Breast hamartoma: A report of 14 cases of an under-recognized and under-reported entity

ObjectivesMammary hamartoma is a rare benign lesion accounting for approximately 4.8% of all benign breast masses. It is often underdiagnosed and therefore is underreported mostly due to lack of awareness of the characteristic clinical and histological features. Raising awareness of this poorly recognized benign entity is of utmost significance as it clinically mimics other breast tumors including both benign and malignant ones. This study is to report and present our experience of breast hamartomas from Johns Hopkins Aramco Healthcare in the Eastern province of Saudi Arabia from which there have not been previous studies in literature.MethodA retrospective review of our pathology files was done from 1994 to 2014 for cases diagnosed as breast hamartoma during this 20 year period.ResultsA total of 14 cases with diagnosis of breast hamartoma were identified in our institute. Histologically the lesion is mostly sharply demarcated showing a mixture of varying proportions of fibrous, adipose, and glandular tissue. 13 cases were seen in females (93%) and only one rare occurrence in a male patient (7%). The age ranges quite vastly from 18 to 51 years (mean 33 years). Two-third of these lesions were seen involving the right breast (9 cases/64.3%) and only one-third in the left side (5 cases/35.7%). 13 out of 14 patients had a well circumscribed lesion (92.9%) while only 1 case showed irregular borders (7.1%). The size varied from 1.4 to 9.5 cm. Three cases (21.4%) showed evidence of myoid differentiation, a histopathologic variance which is important to identify however has no clinical significance. 3 cases had associated epithelial ductal hyperplasia of the usual type varying from mild (2 cases) to moderate (1 case); with two of these cases exhibiting additional features of fibrocystic mastopathy including adenosis, apocrine metaplasia, and cyst formation. None of our cases showed any malignancy or pseudoangiomatous stroma hyperplasia (PASH).     

胃癌的病理分型与预后

胃癌是消化系统的常见恶性肿瘤,因其对人类危害极大,发病率与死亡率多年来居高不下,故引起广大科研人员以及各级政府的重视。在胃癌的多学科攻关团队中,病理学工作者担负着对胃癌组织进行准确的病理分型、对候选肿瘤标志物或药物治疗靶点进行组织表达的验证等职责。胃癌的组织构造与细胞形态的异形性是对胃癌进行精细分型与分化程度判断的主要依据。习惯上将与胃组织相似程度高的肿瘤定义为"高分化";相似程度低的肿瘤     

Necrotizing bacterial skin and software tissue infection with muscular involvement revealing of cancer of the colon

We report the case of a 38-year-old woman with a necrotizing bacterial skin and soft tissue infection with muscular involvement. The clinical picture was similar to a gaseous gangrene of the right lower limb with a septic shock and multiple organ failure, without predisposing factor such as trauma, and necessitating a hip amputation. The primary site of the disease was a perforated colic adenocarcinoma with peritoneal and retroperitoneal infection. The association of necrotizing skin and soft tissue infection with muscular involvement due to Clostridium septicum to a neoplasma is classical and in front of such an infection a neoplasma should be researched.     

Rationale and indications for limited surgery in breast cancer: Current data

A limited number of clinical trials have been performed in the last 20 years to test the validity of techniques for preserving the breast in patients with a mammary carcinoma. From the trials published, a number of conclusions can be formulated: (a) quadrantectomy, axillary dissection, and radiotherapy for small tumors is a procedure as safe as the Halsted mastectomy in terms of local, regional, and distant recurrences, and long-term survival (Milan trial, Villejuif trial); (b) limited resection plus axillary dissection without radiotherapy exposes the patients to a high risk of local recurrences (NSABP trial); and (c) large resection without axillary dissection and with inadequate radiotherapy will increase the risk of axillary recurrences (Guy's Hospital trial). Whether the increase of local/regional recurrences will decrease the long-term survival rates (Guy's Hospital) or will not influence the survival (NSABP) must be clarified. The main problems to be faced by future trials are: the extent of the surgical act (limited excision versus extensive resection, axillary dissection versus no dissection, total axillary dissection versus axillary sampling), the type of radiotherapy (immediate versus delayed, whole breast versus limited direct field, boost versus no boost, regional nodes irradiation versus no nodal irradiation), the comparison with other forms of surgery providing good cosmetic results (conservative treatments versus total mastectomy plus immediate reconstruction), the size of primary tumor to be submitted to conservation procedures, and the pathologic patterns requiring differentiated conservative technique (lobular carcinoma in situ, intraductal noninfiltrating carcinoma, Paget's disease, and minimal carcinoma).

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Resumen Un limitado numéro de ensayos clínicos ha sido realizado en los últimos 20 años para comprobar la validez de las técnicas de preservación del seno en pacientes con carcinoma mamario. Con base en los informes publicados se pueden formular las siguientes conclusiones: (a) la cuadrantectomía, disección axilar, y radioterapia realizadas para tumores pequeños representan un enfoque tan eficaz como la mastectomía de Halsted en cuanto a recurrencia local, regional, y distal, y supervivencia a largo plazo (Milán, Villejuif); (b) la resección limitada con disección axilar pero sin radioterapia expone al paciente a un mayor riesgo de recurrencia local (NSABP); y (c) la resección amplia sin disección axilar y con radioterapia inadecuada aumenta el riesgo de recurrencia axilar (Guy's Hospital). Todavía está por aclarar si el aumento en la tasa de recurrencia local disminuye las tasas de supervivencia a largo plazo (Guy's Hospital) o si, por el contrario, no tiene influencia sobre la supervivencia (NSABP).Los principales problemas que deben resolver futures ensayos clínicos son: la extensión de la resección quirúrgica (resección limitada versus resección amplia, disección axilar versus no disección, disección axilar total versus muestreo axilar), el tipo de radioterapia (inmediata versus tardía, irradiación total del seno versus campo directo limitado, boost versus no boost, irradiación ganglionar regional versus no irradiación ganglionar), la comparación con otras formas de cirugía que dan buenos resultados estéticos (procedimientos conservadores versus mastectomía total con reconstrucción inmediata), el tamaño del tumor primario que pueda ser susceptible de operación conservadora, y los patrones histopatológicos que requieren técnicas conservadoras diferenciales (carcinoma lobular in situ, carcinoma intraductal no infiltrante, enfermedad de Paget, carcinoma mínimo).

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Résumé Un nombre limité d'essais cliniques a été tenté au cours des 20 dernières années pour apprécier la valeur de la technique conservant le sein chez les malades atteintes d'un cancer mammaire. De ces essais ont pu être tirées de nombreuses conclusions: (a) la quadrantectomie, la dissection axillaire, et la radiothérapie pour traiter les petites tumeurs représentent une méthode aussi efficace que l'opération de Halsted aussi bien en ce qui concerne les récidives locales régionales, à distance que la survie à long terme (Milan, Villejuif); (b) la résection limitée associée à la dissection axillaire mais sans radiothérapie expose à un risque élevé de récidive locale (NSABP); et (c) la résection large sans dissection axillaire et radiothérapie inadéquate augmentent les risques de récidive axillaire (Guy's Hospital). Que ces risques aillent de paire avec une diminution de la survie à long terme (Guy's Hospital) ou qu'ils soient sans influence sur la survie (NSABP) restent à démontrer.Les principaux problèmes que les futurs essais auront à résoudre se résument: dans l'extension de l'exérèse (exérèse limitée ou étendue, dissection axillaire ou pas, dissection axillaire totale ou limitée à un échantillon), dans le type de la radiothérapie (immédiate ou secondaire, étendue à tout le sein ou limitée au champ tumoral, survoletage ou non, irradiation ganglionnaire régionale ou non), dans la comparaison entre les autres formes de chirurgie susceptibles de donner de bons résultats esthétiques (traitement conservateur ou mammectome totale avec reconstruction immédiate), dans la taille de la lésion relevant des procédés conservateurs, et dans les types pathologiques nécessitant des techniques conservatrices (cancer lobulaire in-situ, cancer intraductal non infiltrant, maladie de Paget, petit cancer).

     

Breast cancer surgery and diagnosis-related groups (DRGs): Patient classification and hospital reimbursement in 11 European countries

Researchers from eleven countries (i.e. Austria, England, Estonia, Finland, France, Germany, Ireland, Netherlands, Poland, Spain, and Sweden) compared how their DRG systems deal with breast cancer surgery patients.DRG algorithms and indicators of resource consumption were assessed for those DRGs that individually contain at least 1% of all breast cancer surgery patients. Six standardised case vignettes were defined and quasi prices according to national DRG-based hospital payment systems were ascertained.European DRG systems classify breast cancer surgery patients according to different sets of classification variables into three to seven DRGs. Quasi prices for an index case treated with partial mastectomy range from €577 in Poland to €5780 in the Netherlands. Countries award their highest payments for very different kinds of patients.Breast cancer specialists and national DRG authorities should consider how other countries' DRG systems classify breast cancer patients in order to identify potential scope for improvement and to ensure fair and appropriate reimbursement.     

IgA nephropathy: an update on pathogenesis and classification

IgA nephropathy is a primary glomerulopathy characterized by deposition of IgA containing immune deposits in the kidney. Its diagnosis is based on histopathologic and immunoflourescence studies on renal biopsy. The disorder is poorly understood. This review is focused on updates regarding its pathogenesis and discussion on a new proposed histopathological classification of IgA nephropathy.     

Current surgical treatment of breast cancer in Japan and its rationale: foreword

This is a foreword to a collection of articles specially dedicated to describing the present status of local treatment of breast cancer patients in Japan, which continues to be a source of controversy in the midst of collaborative efforts between surgeons, pathologists, and medical and radiation oncologists. Surgical treatment of breast cancer consisting of procedures on the breast parenchyma and on lymph nodes do not appear to have reached the expected technical perfection. A variety of surgical procedures are performed under the name of breast-conserving surgery with widely varied rates of application ranging from 20-85% depending upon the institution. With regard to sentinel node biopsy/dissection, diversified techniques such as different types of tracers and injection sites are currently being utilized, and furthermore long-term analysis may be necessary to determine the superiority as compared with other approaches such as lower axillary sampling/dissection and 4-node biopsy. Since all efforts should be made to prevent locoregional tumor recurrence, surgeons must be alert and attuned to all the details of surgery. Continued efforts of surgeons with a broadened perspective will lead to the improvement of local treatment of breast cancer with the ultimate goal of obtaining better local control and consequently better long-term survival outcomes.     

The introduction of an urodynamic technic synchronized with videocystourethrograms and its data management

The video urodynamics that simultaneously display urodynamic data with radiographic visualization of the lower urinary tract on television monitors was first described by Miller in 1967. This technique has been developed in a growing number of urodynamic laboratories in North American and European countries. The 2100 uro color video system manufactured by DISA elektronik A/S was introduced into our clinic in September in 1984. We have been aware of the lack of a satisfactory way of measuring the function of the bladder neck and posterior urethra during micturiton. But now, from our experience using this system, we conclude that video urodynamics is a comprehensive means of assessing, lower urinary tract disorders.     

Breast cancer following augmentation mammoplasty - a review of its impact on prognosis and management.

The incidence of breast cancer in women with implants is increasing and will continue to do so for the foreseeable future due to the marked increase in breast implant insertion in recent years. Undoubtedly many of these women will wish to know whether the presence of implants worsens the prognosis of their breast cancer. Furthermore, the clinical management of such patients may be difficult, as aesthetic results are likely to be a major concern for women who have already undergone cosmetic surgery to the breast. There is no consensus on surgical approach to this scenario. This article reviews the literature on the prognosis of breast cancer patients with a history of augmentation mammoplasty and examines the available data regarding their surgical treatment.     

Breast cancer information on the internet: analysis of accessibility and accuracy

Studies show internet sourced information often has poor accuracy. However, it is rapidly becoming a major source of patient information. Our aim was to assess accuracy of breast cancer-related information on the internet. The top five breast cancer-related search terms were identified using the commercial program "Wordtracker". These terms were searched using the search-engine "Google" and the top 100 webpages per topic analysed for applicability and accuracy of information. Overall 500 webpages were analysed. 42% were inapplicable to the question asked. Applicable accuracy rates were variable amongst the five terms: "breast cancer symptoms" 84%, "breast cancer care" 87%, "breast cancer stage" 88%, "breast cancer survival" 91% and "breast cancer signs" 78%. Educational websites were more likely to be accurate(p < 0.001) and interest group administered websites less likely to be accurate(p = 0.018) than other websites. Finding accurate breast cancer information on the internet is difficult due to large numbers of inapplicable unregulated websites preferentially returned via search engines.     

Breast Duct Endoscopy: Ductoscopy from a Diagnostic to an Interventional Procedure and its Future Perspective

Objective : Breast duct endoscopy is increasingly used for evaluation of intraductal disease. We present a new rigid instrument for ductoscopy that allows intraductal biopsy and the removal of small lesions.

Methods : Overall, 102 women with breast cancer or pathologic nipple discharge were included in the analysis. All ductoscopies were performed with a rigid gradient index micro-endoscope (0 0.7 mm) in combination with a special device for intraductal vacuum assisted biopsy. Ductoscopy, ductal lavage and intraductal biopsy were correlated with ductal cytology and histopathology of the resection specimen.

Results : Gradient index ductoscopy provided high resolution images of the breast ducts and identified additional intra-ductal lesions in 45% of the patients with breast cancer. The accuracy of ductal lavage, ductoscopy and mammography in the detection of an extensive intraductal component was 14%, 65% and 50%, respectively.

Intraductal vacuum assisted biopsy yielded diagnostic material in 92% of 38 patients with nipple discharge and papillomatous lesions. Histology of the resection specimen confirmed the diagnosis in all cases including 2 in situ carcinoma and 2 invasive ductal carcinoma.

Conclusions : Ductoscopy is a useful supplement for the standard radiological workup of breast cancer especially in patients with extensive intraductal carcinoma. Ductoscopic vacuum assisted biopsy is an effective technique for intraductal tissue sampling and allows ablation of small lesions. This technique provides new perspectives for interventional therapy of intraductal tumours.