Radial scar and carcinoma of the breast: microscopic findings in 32 cases

We retrospectively reviewed the microscopic findings in 32 histologically confirmed radial scars in 31 women diagnosed in our unit during 1994–1998. The median age at diagnosis was 53 years (range 47–63 years). Thirty–one (97%) of 32 lesions presented as screen detected mammographic abnormalities (28 stellate lesions, 2 microcalcifications and only 1 architectural distortion). One lesion presented as a palpable breast mass. Stereotactic or ultrasound-guided fine needle aspiration cytology (FNAC) was performed in 28 cases. Cytological analysis of FNAs revealed malignant cells (C5) in 8 (29%) cases, highly suspicious cells (C4) in 3 (11%) cases, atypical benign cells (C3) in 7 (25%) cases and benign epithelial cells (C2) in 10 (35%) cases.All non-palpable lesions were surgically excised following wire localization. Histological examination of the breast specimens (mean WEIGHT = 16 g) demonstrated, in addition to a radial scar, 6 invasive carcinomas (2 infiltrating ductal, 2 tubular, 1 mixed ductal/lobular and 1 secretory carcinoma) and 4 ductal carcinoma in situ lesions (2 high grade, 1 high grade with micro-invasion and 1 low grade) arising in the radial scar. Of the remaining cases the radial scar was associated with atypical epithelial hyperplasia in 2 cases and regular epithelial hyperplasia in 17 cases (4 florid and 13 mild to moderate). In the 10 cases associated with malignancy, 9 had FNAC and was reported as malignant (C5) in 6 (67%) cases, highly suspicious (C4) in 2 (22%) cases and atypical (C3) in 1 (11%). False positive FNAC (C5) occurred in two patients, one of whom presented with pleomorphic microcalcifications suggestive of ductal carcinoma in situ. This patient was treated with a wire guided segmental mastectomy. All invasive tumours were less than 20 mm in size (T1) and of these 4 were grade I and 2 were grade II. Axillary dissection was performed in 4 patients none of whom had axillary node metastases.Our study demonstrates a significant incidence of malignancy associated with radial scars (31%) suggesting that radial scars may be premalignant lesions. This is supported by detecting various stages of mammary carcinogenesis (atypical epithelial hyperplasia, ductal carcinoma in situ, and early invasive malignancy) in these lesions. Fine needle aspiration cytology seems to be unreliable in the diagnosis of radial scar associated malignancy (67% sensitivity and 91% specificity). Stellate lesions, therefore, should be excised to obtain an histological diagnosis regardless of cytological findings. Further studies examining the biology of radial scars are required.     

热门去疤法 TOP大排行

时光和岁月会给我们留下很多印记。小时候的摔伤、打预防针、青春期的痘痘、意外的事故等等，都可能会在我们身体上留下难以磨灭的疤痕。因为爱美丽，不愿留着这些印记，我们想尽办法，生姜、精油、果酸、激光，甚至令人望而生畏的手术刀，都成了我们去除疤痕的道具。但美丽总是与缺憾同在，由于疤痕“顽固”，各种去除方式也可能不尽人意，虽然效果明显但缺点也不容忽视。因此，在下定决心去除疤痕的同时，一定要跟医师沟通清楚，选择一种最适合你的方式。     

激素与瘢痕

瘢痕尤其是瘢痕疙瘩因其具有持续而强大的增生能力，治疗难，易复发而在临床上倍受重视。作为人体重要调节系统的内分泌系统与瘢痕的发生、发展及转归有密切联系。虽然进行了多年的研究，但其作用机制目前仍不甚清楚，本文对几种与瘢痕有关的内分泌激素的研究情况进行综合与阐述。     

他克莫司抑制兔耳瘢痕增生的作用及其机制研究

目的：他克莫司是临床广泛应用的一种药物,其对增生性瘢痕是否产生作用并无相关报道,为此提出并证实了他克莫司可以抑制兔耳瘢痕增生。方法：建立兔耳增生性瘢痕模型,选10只新西兰大耳白兔双耳腹侧用打孔器制作直径1cm圆形创面,伤后14天创面上皮化后给药,每只兔左耳为空白对照组涂等剂量凡士林软膏,右耳为他克莫司治疗组。分别在伤后14天、21天2、8天3、5天和49天采集标本,行HE染色,观察形态学差异;Real-t i me PCR检测纤维化相关因子TGF-β1、TGF-β2、Col l agen-α1等的表达。结果：HE染色可见他克莫司组成纤维细胞数量及胶原纤维较对照组明显减少,PCR结果可见TGF-β1、TGF-β2及Col l agen-α1表达较对照组在各时间点均减少。结论：实验组较对照组瘢痕明显减轻,证明他克莫司显著抑制兔耳瘢痕增生,可作为临床上治疗及预防瘢痕增生的全新疗法。     

Abdominal scar endometriosis

Background

Abdominal scar endometriosis is an uncommon pathology. It can occur in any abdominal scar, most often after a surgical procedure on the uterus.

Aim

The purpose of this study is to highlight the potential pitfall in the diagnosis of this disease.

Patients and methods

This retrospective study reviewed all cases of proven abdominal scar endometriosis seen in a 5-year period (2002–2006) in our hospital, noting the demographic data of the patients and management. They were all treated by the same surgeon and also had histopathological confirmation of the lesion.

Results

A total of 14 women were treated during this period. They were all pre-menopausal. The mean age was 29.1years (range 20 to 42). Presenting symptoms included painful ‘heaped-up’ scars and cyclical pain related to their menstrual periods. They were referred to the general surgical clinic with various diagnoses such as incisional hernia, granuloma, keloid scar etc. All the patients had history of previous surgical procedures on the uterus for various indications. Treatment was a wide excision of the lesion with apposition of the edges only. Specimens were examined histologically and confirmed to be endometriosis. The follow up periods were rather short as the patients stopped to attend the hospital. During this period, there was no recurrence or wound break-down.

Conclusion

Although scar endometriosis is a rare entity, a good and diligent surgical history and a high index of suspicion are the keys for a pre-operative diagnosis.     

Burn scar sarcoma

A case of malignant fibrous histiocytomas arising in a burn scar is described. Burn scar sarcomas are exceedingly rare tumors whose precise behavior, pathogenesis, and treatment remain to be elucidated.     

Surgical scar endometriosis

Endometriosis is a common disorder in females of reproductive age. Surgical scar endometrioma after cesarean section develops in 1–2 % of patients, and usually presents as a tender and painful abdominal wall mass. The diagnosis is suggested by pre or perimenstrual pelvic pain and is often established only by histology. In this retrospective observational cohort study, we reviewed the medical records of five patients with a histopathological diagnosis of scar endometriosis. A scar mass was found on a previous Pfannenstiel incision in four patients and in a median cesarean section in one patient. The mean age at diagnosis (38.6 years, median 38) was older than reported elsewhere. A histological examination of the surgical specimen confirmed the diagnosis of endometriosis in all cases. During the follow-up period (mean 34.6 months), local recurrence (n = 1) and pelvic recurrence (n = 1) were treated surgically. Surgery is the treatment of choice for surgical scar endometriosis. Excision with histologically proven free surgical margins of 1 cm is mandatory to prevent recurrence. As scar endometriosis may be associated with pelvic localization, explorative abdominal laparoscopy may be indicated to exclude the intraperitoneal spread of the disease in symptomatic patients.     

Postburn scar carcinoma

A review of 20 patients with postburn scar carcinoma is presented. Eight early cases treated by wide excision and repair by skin grafting have been free of the tumour for the last 5-7 years. Nine patients treated by surgery and three patients who refused surgery and were treated by topical 5-fluorouracil developed metastasis and have since died.     

Pyelonephritic scar formation

Pyelonephritic scars almost never develop after urinary tract infections alone, but require in addition certain risk factors. The most important risk factors are: vesicoureteral reflux, intrarenal reflux, obstructive uropathy, and nephrolithiasis. Most of the pyelonephritic scars develop in early childhood, where we find the combination of vesicoureteral reflux, intrarenal reflux, and urinary tract infections. Urinary tract infections alone almost never result in pyelonephritic scars. After the age of 3 years the risk to develop pyelonephritic scars is not more than 10% in those with the combination of urinary tract infections and vesicoureteral reflux. In this age group the risk to develop pyelonephritic scars is not altered by antireflux operation.     

Radial polydactyly

Excessive longitudinal segmentation of the radial portion of the limb bud results in the clinical presentation of duplicated and triphalangeal thumbs. These are common congenital problems with various possible associated anomalies and variable inheritance patterns. Reconstruction of a thumb with stable joints, muscle balance, and good alignment requires attention to each tissue component at the time of the initial surgery.