Collagenous spherulosis of the breast

Fifteen examples of a hitherto undescribed lesion, which we have designated "collagenous spherulosis," were encountered in breast tissue from women aged 39 to 55 years. The lesion, which was multifocal in eight cases, was an incidental microscopic finding involving lobular acini and ductules, and consisted of intraluminal clusters of eosinophilic spherules measuring approximately 20-100 mu in diameter. The spherules typically were found, and appeared to originate, within the spaces of fenestrated epitheliosis ("papillomatosis"). Special stains indicated that the spherules were collagen-rich, but also contained variable amounts of acidic mucin, PAS-positive, basement membrane-like material, and elastin. With immunoperoxidase staining, the cells immediately surrounding the spherules stained positively for actin, suggesting myoepithelial differentiation. Collagenous spherulosis was typically situated adjacent to, or encompassed by, other benign proliferative processes, including intraductal papillomas, sclerosing adenosis, and "infiltrating epitheliosis" (radial scars). Collagenous spherulosis is a clinically and histologically benign lesion that on microscopic examination has been confused with--and should be distinguished from--malignant lesions including adenoid cystic carcinoma of the breast and so-called intraductal signet-ring carcinoma.     

Collagenous spherulosis of breast: morphologic study of 59 cases and review of the literature

Collagenous spherulosis is a rare benign lesion that can microscopically mimic atypical ductal hyperplasia, cribriform ductal carcinoma in situ, or adenoid cystic carcinoma. Seventy-nine cases of collagenous spherulosis in women aged 36 to 90 years (mean age, 52 +/- 11 years) were identified from the University of Texas M. D. Anderson Cancer Center pathology files from the last 10 years. The pathology reports and slides from 59 patients were reviewed. This study does not attempt to evaluate the overall incidence of collagenous spherulosis because only cases with an actual diagnosis of collagenous spherulosis in pathology report were reviewed. The aim of this study was to investigate the underlying pathology within collagenous spherulosis and its relation to other pathologic findings within the specimen. Collagenous spherulosis was present as multiple foci ranging in size from 0.1 to 0.3 cm in 44 (75%) of the 59 cases. Collagenous spherulosis was associated with benign lesions of the breast in 41 cases, with atypical ductal hyperplasia in 3 cases, and with lobular carcinoma in situ in 15 cases. Microcalcifications were found in lesions involved by collagenous spherulosis in 15 cases. In summary, although collagenous spherulosis was mostly associated with benign breast lesions, in our study it was also frequently seen in association with lobular carcinoma in situ. Collagenous spherulosis could present as a mammographically suspicious mass or density and could be associated with microcalcifications. Increased numbers of cases of collagenous spherulosis may be expected in the future as a result of breast cancer-screening programs. Caution is needed not to overinterpret collagenous spherulosis as atypical or ductal carcinoma in situ, especially on core needle biopsy specimens.     

Cutaneous Metastasis From Adenoid Cystic Carcinoma of the Parotid Gland

BACKGROUND: Cutaneous metastasis from adenoid cystic carcinoma of the salivary gland is very rare. OBJECTIVE: To present an unusual case of cutaneous metastasis from adenoid cystic carcinoma of the right parotid gland. METHODS: A 63-year-old woman with multiple subcutaneous nodules on the abdomen and a gradually enlarged mass over the right parotid area was examined. A skin biopsy was taken from one of the abdominal nodules. RESULT: Skin biopsy demonstrated the characteristic histopathologic features of metastatic adenoid cystic carcinoma. A subsequent computerized tomography of the head and neck revealed a huge soft tissue mass involving the right parotid gland. Computerized tomography of the chest revealed extensive nodular pleural thickening, and pleural biopsy also showed typical histopathologic features of metastatic adenoid cystic carcinoma. All of these results are consistent with the diagnosis of an adenoid cystic carcinoma of the right parotid gland with disseminated metastases. CONCLUSION: We report a rare case of cutaneous metastasis from adenoid cystic carcinoma of the right parotid gland. The presentation of cutaneous metastasis is often nonspecific and may mimic benign lesions. Subcutaneous nodules that are rapidly developing or eruptive, are rapidly growing and have stony hardness in nature, have pain or tenderness, and have nonhealing ulceration remind us of the possibility of cutaneous metastases. Dermatologists and dermatologic surgeons should keep the diagnosis of cutaneous metastasis in mind and always perform skin biopsy when encountering these lesions.     

Adenoid cystic carcinoma of the breast--two case reports

Adenoid cystic carcinoma is a rare type of breast carcinoma with a good prognosis. It represents less than 0,1% of breast carcinomas. We present two cases of adenoid cystic carcinoma diagnosed in the Surgical Department of Coltea Hospital in the last 3 years. The first case is a 66 years old patient with a breast tumor that has clinical and imagistic features compatible with a benign diagnosis. The frozen sections established the diagnosis of adenoid cystic carcinoma, confirmed by histopathologic examination of paraffin embedded tissue and immunohistochemistry. The second case is a 68 years old patient with a breast tumor located in the central quadrant of the left breast, with skin infiltration. Preoperatory fine needle aspiration is sugestive of a papillary tumor, so the cytologic exam cannot establish malignancy. The frozen sections established the diagnosis of ductal invasive carcinoma and histopathologic examination of paraffin embedded tissue and immunohistochemistry established the diagnosis of adenoid cystic carcinoma associated with ductal invasive carcinoma grade I and adenomyoepitelioma. The cytology had a false papillary aspect, in fact there was amorphous material contained in pseudoluminal spaces. In both cases the treatment was surgical resection with tumor excision and free resection margins. In the second case lymphadenectomy was also performed.     

A case showing sclerosing adenosis and an unusual form of basal cell hyperplasia of the prostate

We describe an unusual case of benign prostatic hyperplasia that demonstrated florid sclerosing adenosis--an uncommon lesion that may be confused with prostate carcinoma. Immunohistochemistry utilizing Keratin 903, a basal cell-specific antikeratin antibody, was useful in identifying basal cells in sclerosing adenosis, thus verifying its benign nature. In addition, this case had an unusual form of basal cell hyperplasia that resembled basaloid carcinomas (adenoid cystic carcinoma) involving the prostate.     

Solitary cylindroma (dermal analog tumor) of the breast: a previously undescribed neoplasm at this site

The authors report a previously undescribed small, well-demarcated breast tumor similar to a dermal cylindroma in a 63-year-old woman. The tumor was an incidental finding in a lumpectomy specimen for infiltrating lobular carcinoma. The cylindroma was surrounded by normal-appearing breast parenchyma and had the typical "jigsaw" pattern of epithelial basaloid islands. The islands showed focal squamous and myoepithelial differentiation. A notable number of reactive dendritic Langerhans cells permeated the epithelial cell islands, a feature considered to be characteristic of dermal cylindroma. There was also ductal differentiation. Thick bands of hyaline periodic acid-Schiff (PAS) stain and collagen IV-positive basement membrane material bordered the cell islands, and PAS-collagen IV-positive hyaline globules were seen within the cell islands. There was no nuclear pleomorphism or mitotic figures. The cylindroma did not express gross cystic disease fluid protein 15, carcinoembryonic antigen, estrogen and progesterone receptors, or cytokeratin 20 (CK20). There was diffuse and strong immunoreactivity to CK AE1/AE3, and focal reactivity for CK7 and smooth muscle actin. Cylindroma of the breast should be distinguished from adenoid cystic carcinoma and basal cell carcinoma. Although clearly epithelial, the exact histogenesis and cell phenotype of this unusual dermal type cylindroma of the breast are unknown.     

Infiltrating ductal carcinoma of breast presenting as areolar dermal lesion

Infiltrating ductal carcinoma is the most common form of invasive breast cancer. It accounts for 80% of all types of breast cancer. We report an unusual presentation of histologically proven case of infiltrating ductal carcinoma of breast presented clinically as a small palpable areolar dermal lesion. Well defined hypoechoic cystic lesion in areolar dermis was present on ultrasound with a negative mammogram.     

Breast Tumor Resembling the Tall Cell Variant of Papillary Thyroid Carcinoma

Abstract:  We describe the case of a 66-year-old woman with a palpable mass in her left breast. Although the diagnosis on core biopsy was an intraductal papilloma, the surgically excised lesion showed it to be an infiltrating carcinoma which appeared to arise in a complex sclerosing lesion and is similar to the recently described breast tumor resembling the tall cell variant of papillary thyroid carcinoma.     

Cystic lymphatic malformation of bladder presenting as a pelvic mass

We report a 5-year-old boy with a cystic lymphatic malformation (LM) of bladder, and the imaging characteristics of the lesion are reported. Cystic LM of the urinary system is rare, and a location in the bladder is extremely rare. The exact mechanism of the lesion that occurs in bladder is unknown. This case is different from the 3 cases reported before, for it is only presented with a palpable pelvic mass and the lesion did not penetrate full thickness of bladder. Although imaging examinations are helpful in the definition of cystic LMs, no characteristic findings are available to diagnose a cystic LM of the bladder before surgery. The diagnosis is always made after surgical intervention. Surgical excision is ideal, and an extensive operation is not warranted because the lesion is benign. Once excised completely, the prognosis of the disease is good.     

Myoid hamartoma of the breast: a case report and review of the literature

Myoid hamartomas of the breast are extremely rare breast lesions, with a poorly understood pathogenesis. A 60-year-old woman presented with a palpable mass in the right breast. Breast ultrasonography and mammography showed the presence of a breast lesion with benign characters, but were not diagnostic. A local excision of the mass was performed; histology revealed that the tumor was composed of epithelial and stromal cells. Histological and immunohistochemical findings established the diagnosis of myoid hamartoma. The patient is well 4 years later without tumor recurrence. Breast myoid hamartomas are exceptionally rare benign lesions; complete surgical excision achieves cure.     

Brain metastasis: a rare manifestation of adenoid cystic carcinoma of the breast

Adenoid cystic carcinoma of the breast is a rare neoplasm that usually has a benign biological behavior. A patient who was operated upon for removal of this tumor developed metastases to the lungs and brain 12 years after mastectomy. This is probably the first report in the literature of brain metastasis from adenoid cystic carcinoma of the breast. Radiological and histological evidence of both primary breast tumor and the metastasis to the brain are presented.     

Radial scars diagnosed on breast core biopsy: Frequency of atypia and carcinoma on excision and implications for management

AimsThe risk of finding carcinoma in excisions following a core needle biopsy diagnosis of radial scar is not well defined and clinical management is variable.The aim of this study is to determine the frequency of high-risk lesions, ductal carcinoma in situ, and invasive carcinoma in excisions following a core biopsy diagnosis of radial scar.Methods and resultsDedicated breast pathologists and radiologists correlated the histologic and radiologic findings and categorized radial scars as the target lesion or an incidental finding. High-risk lesions were defined as atypical hyperplasia or classical lobular carcinoma in situ.Of the 79 radial scars identified over a 14-year period, 22 were associated with atypia or carcinoma in the core biopsy. Thirty-seven (37) of the 57 benign radial scars underwent excision with benign findings in 30 (81%), high-risk lesions in six (16%), and flat epithelial atypia in one (3%). There were no upgrades to carcinoma. One patient with a benign radial scar developed a 3-mm focus of intermediate-grade estrogen receptor-positive ductal carcinoma in situ in the same quadrant of the ipsilateral breast 72 months after excision. One patient with an incidental un-excised benign radial scar was diagnosed with ductal carcinoma in situ at a separate site of suspicious calcifications.ConclusionsIn this series, none of the benign radial scars was upgraded to carcinoma. Radial scar was the targeted lesion in all cases with high-risk lesions on excision. Surgical excision may not be mandatory for patients with benign incidental radial scars on core biopsy.     

Primary aneurysmal cyst: bone type in the breast

A 60-year-old women presented with one month’s history of a large breast lump. On examination she had irregular hard mass occupying the central and outer quadrants of the right breast with no palpable lymph nodes. Fine needle aspiration cytology (FNAC) diagnosis was a benign stromal lesion. In view of the large size, a simple mastectomy was performed. We are reporting this case of primary extrasseous aneurysmal cyst of the bone in the breast as the first case described in the literature.     

Macroscopic sertoli cell nodule: a study of 6 cases that presented as testicular masses

Sertoli cell nodules are almost always incidental microscopic lesions found in both cryptorchid and normally descended testes. Sertoli cell nodules, when present as masses or ultrasonographic lesions, may create diagnostic confusion. Herein, we report 6 cases of macroscopic Sertoli cell nodules that were received in consultation. The referral diagnoses included Sertoli cell tumor (2 cases), sex cord tumor with annular tubules (1 case), and gonadoblastoma (1 case). The patients were 19 to 36 years old: 3 patients presented with palpable testicular masses and 3 with lesions that were worrisome for neoplasms in ultrasonographic examinations conducted for pain (2 cases) or infertility (1 case). All were phenotypically normal male patients who lacked endocrine symptoms. The Sertoli cell nodules ranged from 6 to 10 mm in diameter and on microscopic examination consisted of circumscribed proliferations of immature Sertoli cells, globules and trabeculae of basement membrane, and spermatogonia in varying proportions. In 2 cases the lesion was distinctly intratubular, consisting of closely packed tubules containing various components; in the other cases there was confluent growth of the tubules. Immunostains for α-inhibin highlighted the Sertoli cells (5 of 5 cases), with the germ cells appearing in negative relief. An antibody for testis-specific protein, Y-encoded (TSPY), stained the spermatogonia (2 of 2 cases), whereas OCT 3/4 was negative in all the cases (5 of 5 cases). We conclude that Sertoli cell nodules may present clinically as mass lesions, and that it is important to distinguish them from true neoplasms to avoid unnecessary procedures.     

Histologic sampling of grossly benign breast biopsies. How much is enough?

To develop a cost-effective approach to the detection of clinically significant lesions in grossly benign breast biopsies, we reviewed 384 consecutive breast biopsies performed because of a palpable mass in which gross examination revealed only benign fibrofatty tissue. All tissue was submitted for histologic examination (total of 3,342 blocks). Carcinoma or atypical hyperplasia (AH) was detected in 26 cases (6.8%). This group included 12 cases of lobular carcinoma in situ, four cases of atypical lobular hyperplasia, four cases of ductal carcinoma in situ, three cases of atypical ductal hyperplasia, and three cases of invasive carcinoma. In 25 of the 26 cases, at least a portion of the lesion was present in fibrous parenchyma; in only one case of atypical lobular hyperplasia was the lesion present exclusively in grossly fatty tissue. If, as a maximum, the first five tissue blocks had been submitted for each case and the remaining tissue was submitted only for cases of carcinoma or atypical hyperplasia, 1,386 (41%) fewer blocks would have been submitted. However, six (23%) of the carcinomas or atypical hyperplasias would have gone undetected. In contrast, submitting the first 10 blocks in each case would have resulted in 610 (18%) fewer blocks submitted but in the detection of all cases of carcinoma and atypical hyperplasia, except for a single focus of lobular carcinoma in situ in one case. We also used statistical models to investigate further the factors important in determining the probability of detecting carcinoma or atypical hyperplasia in grossly benign breast biopsies. We found that the percentage of blocks containing the lesion and the actual number of blocks submitted were the most important of these factors and that the total specimen size was a relatively minor determinant of the probability of detection. We conclude that (a) the likelihood of detecting carcinoma or atypical hyperplasia exclusively in the adipose tissue component of grossly benign breast biopsies is extremely low, and (b) a possible cost-effective method of sampling grossly benign breast biopsies consists of initially submitting a maximum of 10 blocks of fibrous parenchyma for each case, then examining the remaining tissue histologically only if carcinoma or atypical hyperplasia is found among these blocks.     

Adenoid cystic carcinoma of female breast: A case report

INTRODUCTIONAdenoid cystic carcinoma (ACC) of the breast is a rare neoplasm accounting for 0.1% of breast carcinomas.PRESENTATION OF CASEA 30 year old female patient presented with multiple lumps in the right breast. Excision biopsy of a lump in the lower outer quadrant revealed adenoid cystic carcinoma. A right sided modified radical mastectomy (MRM) was performed, with axillary clearance. Histopathology revealed a fibroadenoma accounting for one mass and adenoid cystic carcinoma in another, confirmed on Periodic acid Schiff (PAS) staining. Three out of the eight excised axillary lymph nodes contained malignancy. There was no evidence of recurrence or distant spread at follow-up 6 months postoperatively.DISCUSSIONACC of the breast is a rare neoplasm accounting for 0.1% of breast carcinomas and is of special interest because of its favourable prognosis and distinctive histological appearance. This tumor occurs predominantly in women in their sixth decade and usually presents as a tender breast mass, often in the subareolar area though in our case it was not tender and presented as multiple lumps in the right breast. The diagnosis can be made on fine needle aspiration cytology (FNAC), but in our case FNAC was inconclusive. We performed MRM with axillary clearance, and three out eight lymph nodes proved positive for malignancy.CONCLUSIONACC is a rare malignant neoplasm. Surgical treatment is the mainstay with little role for radiotherapy and chemotherapy according to the published literature.     

Cardiac mesothelial/monocytic-incidental-excrescence: more than an artifactual lesion?

Mesothelial/monocytic incidental cardiac excrescence (MICE) is a benign finding made up of a mixture of cuboidal mesothelial cells, histiocytes and fibrine and is mainly found incidentally during open heart surgery, commonly after cardiac catheterization. Clinical importance of this lesion has been emphasized because of its potential confusion with malignancies, especially with metastatic carcinoma. We report a case of an asymptomatic 72-year-old man with incidental finding of a pericardial effusion and a small mass attached to the left appendage.     

Collagenous gastritis: a report of six cases.

Collagenous gastritis is an exceptional entity with eight cases documented to date characterized by the presence of a thick subepithelial collagen band associated with an inflammatory infiltrate of the gastric mucosa. The aim of our study was to describe the clinical and histologic characteristics of six new cases of collagenous gastritis. All cases showed a subepithelial collagen band that averaged 30 microm but often measured up to 120 microm. This finding was almost always accompanied by mixed chronic inflammation in the lamina propria and by surface epithelial damage of varying severity. Our study seems to delineate two subsets in patients with collagenous gastritis: 1) collagenous gastritis occurring in children and young adults presenting with severe anemia, a nodular pattern on endoscopy, and a disease limited to the gastric mucosa without evidence of colonic involvement, and 2) collagenous gastritis associated with collagenous colitis occurring in adult patients presenting with chronic watery diarrhea. These findings highlight the fact that subepithelial collagen deposition may be a generalized disease affecting the entire gastrointestinal tract.     

Diagnostically Challenging Epithelial Odontogenic Tumors: A Selective Review of 7 Jawbone Lesions

Considerable variation in the clinicopathologic presentation of epithelial odontogenic tumors can sometimes be confusing and increase the chance of misdiagnosis. Seven diagnostically challenging jawbone lesions are described. There were 2 cases of mistaken identity in our ameloblastoma file. One unicystic type, initially diagnosed and treated as a lateral periodontal cyst, showed destructive recurrence 6 years postoperatively. The other globulomaxillary lesion was managed under the erroneous diagnosis of adenomatoid odontogenic tumor and recurred 4 times over an 11-year period. This tumor was found in retrospect to be consistent with an adenoid ameloblastoma with dentinoid. The diagnosis of cystic squamous odontogenic tumor (SOT) occurring as a radicular lesion of an impacted lower third molar was one of exclusion. Of two unsuspected keratocystic odontogenic tumors, one depicted deceptive features of pericoronitis, while the other case has long been in our files with the diagnosis of globulomaxillary SOT. Two cases of primary intraosseous squamous cell carcinoma appeared benign clinically and exhibited unexpected findings; an impacted third molar began to erupt in association with the growth of carcinoma and another periradicular carcinoma showed dentinoid formation. Cases selectively reviewed in this article present challenging problems which require clinical and radiographic correlation to avoid potential diagnostic pitfalls.     

Solid variant of mammary adenoid cystic carcinoma with basaloid features: a study of nine cases

Adenoid cystic carcinoma of the breast is a rare neoplasm that represents <1% of breast carcinomas. The tumors are histologically indistinguishable from examples in other sites, and they have a generally favorable prognosis. Several studies have investigated the possible correlation between histologic grade in adenoid cystic carcinoma (largely determined by cytology and growth pattern) and prognosis. Some earlier reports concluded that a solid variant of mammary adenoid cystic carcinoma had a more aggressive clinical course, but others did not confirm this impression. This report describes nine patients with a solid variant of mammary adenoid cystic carcinoma that has a striking basaloid appearance. All were women ranging in age from 37 to 83 years. A solitary mass was evident in all patients. Tumor size was 1.1-15 cm (mean 3.7 cm). The tumors exhibited a predominantly solid architecture comprised of basaloid appearing cells with moderate to marked nuclear atypia. Five tumors had >5 mitotic figures per 10 high power microscopic fields. Intercalated ducts were found in all tumors, being well formed in six and poorly formed in three. Immunohistochemical stains for cytokeratins, basement membranes, and vimentin were consistently positive. Surgery was performed in all cases consisting of excision in seven and mastectomy in two. Axillary lymph node metastases were found in two of six axillary dissections and four had negative lymph nodes. The lymph nodes were not examined in three patients. Follow-up information was available for seven patients. Six women had no evidence of disease after follow-up of 2-88 months (mean 32 months), one patient died of unknown causes, and one patient was lost to follow-up. It is concluded that the solid variant of mammary carcinoma with basaloid features is a histologically distinct tumor that is capable of axillary metastases. Long-term follow-up of a larger series of cases will be needed to determine whether the prognosis of these patients differs significantly from that of women with conventional adenoid cystic carcinoma. Presently, these patients are candidates for axillary staging by sentinel lymph node mapping or low axillary dissection if there is no clinical evidence of axillary metastases. Systemic adjuvant treatment would be prudent when axillary nodal metastases are present. Breast-conserving surgery with radiation is an option if negative margins can be achieved because this appears to be a unicentric form of carcinoma.