Benign papillary neoplasms of the breast: mammographic findings

The clinical presentation, pathologic characteristics, and mammographic/ductographic (also known as galactographic) findings were reviewed in 77 patients with histologically proved benign papillary neoplasms of the breast. Patients were classified as having either solitary or multiple papillomas. Patients with multiple papillomas were further subclassified as having either central or peripheral papillomas. Fifty-one patients (66%) had solitary papillomas. Thirty-seven of these patients were symptomatic; 36 had spontaneous nipple discharge, and one had a palpable mass. Ductography was positive in 32 of the 35 patients who underwent the procedure. In the 14 asymptomatic patients, subareolar (n = 10) and peripheral (n = 4) mammographic abnormalities prompted biopsy. Fourteen patients (18%) had multiple peripheral papillomas, and one patient also had bilateral central solitary papillomas. Eleven of these patients were asymptomatic, while two presented with palpable abnormalities and one with spontaneous bilateral discharge. Mammographic findings included microcalcifications (n = 5) and clustering nodules (n = 2). Associated atypical ductal hyperplasia was found in six (43%) of the 14 patients with multiple peripheral papillomas. Some of these patients also had lobular carcinoma in situ and radical scars. Twelve patients had multiple central papillomas; all presented with spontaneous nipple discharge and had positive ductograms.     

Galactography: method of choice in pathologic nipple discharge?

Our objective was to assess the role of galactography in the diagnostic work-up of patients with pathological nipple discharge together with exfoliative cytology, and investigation of secretion colour. All galactographies performed in this center between 1993 and 1998 were evaluated retrospectively. In 134 cases, outcomes, defined as either a postoperative histology or a negative follow-up over 2 years after galactography, were available. In 96 of these cases, exfoliative cytology was performed, and in 65 cases the colour of the secretion was determined. Galactograms, cytological findings and colour of the secretions were compared with the outcomes. At galactography, the radiographic findings had the following individual sensitivities/specificities in detecting carcinomas: filling defect 55.6%/62.1%; ductectasia 22.2%/94%; and filling stop 5.6%/77.6%. Normal galactograms (n=33, 25%) had a sensitivity of 78% and a specificity of 93% in predicting absence of disease. Technically inadequate investigations occurred in 16 (12%) cases. Cytology showed 69.2%/66.8% for papillomatous borderline or malignant cells; 53.8%/75.3% for borderline or malignant cells; and 7.7%/100% for one case of malignant cells. For the assessment of pathological secretions, galactography is a sensitive but unspecific method for the detection of papillomas or carcinomas. Filling defects, ductectasia and ductal distortion carry the highest levels of suspicion for carcinoma. A normal galactogram is a specific yet moderately sensitive indicator of absence of localized disease. Exfoliative cytology shows low sensitivity but better specificity for carcinomas when borderline or malignant cells are found. In the present series, the colour of the secretions does not add significant information about underlying pathology. Electronic Publication     

Solitary breast papilloma: comparison of mammographic, galactographic, and pathologic findings.

OBJECTIVE. Our purpose was to determine the mammographic/galactographic features of solitary breast papillomas and to correlate these features with the pathologic findings. MATERIALS AND METHODS. Retrospective review of pathology files revealed 72 women in whom breast biopsy reports described a solitary papilloma. All patients with additional pathologic abnormalities were excluded from this study. Patients meeting the pathologic criteria and for whom mammograms, galactograms, or both were available and had been obtained within 6 months before biopsy were included. Twenty-four women met these criteria and form the basis of this study. Presenting clinical signs and symptoms were reviewed. Abnormal mammographic/galactographic findings were correlated with pathologic features. RESULTS. Nipple discharge was present in 21 (88%) of 24 patients, two (8%) of 24 patients had abnormal findings on screening mammography, and one patient had a palpable mass that was visible on mammograms. Eight (42%) of 19 mammograms had abnormal findings, including dilated duct(s) in five cases (26%), nodules in two cases (11%), and microcalcifications in one case (5%). All technically adequate galactograms (13/15) had abnormal findings, with 12 (92%) of 13 showing an intraluminal filling defect. The other technically adequate galactogram (8%) showed only a solitary obstructed duct. Ductal dilatation was greatest at or central to the papilloma on 12 (92%) of 13 galactograms. Imaging features correlated well with the histologic findings. CONCLUSION. Patients with solitary papillomas most commonly have nipple discharge, normal mammographic findings, and a galactographic filling defect. Galactography is useful for localizing papillomas.     

Additional role of colour Doppler ultrasound imaging in intracystic breast tumours

Purpose

Cystic breast lesions with a nonsimple appearance, either complicated or complex, pose unique diagnostic difficulties, in part owing to their potentially malignant nature. Current ultrasound classification systems are based on morphostructural aspects only. The objective of this paper is to highlight the adjunctive role of Doppler techniques.

Materials and methods

Over a 1-year period, we prospectively evaluated 45 women with atypical breast cysts of type IV, V or VI according to the Chang classification. Forty patients were symptomatic, whereas the cyst was discovered as an incidental finding in five cases. Our assessment included morphostructural, angioarchitectural and flowmetric aspects.

Results

Twenty-three nontumoural lesions were managed conservatively. All 19 type-IV cysts and all four type-V cysts according to the Chang classification showed absence of signal flow at colour Doppler imaging. Among the 22 tumoural lesions, there were eight papillomas, one atypical ductal hyperplasia and 13 carcinomas. The eight papillomas showed single (four cases) or multiple (four cases) mural projections. The atypical ductal hyperplasia showed a single parietal nodule. Among the 13 carcinomas, patterns included mural projections in 11 cases, eccentric cystic wall thickening in one and coarse intracystic septa in one. Cystic content appeared clear in six papillomas and in the case of atypical ductal hyperplasia, whereas it exhibited fine echoes in two papillomas. Among the carcinomas, cystic content showed coarse echoes in two cases and fine echoes in 11. Intralesional calcifications were seen in three carcinomas. Posterior enhancement was present in all carcinomas, whereas none showed posterior shadowing. In three carcinomas, some small solid satellite nodules were evident. Colour Doppler imaging showed lack of flow in four papillomas and subtle flow in the remaining four papillomas and in the atypical ductal hyperplasia. All 13 carcinomas showed diffuse vascularity, with multiple sparse vessels and multiple vascular poles. The resistive index, measurable in 4/8 papillomas, was 0.43 on average. Spectral analysis was measured in all carcinoma cases, yielding a mean resistive index of 0.71.

Conclusions

Intracystic breast tumours exhibit distinctive morphostructural and colour Doppler features that allow effective differentiation from nontumoural cysts. Frequently, a presumptive differentiation between papillomas and carcinomas can be achieved. Absence of flow signals represents an additional criterion for complicated/complex cysts, allowing conservative management. Vascularity indicates the need for excision or biopsy of the solid projections, even in cases with negative cytology.     

乳腺导管造影对乳腺溢液性疾病诊断的临床价值

目的:探讨乳腺导管造影对溢液性乳腺疾病的诊断价值,提高其X线诊断与鉴别诊断水平。方法:回顾性分析39例乳头溢液患者的临床、影像及病理资料。结果:39例患者46个病灶乳头溢液患者中纤维腺瘤5个,乳腺癌6个,导管内乳头状瘤12个,纤维囊性乳腺病及小叶增生5个,误诊1例,乳腺癌诊断准确率为85.7%。结论:乳腺导管造影术是诊断溢液性乳腺疾病的有效方法,对其诊断与鉴别诊断有很重要的价值,可为临床提供可靠的诊断治疗依据。     

Galactography: the diagnostic procedure of choice for nipple discharge

Galactography was performed in 204 women with a nipple discharge and the secretion confirmed histopathologically. All 116 intraductal tumors (papilloma, papillomatosis, carcinoma), which were associated with a serous or bloody discharge, were detected preoperatively. A palpable mass had little diagnostic significance, and exfoliative cytology was positive in only 11% (2/18) of the patients with carcinoma. The authors recommend that all patients with a spontaneous bloody or serous discharge from a single lactiferous orifice undergo galactography in addition to physical, cytological, and mammographic examination. Intraductal injection of methylene blue dye will demonstrate the affected duct system to the surgeon and can often make surgery less radical or even unnecessary.     

The role of magnetic resonance in the study of cerebrospinal malformations in childhood. An analysis of 51 clinical cases

This study was aimed at assessing MR utility in the evaluation of cerebral-medullar malformative pathologic conditions in infants. Among 274 patients 2 months to 15 years old examined by means of MR imaging, 51 (18.6%) were affected with cerebral-medullar abnormalities. Seventeen different types of pathologic conditions were identified, some of which single and some multiple; tethered cord was the most frequent finding. 45/51 patients affected with malformative pathologic conditions required sedation. The high incidence of malformative pathologic conditions in pediatrics highlights the importance of this subject for all the radiologists dealing with MR imaging in pediatrics. MR imaging appears to be the method of choice for the evaluation of cerebral-medullar abnormalities.     

High-risk focal breast lesions in echography and mammography

Proliferative breast diseases include a group of lesions which occupy an intermediate position between benign and malignant lesions and are extremely likely to develop into carcinomas. The authors studied 81 patients who had been surgically biopsied on the basis of mammographic and/or US findings. In 33/81 (40.7%) of them proliferative lesions were diagnosed at histology. Mammography was able to identify 18/33 lesions (54.5%) versus US 26/33 (81.8%). On the basis of these findings, a group of patients at risk for cancer could be identified. As a matter of fact, proliferative lesions, especially those presenting with atypical hyperplasia, are associated with a higher risk of developing into carcinomas than those presenting with typical features. For these patients, the authors suggest more frequent clinical and instrumental screening.     

Ultrasonically guided biopsy of intra-abdominal changes. Report of the results of a 5-year study

Ultrasound guided biopsies of intraabdominal changes have been performed in 215 patients within a five-year period. The most frequent pathologic changes were liver neoplasms--liver metastases in 51 patients, angiomas in 16 and primary carcinomas in 17. The most frequent extrahepatic pathologic changes were pancreatic diseases in 22 patients and colonic carcinomas in 17 patients. This method of biopsy enables most rapid and reliable diagnosis and it is also simple and safe.     

CT and radiographic assessment of tube thoracostomy

The problem of multiple primary bronchogenic carcinomas in a single patient is not well known to radiologists. Six patients who exemplified the clinical, radiographic, and pathologic difficulties in diagnosis are reported. The most frequent pathologic associations are squamous carcinoma and squamous carcinoma, squamous carcinoma and small-cell carcinoma, and squamous carcinoma and adenocarcinoma. The previously undescribed association of small-cell carcinoma and bronchioloalveolar cell carcinoma was present in one of six patients. While many patients have a synchronous presentation, the tumors are metachronous in 66%. Since the incidence of second primary carcinoma increases with time, close long-term monitoring is recommended.     

Echo-guided needle biopsy of the thyroid. An assessment of 52 thyroid neoplasms found in 1042 consecutive patients]

The authors report on a series of 1,043 fine-needle biopsies of the thyroid performed under US guidance; the patients had been selected for thyroid pathologic conditions. Fifty-two neoplasms were observed (46 papillary carcinomas, 1 medullary carcinoma, 2 follicular carcinomas, and 3 metastases), which had been detected by cytology and confirmed by histology or autopsy. The authors focus on 46 cases of papillary carcinoma: their US features were studied which, through a correlation of variables, allow a quick and "safe" recognition of the type of carcinoma (papillary carcinomas account for nearly 60% of thyroid neoplasms). Tumor echogenicity and outline, and the presence/absence of calcifications were evaluated: in most cases, papillary carcinomas presented as focal lesions (alone or associated with other goiter lesions), with irregular and blurred outline, no hypo/anechoic halo and, in about 1/3 of the cases, with calcifications and colliquative areas. In 17% of papillary neoplasms, metastases to loco-regional nodes were observable at US; in 3 cases the carcinoma did involve a loco-regional node but there were no US signs suggestive of it. The incidence of neoplasms on the total of fine-needle biopsies is 4.9%, while in a previous series of 3,038 fine-needle biopsies, without US guidance, on clinically detectable lesions, the figure was about 2%.     

Case report: galactography-guided wire localization of an intraductal papilloma

Galactography is used to evaluate spontaneous unilateral nipple discharge by catheterization of the duct orifice and instillation of radiopaque contrast material. The most common cause of a bloody discharge is an intraductal papilloma which appears as a smooth lobulated intraluminal filling defect or a solitary obstructed duct on galactography. Carcinomas may be the cause of up to 13% [1] of abnormal nipple discharge and cannot be reliably distinguished from papillomas at galactography. Thus any intraductal filling defect or irregularity in symptomatic patients should be surgically evaluated to obtain a tissue diagnosis. Unfortunately, the histologic examination of the biopsy specimen does not always identify the lesion seen at galactography [2]. A potentially more reliable method of locating lesions identified on galactography is described. Chow, J. S. (2001). Clinical Radiology56, 72-73.     

Galactography: an important and highly effective procedure

Galactography should only be performed if there is spontaneous bloody or serous discharge from a single lactiferous duct of one breast. If this is observed, only pathologic processes instead of normal breast tissue are removed upon surgery and there is a close correlation between radiologic results and pathologic findings. Galactography localizes intraductal pathologic processes precisely and thus contributes to minimal volume surgery.     

Intraperitoneal hemorrhage due to spontaneous rupture of hepatocellular carcinoma: treatment by hepatic artery embolization

Seventeen patients with intraperitoneal hemorrhage due to spontaneous rupture of hepatocellular carcinoma were treated by emergency transcatheter arterial embolization. Fine-needle aspiration cytology was used to establish the histologic diagnosis in 11 patients with no history of hepatic malignancy. The other six patients had a pathologic confirmation of hepatic malignancy by open biopsy before admission. Pretreatment angiography showed extravasation of contrast material from the hepatic tumor in four patients (24%). In the other 13 patients, only hypervascular tumors were seen. Successful hemostasis was achieved in all patients. Fourteen patients survived after the embolization; the other three died immediately after embolization. Of the 14 patients, 11 died later (survival time ranged from 16 to 386 days). The remaining three patients are still alive at 3, 7, and 15 months, respectively, after the procedure. No serious complications related to embolization were encountered. Most patients had pain and fever. We conclude that emergency arterial embolization is an effective alternative to surgery for hepatic hemostasis in patients with spontaneous rupture of hepatocellular carcinoma.     

Diagnosis of papillomas of the breast: value of magnetic resonance mammography in comparison with galactography

The aim of this study was evaluation of MRI alone and in combination with mammography and galactography in the diagnosis of intraductal papillomas. From 1994 to 1998, a total of 48 women presenting with pathologic mammary secretion underwent galactography and magnetic resonance mammography (MRM). Thirty-five patients aged 16–71 years (average age 46 years) subsequently underwent surgery or diagnostic puncture and the histologic findings were compared with the results of the radiologic examination. Histology revealed papillomas in 16 cases. In 6 of these patients, there was associated malignant degeneration. Malignancy without associated papilloma was observed in 3 cases. Galactography displayed a sensitivity of 94 % and a specificity of 79 % with five false-positive findings and one false-negative finding in the recognition of intraductal papillomas. Malignant processes were detected by mammography/galactography in only one instance. Magnetic resonance mammography visualized pathologic contrast medium uptake in 8 of 9 cases of malignant disease (sensitivity 89 %). One patient with in situ ductal carcinoma escaped detection with MRM. Papillomas showed no or below-the-threshold-lying contrast uptakes with no specific sign suggestive of papilloma. Galactography in combination with mammography remains the primary diagnostic procedure in cases of pathologic mammary secretion or suspected papilloma. The addition of MRI permits exclusion of malignant disease with a high degree of certainty; thus, expectant management in individual cases with negative findings appears justified. Received: 18 November 1999; Revised: 20 March 2000; Accepted: 25 April 2000     

Ultrasound spectrum in intraductal papillary neoplasms of breast

Intraductal papillary neoplasms (IPNs) of breast form a wide spectrum of pathological changes with benign intraductal papilloma occupying one end of the spectrum and papillary carcinoma at the other end. Intraductal papillomas are known to occur anywhere within the ductal system and are broadly classified into central and peripheral types. Intraductal papillary carcinoma is an uncommon ductal malignancy forming papillary structures, and these lesions characteristically lack the myoepithelial layer present in benign papillary neoplasms. Three basic patterns of IPNs are recognized on ultrasound - intraductal mass with or without ductal dilatation, intracystic mass and a predominantly solid pattern with the intraductal mass totally filling the duct. Benign papillomas are known to exhibit calcifications which tend to be extremely dense and coarse. IPNs are highly vascular tumours and have a propensity to bleed spontaneously. A distinct vascular pedicle is identified within the central core of IPNs, with branching vessels arborising within the mass. In an older age group, presence of a large solid component and evidence of spontaneous intracystic bleed are more suggestive of papillary carcinomas than benign papillomas. We have serially studied 42 cases of intraductal papillary neoplasms with sonomammography and mammography from 2001 to 2004.     

Papilloma and carcinoma of the choroid plexus in pediatric patients

Papillomas of the choroid plexus are rare tumors of neuroectodermal origin; they represent less than 5% of all central nervous system (CNS) tumors in pediatric patients. Choroid plexus carcinomas are even rarer. We reviewed the incidence of these neoplasms at our reference hospital and found six tumors of the choroid plexus (five papillomas and one carcinoma) in five patients. Patient age ranged from prenatal to 25 months. All five patients underwent computed tomography (CT) examination. Four perinatal patients underwent ultrasound examination, four magnetic resonance imaging (MRI), and one (years ago) angiography. All patients had tumors located in the lateral ventricles, and one patient had a second tumor located in the third ventricle. These tumors are predominantly solid, intraventricular, with well-defined polylobulated margins. They show intense vascularization on Doppler studies and marked contrast enhancement on CT and MRI studies. Hydrocephalus was present in three cases. All patients underwent surgery; total resection was achieved in the five papillomas, whereas the carcinoma was partially resected and the patient is currently undergoing chemotherapy. The three patients with a single papilloma are disease free at follow-up (range 7 months to 11 years). The patient with two papillomas shows good recovery at follow-up, whereas the patient with carcinoma of the choroid plexus has a poor prognosis.     

Adjunctive diagnostic value of ultrasonography evaluation in patients with suspected ductal breast disease

PURPOSE: The purpose of this study was to evaluate the adjunctive diagnostic value of breast ultrasonography (US) in the study of benign ductal breast disease. MATERIALS AND METHODS: Fifty-two patients underwent US examinations for bloody nipple discharge, palpable retroareolar masses, retroareolar opacities or ductal pattern on mammography. US enabled visualisation of mammary-duct ectasia (simple or pseudocystic, retroareolar and/or peripheral) and focal masses (endoluminal or periductal, with ill-defined or regular margins). All patients with nipple discharge underwent cytological evaluation. After the US examination, all focal masses with ill-defined margins underwent fine-needle aspiration biopsy (FNAB), if necessary. The benign alterations were followed up. RESULTS: In 38/52 cases, US diagnosed mammary-duct ectasia and in 30/52 cases, the presence of focal masses (mean size 7 mm). In the nine women who underwent biopsy, histopathological evaluation diagnosed five solitary papillomas, one solitary papilloma with a focal area of ductal carcinoma in situ (DCIS), two multiple papillomas of the nipple and one papillomatosis. CONCLUSIONS: High-frequency US plays an important role in the detection of benign ductal disease both for the diagnosis and classification of focal masses and mammary-duct ectasia. US can be used as a complementary imaging method to galactography or as a valuable alternative when galactography is not available.     

Breast disease in the male: galactographic evaluation

Seven men with unilateral nipple discharge underwent galactography. In two patients the diagnosis was carcinoma, two were benign papillomas, one was a breast abscess, and two were ductal ectasia. Galactography is useful in men and women with nipple discharge, especially when the discharge is bloody and there is no palpable tumor. The precise location of an intraductal lesion through the use of galactography guides the biopsy and makes conservative surgery easier.     

军人IgA肾病56例临床病理分析

目的　探讨军人IgA肾病 (IgAN)的临床分型与病理类型特点。方法　通过肾穿刺活检确定IgAN的病理类型 ,结合临床分型进行分析。结果　临床分型 :慢性肾炎型 31例 ( 5 5 3% ) ,隐匿性肾小球疾病型 2 2例 ( 39 3% ) ,肾病综合征型 3例 ( 5 4 % )。病理类型 :轻度系膜增生 32例 ( 5 7 1 % )、中度系膜增生 1 8例 ( 32 1 % )、重度系膜增生和增生硬化各 2例 ( 7 2 % )、局灶节段肾小球硬化 (FSGS)和硬化性肾炎各 1例 ( 3 6 % )。疗效 :隐匿性肾小球疾病型、肾病综合征型、慢性肾炎型和轻、中系膜增生、重度系膜增生 +硬化的完全缓解率分别为 95 5 % ,1 0 0 % ,38 7%和 90 6 % ,38 9% ,0 %。结论　临床分型与病理类型相关 ,疗效与临床分型、病理类型及病变程度密切相关