectomy and chemotherapy or radiation therapy. Two of the patients with angiosarcoma died 3 years after diagnosis and the other 2 patients are alive without disease at 5 and 6 years. Therefore, distinguishing PEH and angiosarcoma is essential for appropriate management. This is the first series to compare these lesions on core needle biopsy and the first to note important clinical, imaging, and histologic differences that aid in making a diagnosis of PEH with confidence on breast core needle biopsy.     

Effect of time interval on residual disease in breast cancer

The histologic responses of breast tissue to injury are limited. Needle core biopsies of the breast are associated with displacement of tumor cells, and the incidence of tumor displacement decreases as the time interval between needle core biopsy and subsequent excision increases. This suggests that displaced tumor cells are destroyed by reparative processes induced by tissue injury. Residual tumor in a lumpectomy site may also be subjected to the same destructive processes associated with tissue repair. A total of 259 consecutive cases of infiltrating ductal carcinoma with margin-positive lumpectomies and their associated reexcision specimens obtained over a 7-year period were analyzed for the presence, type, and quantity of residual disease. The overall incidence of residual disease was 69%. Residual infiltrating ductal carcinoma was present in 35% of cases, and residual ductal carcinoma in situ was present in 50%. An increased time interval between lumpectomy and reexcision was associated with a decreased incidence of residual infiltrating carcinoma (p <0.0043); this decrease was not found associated with ductal carcinoma in situ. These findings suggest that the host response to injury may destroy residual infiltrating carcinoma cells in some margin-positive cases.