Vulvar Atypical Granular Cell Tumor in a Preadolescent Patient

BackgroundGranular cell tumor is an uncommon benign neoplasm with a predisposition for upper aerodigestive tract, skin and soft tissue involvement. Malignant and atypical granular cell tumors account for less than 2% of the lesions and in the pediatric population they are extremely rare and atypia has not been previously reported.CaseWe present a case of a rapidly growing granular cell tumor of the vulva of a 12-year-old girl exhibiting atypical histology. The lesion demonstrated prominent Ki-67 proliferation index (up to 20%), localized areas of spindling of tumor cells, scattered apoptotic bodies and p53 overexpression.ConclusionThe current histologic diagnostic criteria of atypical granular cell tumors are evaluated while physician awareness and the need for follow-up of patients for potential recurrences of this rare entity are emphasized.     

Surgical Treatment of the Solid Breast Masses in Female Adolescents

Study ObjectiveTo evaluate the histopathologic results of the excised solid breast masses in our clinic and to draw attention to breast masses in adolescents.DesignA retrospective chart review study and review of the literature.SettingThis study was conducted in Baskent University Adana Research Center between March 2003 and May 2011.ParticipantsPatients included 10 adolescent girls admitted to pediatric surgery clinic with the complaint of palpable breast mass who underwent surgical excision of the breast mass.Main Outcome MeasuresThe necessity of surgery in breast masses of female adolescents.Results10 female patients with an average age of 14 years were operated on for breast masses. A palpable mass in the breast and social anxiety were the cardinal complaints. Two patients had a family history of breast carcinoma. One patient had a history of neuroblastoma in remission. Histopathologic examination revealed 3 juvenile fibroadenomas, 1 conventional fibroadenoma, 3 tubular adenomas, and 3 phyllodes tumors.ConclusionsPalpable breast masses in adolescents are uncommon and are usually benign. The low malignancy risk and rarity of breast masses in childhood create a controversy as how to manage breast masses. Ultrasonography is the initial imaging modality to define the characteristics of the breast mass. Excisional biopsy and histopathologic examination is essential to rule out rare, but probable malignant, lesions in adolescents in selected patients such as maternal history of breast carcinoma, previous malignancy history in the patient, big size of the mass, and no regression on follow-up.     

Late Complications of Childhood Female Genital Mutilation

BackgroundCanada’s immigrants are increasingly from non-English-speaking countries with different medical issues. Female genital mutilation (FGM) is a procedure performed for non-medical reasons that is not traditionally encountered in Canada and that has serious health implications for women.CaseA 36-year-old woman, who underwent FGM at the age of four, presented to our colposcopy unit with increasing swelling of the vulva. Examination revealed a large cystic mass in the midline of the vulva, and MRI identified two well-defined cystic lesions. The mass was excised, and histologic examination confirmed an epidermal inclusion cyst.ConclusionAn epidermal inclusion cyst can develop as a long-term consequence of FGM. Although it grows slowly and usually without symptoms, it may require excision because of inflammation, secondary infection, or, in rare cases, malignancy developing within the cyst.     

Ovarian surface papillomatosis of borderline malignancy.

Bilateral ovarian surface papillomatosis of borderline malignancy is a rare condition. In our case it was associated with benign serous cystadenofibroma. The histologic diagnosis and the clinical aspects are discussed.     

Adolescent Vulvar Angiokeratoma Associated with Lichen Sclerosus

BackgroundWe present an adolescent with multiple vulvar angiokeratomas within a background of lichen sclerosus.CaseA 13-year-old girl presented with vulvar pruritus and wart-like vulvar lesions. Four lesions were resected because of discomfort and uncertainty of the diagnosis. Pathology revealed angiokeratomas with chronic inflammation suggestive of lichen sclerosus. Postoperatively, pruritus continued in the largest excised lesion, which was associated with lichen sclerosus, and symptoms were treated successfully with topical steroids.Summary and ConclusionVulvar angiokeratomas are asymptomatic red papular lesions and are rare in the female adolescent population. In this case, the pathology revealed the rare co-occurrence of angiokeratomas and lichen sclerosus. Biopsies of vulvar vascular lesions in symptomatic adolescents are recommended. Vulvar angiokeratomas might manifest rare genetic disease in otherwise asymptomatic female patients and warrant further follow-up.     

Pseudoangiomatous Stromal Hyperplasia of Breast in an Adolescent: A Case Report and Review of the Literature

BackgroundPseudoangiomatous stromal hyperplasia (PASH) is a rare benign breast lesion that is is extremely rare in children and adolescents.CaseA 13-year-old girl was admitted to our clinic with a giant mass in the left breast for 3 months. Physical examination findings of the patient were normal except for the mass in the breast. The mass was removed totally, and its pathological diagnosis was pseudoangiomatous stromal hyperplasia. The patient has been followed up for 6 months without disease.     

Typical medullary carcinoma of the breast: a retrospective study about 33 cases

ObjectiveTypical medullary carcinoma of the breast is a rare histological form of breast carcinoma. It represents less than 5% of all breast cancer. It is known for its favourable prognosis. Considering the rarity of the series we could retrieve, we aimed at underlining the particularities of this pathology.Patients and methodsRetrospective study about 33 cases of typical medullary carcinoma managed at the Salah-Azaïz Institute during a period of six years between 1994 and 1999.ResultsThe mean age was 47.5 years. The left breast was concerned in about 55% of cases. Mean tumoral size was 46 mm. Sixty-one percent of our patients were treated by radical surgery. Seventy-three percent undergo radiotherapy, 57% chemotherapy and 42% hormonotherapy. The five-year free-disease survival was about 85%.Discussion and conclusionTypical medullary carcinoma of the breast is a rare histological form of breast carcinoma. Its treatment is similar to the other breast cancers. Our results agree with the different published studies and confirm its favourable prognosis.     

Vulvar Hibernoma: An Unusual Lipomatous Tumor in an Adolescent

BackgroundLipomatous tumors of the vulva are exceedingly rare, particularly in adolescents. We describe the work-up and management of an adolescent girl who presented with a large, well-vascularized vulvar mass.CaseA 14-year-old girl presented with a large vulvar mass of unclear etiology. Magnetic resonance imaging of this mass revealed an ill-defined, well-vascularized mass with fat signal characteristics suggestive of a lipomatous tumor that was concerning for malignancy. We performed complete resection of the mass, and histologic evaluation revealed a vulvar hibernoma. There have been no signs of recurrence 1 year later.Summary and ConclusionAlthough rare, a hibernoma of the vulvar region may present in adolescence and may be concerning for malignancy on imaging. Complete resection of these tumors is recommended for definitive diagnosis and treatment.     

Accuracy of mammographic appearances after breast fine-needle aspiration

OBJECTIVE: The objective of this study was to document the observation that fine-needle aspiration of palpable breast masses by use of a modified technique performed shortly before mammography need not adversely interfere with mammographic interpretation nor produce falsely suspicious mammographic lesions that delay meaningful evaluation and management in this breast clinic.STUDY DESIGN: In a retrospective record review 1007 women who were seen in the Breast Diagnostic Center at Women's and Children's Hospital from January 1992 until April 1995 and who had fine-needle aspiration of a palpable solid breast mass within 2 weeks before mammography were analyzed overall and in 10-year age group subsets. The mammographic reports of “suspicious” lesions were correlated with having had a prior fine-needle aspiration (within 2 weeks).RESULTS: Of the 1007 women undergoing fine-needle aspirations, 91 had a cytologic or tissue biopsy specimen diagnosis of malignancy. Of these, 72 had “suspicious” mammograms and 19 had “nonsuspicious” mammograms. The calculated positive predictive value was 58%. The negative predictive value was 98%. Mammographic sensitivity was 79%. Specificity was 94%. Age stratification did not reveal any meaningful trends. Of the 916 patients with benign cytologic results of fine-needle aspiration specimens, 52 had “suspicious” mammograms and 864 had “nonsuspicious” mammograms.CONCLUSION: For patient convenience and expeditious diagnosis of a palpable breast mass, fine-needle aspiration can be performed on the initial visit and mammograms subsequently taken within 2 weeks without undue clinical confusion or misleading mammographic findings. Concordance of the diagnostic triad consisting of (1) clinical impression (by history and examination), (2) fine-needle aspiration, and (3) mammography gives a reliable conclusion and can appropriately be used as the basis for clinical management of a breast mass. However, when there is doubt or anxiety about the diagnosis either on the part of the patient or the physician, a definitive histologic tissue diagnosis should obtained. (Am J Obstet Gynecol 1997;176:1286-92.)     

Breast Disease in Children and Adolescents in Eastern Nigeria—a Five-Year Study

Aims and Objectives(1) To define the spectrum of breast diseases in the children and adolescents in Eastern Nigeria. (2) To provide where possible, an international comparison of statistical variations of both benign and malignant lesions in these age groups.Materials and MethodsThe Morbid Anatomy Department of the University of Nigeria Teaching Hospital (UNTH) Enugu is a referral center for over 30 million people. The laboratory receives around 2,000 surgical pathology specimens per year. Virtually all children and adolescents (4–19) years who complained of a breast mass had a biopsy, and results of all excised breast specimens from children and adolescent age groups from 4 to 19 years were included in the study. The case files of these patients were retrieved and reviewed to ascertain the size and duration of the breast lesions. The number of phyllodes tumors seen in the child and adolescent population was compared to those seen in the adult population at the same period.Two independent pathologists reviewed the slides, and their results compared.ResultsA total of 1050 breast specimens were received in the department of morbid anatomy from all age groups, from January 1, 2000 to December 31, 2004, out of which 121 (11.5%) were breast specimens from the children and adolescent age groups. On the average most patients with benign breast lesions presented within 3–5 months of their symptoms, which usually was a palpable lump detected in all cases by either the child or the mother. Their sizes vary from 2–3 cm and only ten were multiple but they were all confined to one breast. Those with phyllodes presented typically within 3 months probably because of the faster rate of growth. Their sizes varied from 5–13 cm and they were all unilateral. Phyllodes tumor in this age group constitute 28.6% of all phyllodes seen in this period and were all benign. The mean age was approximately 11.5 years while the median age was 18 years. Three cases were malignant.ConclusionFibro adenoma, fibrocystic breast disease, and low grade phyllodes tumor were the most common breast lesions seen in our children and adolescent population. The three cases of malignancy observed included invasive intraductal carcinoma, a non-hodgkin lymphoma, and metastases involving the lymph nodes from an uncharacterized secondary malignancy. Phyllodes tumors were typically larger in size and tended to present earlier. Genetic characterization of such lesions is recommended for future studies as well as their relationship to lesions seen among other Africans in Diaspora.     

Occurrence of Two Rare Malignant Neoplasms (Breast and Ovarian) in an Adolescent Female

BackgroundPhyllodes breast tumors, particularly malignant ones, are rare in adolescents. Tumor behavior does not correlate with histopathology. This case of an adolescent with a malignant phyllodes tumor, followed by the occurrence of a borderline ovarian tumor, also uncommon in adolescence, may shed light on our understanding of phyllodes and uncommon gynecologic malignancies in the young.CaseA-14 year-old Caucasian female underwent wide local excision of a 4-cm malignant phyllodes breast tumor. At 17 years of age she had excision of a serous borderline tumor of the ovary.CommentsThe occurrence of two rare neoplasms in an adolescent female raises questions about a common underlying etiology, such as a genetic mutation. Genetic evaluation of minors is a sensitive and complex issue. Natural history studies regarding phyllodes tumors presenting in adolescence are needed to establish recommendations regarding best practice, including the role of genetic evaluation in this population.     

Breast aspiration biopsy with multihole needles for histologic and cytologic examination

Multihole needle biopsy has been performed on 166 patients. Commercially available 22-, 20-, 18-, and 16-gauge hypodermic needles (40 to 75 mm in length) are prepared with three sharp-edged holes around the distal part of the needle, allowing aspiration of 3 to 6 ml or more of tissue, for both histologic and cytologic examination. Of patients with carcinoma, fibrocystic disease, fibroadenoma, intraductal proliferation (papillomatosis), and duct ectasia, multihole needle cytologic examination is significantly more accurate (35% to 83%) than single-hole needle examination (11% to 67%). Multihole needle histologic examination, however, is far more accurate, with diagnostic success ranging from 75% to 94% for the disorders described above. The procedure has several uses. For patients with isolated fibrocystic areas, duct ectasia, or papillomatosis, multihole needle biopsy not only is diagnostic but may also be therapeutic by virtue of removal of abnormal tissue by aspiration. Biopsies of areas of microcalcification can be obtained under x-ray control. In patients at high risk of breast cancer (carcinoma in mother and/or sister), breast aspiration is performed when the slightest suspicion arises. In patients with unilateral breast cancer at high risk of bilateral carcinoma (premenopausal breast cancer, lobular carcinoma, tubular carcinoma, family history of breast cancer), random needle biopsy is performed in the contralateral breast for cancer detection. Furthermore, during follow-up of breast cancer patients, biopsies of locoregional changes or suspicious areas in the contralateral breast are obtained with the multihole needle for diagnostic evaluation. Thus multihole needle biopsy represents an improvement over the single-hole needle currently used, with enough tissue provided for adequate initial diagnosis and follow-up diagnostic evaluations in patients with benign and malignant breast disease.     

Supernumerary Nipple Presenting as a Vulvar Mass in an Adolescent: Case Report and Literature Review

BackgroundEctopic breast tissues can be found along the embryonic mammary ridges and can occur in the vulva. While ectopic breast tissue is not uncommon, functional breast with overlying nipple located within the vulva is exceedingly rare.CaseA 17-year-old with undiagnosed hypothyroidism presents with vulvar mass draining milky white fluid. A small lesion with appearance similar to a skin tag is noted and milky fluid expressed. Biopsy and excision of this mass confirmed the presence of a functional supernumerary nipple.Summary and ConclusionsThis appears to be the first reported case of a supernumerary nipple with symptomatic lactation in a non-pregnant adolescent. Supernumerary nipple should be considered in the differential diagnosis of a vulvar mass. Ectopic breast tissue in the vulva can undergo malignant transformation, therefore excision of this tissue is generally recommended.     

Voluminous juvenile papillomatosis: Diagnostic, therapeutic and prognostic difficulties - a case report

The juvenile papillomatosis is a rare entity. We shall systematically check for a cancer. A 20-year-old woman patient without any familial medical history of breast carcinoma, was presenting a voluminous nodule of the left breast. A core needle biopsy allowed to diagnose papilloma. A conservative surgical treatment was proposed and realized despite any possibility of complete resection. Histological examination of the surgical specimen concluded to a juvenile papillomatosis. A closed follow-up was proposed to the patient. This case illustrates the difficulty of a voluminous tumor surgery on a young woman. The main problem is to combine the cosmetic constraints with oncology risk.     

An Atypical Growth of a Giant Fibroadenoma after Trauma

BackgroundFibroadenomas are the most common benign breast lesion in female adolescents. However, it is important to recognize that a small percentage have been shown to progress to giant fibroadenomas. Giant fibroadenomas can spontaneously infarct leading to significant morbidity and are also difficult to distinguish from the more aggressive phyllodes tumors.CaseWe describe the first case, to the best of our knowledge, of a 12-year-old girl who presented with a giant fibroadenoma complicated by a central infarct and an intra-lesional hemorrhage from a trauma to the breast.Summary and ConclusionThe complicated giant fibroadenoma with an intra-lesional hemorrhage has characteristics of both benign and malignant lesions, and is difficult to distinguish by history and physical alone. Ultrasonography is a valuable tool yet the core needle biopsy remains the gold standard to confirm the diagnosis.     

Intracystic Papillary Breast Cancer in a 16-Year-Old Patient

BackgroundPrimary breast cancer in the pediatric population is rare. To our knowledge, no cases of intracystic papillary carcinoma have been reported in patients younger than 21 years.CaseA 16-year-old patient presented with a retroareolar mass and bloody nipple discharge in her left breast. A biopsy established papillary intracystic carcinoma. The patient was treated surgically and a risk reduction strategy developed in a multidisciplinary session was implemented.     

Place de l’imagerie dans le diagnotic des cancers du sein bilatéraux synchrones

ObjectiveTo investigate the role of imaging procedures in the diagnosis of synchronous bilateral breast cancer (SBBC)Patients and methodsThe patient group consisted of consecutive women undergoing managed for SBBC in our institution between January 2006 and July 2012. We defined SBBC as bilateral breast tumors diagnosed simultaneously or up to 3 months after initial diagnosis. Clinical data included comorbidities, BMI (kg/m²), preoperative breast imaging modalities used and their findings.ResultsOf the 2322 patients with newly diagnosed breast cancer treated on the study period, 46 patients with the diagnosis of SBBC were enrolled to the study. A total of 41.3% patients had family history of breast cancer. A total of 56.52% had clinical symptoms. The most frequent situation of diagnosis (32.6%) was the association of a palpable tumor and a contralateral radiologic abnormality. MRI permitted the diagnosis of 19.6% occult contralateral lesions.Discussion and conclusionClinical examination and conventional imaging procedures (mammography and sonography) detects the majority (76%) of synchronous contralateral breast cancers. A family history of breast cancer, a multifocal breast tumor or the presence of an invasive lobular carcinoma should be arguments for the realization of a breat MRI to eliminate contralateral malignancy.     

Mastopatía fibroquística. Aspectos controvertidos

ObjectivesTo elucidate the most controversial features of fibrocystic breast disease, which is highly prevalent.MethodsWe reviewed the literature on the topic.ResultsIn fibrocystic breast disease, the diagnostic method of choice is ultrasound, which shows similar characteristics to those in cystic tumors but with differences in number and maximum diameter. With dominant, or separate, nodules, ultrasound can be used to determine whether the lesion is cystic or solid. In cystic lesions, fine-needle aspiration can be used; in solid lesions, core needle biopsy can be employed. No active treatment is required if there is mastalgia and nodularity without a dominant nodule, or if diffusely nodular breasts are painless.Conclusions1. There is no risk of malignancy in simple fibrocystic breast disease but proliferative mastopathy with atypical cells has a relative risk of 4-5. 2. The diagnostic technique of choice for differentiating simple from complex cysts is ultrasound, which can also be used for monitoring and as a guide when aspirating the cyst. 3. When there are clinical and radiologic signs suspicious for malignancy (BI-RADS 3) or suggestive of malignancy (BI-RADS 4 and 5), the first step is fine-needle aspiration or core needle biopsy, or both. 4. Asymptomatic fibrocystic breast disease does not require follow-up, while symptomatic disease can be monitored with ultrasound and/or mammography.     

The relationship between vulvar micropapillomatosis and HPV-infection

The etiology and the clinical significance of vulvar papillomatosis are still controversial. In order to study the relationship between micropapillomatosis labialis with some types of HPV infection we examined 60 patients with colposcopic characteristics of vulvar papillomatosis. Vulvar biopsies were taken for histological examination and for in situ hybridisation. 20 patients with vulvodynia without pathological findings in the region of the vulva served as a control group. Histological evidence for HPV infection were discovered in 50 patients /83.33%/ with vulvar papillomatosis, while 3 patients /5%/ were positive for HPV-DMA. These results show the rare relationship between the vestibular papillomatosis and HPV-infection. According to our study the physicians must be very cautious when treating these lesions, by positive histological results. The colposcopy is of fundamental importance for accurate diagnosis of vestibular papillomatosis and for successful treatment.