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Cureus May 2023Breast cancer is the most common cancer among women and the leading cause of cancer-related deaths globally. Ductal carcinoma of no special type is the most prevalent,...
Breast cancer is the most common cancer among women and the leading cause of cancer-related deaths globally. Ductal carcinoma of no special type is the most prevalent, followed by lobular carcinoma. Finding a triple-negative breast cancer of intermediate grade on core biopsies should raise the possibility of dealing with one of the rare subtypes such as microglandular adenosis (MGA)-associated carcinoma. Here, we present a case of a 40-year-old female, who presented with bilateral breast masses, in which one of them was a high-grade carcinoma and the other turned out to be an MGA-associated carcinoma, which was misdiagnosed initially on the core biopsy as a grade II triple-negative ductal carcinoma of no special type. Such diagnosis is challenging to pathologists, especially on small biopsies where the full morphological spectrum is not evident.
PubMed: 37250605
DOI: 10.7759/cureus.39531 -
Surgical Case Reports May 2023Neurofibroma of the breast is extremely rare, with only a few reported cases. Here, we report a case of solitary neurofibroma of the breast in a 95-year-old woman.
BACKGROUND
Neurofibroma of the breast is extremely rare, with only a few reported cases. Here, we report a case of solitary neurofibroma of the breast in a 95-year-old woman.
CASE PRESENTATION
A 95-year-old woman presented with a palpable mass in the left breast. Mammography revealed a well-defined mass. A 1.6-cm round mass was found in the lower outer quadrant of the left breast on ultrasonography. The internal echo of the tumor was a mixture of relatively uniform hypoechoic areas with posterior enhancement and heterogeneous hyperechoic areas. She underwent a core needle biopsy. The pathological findings revealed a spindle cell lesion with no malignant findings. At 2 months follow-up, repeat breast ultrasonography showed that the mass had enlarged to be 2.7 cm in size. A repeat core needle biopsy, however, revealed no particularly new information. Because the tumor was growing and a definite diagnosis was not made, lumpectomy was performed. We found bland-spindled cells with shredded-carrot collagen bundles. Immunohistochemical antibody markers (S100, SOX10, and CD34) were positive for the spindle cells. Some of the tumors maintained the bilayer nature of luminal cells and myoepithelial cells, which might be the reason for internal heterogeneity on ultrasound. A histological diagnosis of neurofibroma with adenosis was made. At 6 months follow-up, no recurrent lesions were found.
CONCLUSIONS
Ultrasound and pathological images revealed an extremely rare case of neurofibroma combined with adenosis. Tumor resection was performed because it was difficult to make a definitive diagnosis using needle biopsy. Even when a benign tumor is suspected, short-term follow-up is necessary, and if an enlargement is observed, early tumor resection is recommended.
PubMed: 37246203
DOI: 10.1186/s40792-023-01673-0 -
Cureus Apr 2023Microglandular adenosis (MGA) is a proliferative breast lesion composed of small, uniform glands lacking a myoepithelial cell layer while still invested by the basement...
Microglandular adenosis (MGA) is a proliferative breast lesion composed of small, uniform glands lacking a myoepithelial cell layer while still invested by the basement membrane. The glands percolate haphazardly through the breast parenchyma rather than maintaining a lobular architecture, typical of other forms of adenosis.MGA is a benign lesion though atypical forms have been well described, often in close association with carcinoma. MGA, atypical MGA (AMGA), and the vast majority of MGA-associated carcinomas (MGACA) are negative for estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor 2 (HER2) by immunohistochemistry. In light of these findings and early molecular studies, MGA is hypothesized to represent a clonal process and nonobligate precursor of basal-type breast carcinomas. We present the case of a 58-year-old woman and the first published molecular comparison of a luminal-type invasive ductal carcinoma with its associated MGA/AMGA. Analysis of small nucleotide variants (SNVs) revealed that 63% of the SNVs identified in the MGA were present in the AMGA while only 10% of them were present in the MGACA, suggesting a direct relationship between MGA and AMGA but not MGA and MGACA.
PubMed: 37159793
DOI: 10.7759/cureus.37198 -
World Journal of Surgery Sep 2023To evaluate the relevant factors associated with malignancy in Breast Imaging Reporting and Data System (BI-RADS) 4A and to determine whether it was possible to...
Can Short-term Follow-up with Ultrasound be Offered as an Acceptable Alternative to Immediate Biopsy or Surgery for Patients with First Ultrasound Diagnosis of BI-RADS 4A Lesions?
OBJECTIVES
To evaluate the relevant factors associated with malignancy in Breast Imaging Reporting and Data System (BI-RADS) 4A and to determine whether it was possible to establish a safe follow-up guideline for lower-risk 4A lesions.
METHODS
In this retrospective study, patients categorized as BI-RADS 4A on ultrasound who underwent ultrasound-guided biopsy or/and surgery between June 2014 and April 2020 was analyzed. Classification-tree method and cox regression analysis were used to explore the possible correlation factors of malignancy.
RESULTS
Among 9965 patients enrolled, 1211 (mean age, 44.3 ± 13.5 years; range, 18-91 years) patients categorized as BI-RADS 4A were eligible. The result of cox regression analysis revealed the malignant rate was only associated with patient age (hazard ratio (HR) = 1.038, p < 0.001, 95% confidence interval (CI): 1.029-1.048) and the mediolateral diameter of the lesion (HR = 1.261, p < 0.001, 95% CI: 1.159-1.372). The malignant rate for patients (≤ 36 y) with BI-RADS 4A lesions (the mediolateral diameter ≤ 0.9 cm) was 0.0% (0/72). This subgroup included fibrocystic disease and adenosis in 39 patients (54.2%), fibroadenoma in 16 (22.2%), intraductal papilloma in 8 (11.1%), inflammatory lesions in 6 (8.3%), cyst in 2 (2.8%), and hamartoma in 1 (1.4%).
CONCLUSIONS
Patient age and lesion size are associated with the rate of malignancy in BI-RADS 4A. For patients with lower-risk BI-RADS 4A lesions (≤ 2% likelihood of malignancy), short-term follow-up with ultrasound may be offered as an acceptable alternative to immediate biopsy or surgery.
Topics: Female; Humans; Adult; Middle Aged; Retrospective Studies; Follow-Up Studies; Ultrasonography, Mammary; Breast Neoplasms; Biopsy; Image-Guided Biopsy
PubMed: 37115232
DOI: 10.1007/s00268-023-07037-x -
Cureus Mar 2023Fibrocystic changes (FCCs) are common, often benign, breast lesions characterized by adenosis, fibrosis, and cyst formation. These changes are believed to be associated...
Fibrocystic changes (FCCs) are common, often benign, breast lesions characterized by adenosis, fibrosis, and cyst formation. These changes are believed to be associated with fluctuating hormone levels and are predominantly found in premenopausal women due to higher levels of estrogen. Certain conditions that cause hormonal imbalances, such as polycystic ovarian syndrome, have also been associated with an increased risk of FCCs. FCCs can occur in postmenopausal women on hormonal replacement therapy but are otherwise extremely rare. Although this condition is primarily considered benign, complex cysts presenting in a rare demographic warrant further evaluation beyond screening mammograms to exclude the possibility of malignancy. In this paper, we present the case of new FCCs in a postmenopausal woman and explore the radiology, histology, carcinogenic potential, treatment options, and potential contributing factors of the condition.
PubMed: 37073209
DOI: 10.7759/cureus.36292 -
Arkhiv Patologii 2023The presented case describes the difficulties of diagnosis of the breast microglandular adenosis (MGA), taken by clinicians for a malignant process due to the nature of...
The presented case describes the difficulties of diagnosis of the breast microglandular adenosis (MGA), taken by clinicians for a malignant process due to the nature of growth and large size. Criteria for histological and immunohistochemical diagnosis and differentiation of MGA with malignant neoplasms, in particular, with tubular breast carcinoma, are presented. Taking into account the rarity of the pathology and the absence of described cases in the Russian-language literature, the observation is of interest to pathologists and clinicians.
Topics: Female; Humans; Fibrocystic Breast Disease; Immunohistochemistry; Carcinoma, Ductal, Breast; Diagnosis, Differential; Breast Neoplasms
PubMed: 37053352
DOI: 10.17116/patol20238502140 -
European Journal of Breast Health Apr 2023A radial scar (RS) is a benign breast lesion (BBL) that has an obscure etiology. RS is easily confused with breast carcinoma and therefore correct identification...
OBJECTIVE
A radial scar (RS) is a benign breast lesion (BBL) that has an obscure etiology. RS is easily confused with breast carcinoma and therefore correct identification radiologically and pathologically is important. The aim of this study was to determine the incidence of atypical lesions by evaluating RS detected with BBL and to investigate whether atypia and RS are related to their characteristics.
MATERIALS AND METHODS
A total of 1.370 patients with a diagnosis of BBL postoperatively in a single department were analyzed retrospectively. Forty-six confirmed RS/complex sclerosing lesion (CSL) cases were selected. The demographic and clinical characteristics of the patients and the relationship between RS and other BBL were evaluated. In addition, the relationship between RS/CSL and the presence of atypia was interpreted.
RESULTS
The mean age was 45.17±8.72 years. Spiculated lesion (34.8%) on mammography and microcalcification (37%) on histopathological examination were the most common features. The most common BBL accompanying RS/CSL was adenosis. Atypical epithelial hyperplasia (AEH) was presented in 15 (32.6%) of those diagnosed with RS. Although all patients were benign, the frequency of AEH accompanying RS was found to be significantly higher. The mean size of RS was 10.8±8.4 mm (2-30 mm). The size of RS/CSL was not significantly associated with atypia.
CONCLUSION
RS/CSLs usually present as suspicious lesions that must be distinguished radiologically from malignancy. However RS, which can be present with malign breast lesions, can be also seen with all BBL. Therefore, core biopsy and/or excisional biopsy continue to be important for definitive histopathological diagnosis.
PubMed: 37025577
DOI: 10.4274/ejbh.galenos.2023.2022-10-4 -
Frontiers in Oncology 2023We aimed to develop an ultrasound-based radiomics model to distinguish between sclerosing adenosis (SA) and invasive ductal carcinoma (IDC) to avoid misdiagnosis and...
OBJECTIVES
We aimed to develop an ultrasound-based radiomics model to distinguish between sclerosing adenosis (SA) and invasive ductal carcinoma (IDC) to avoid misdiagnosis and unnecessary biopsies.
METHODS
From January 2020 to March 2022, 345 cases of SA or IDC that were pathologically confirmed were included in the study. All participants underwent pre-surgical ultrasound (US), from which clinical information and ultrasound images were collected. The patients from the study population were randomly divided into a training cohort (n = 208) and a validation cohort (n = 137). The US images were imported into MaZda software (Version 4.2.6.0) to delineate the region of interest (ROI) and extract features. Intragroup correlation coefficient (ICC) was used to evaluate the consistency of the extracted features. The least absolute shrinkage and selection operator (LASSO) logistic regression and cross-validation were performed to obtain the radiomics score of the features. Based on univariate and multivariate logistic regression analyses, a model was developed. 56 cases from April 2022 to December 2022 were included for independent validation of the model. The diagnostic performance of the model and the radiomics scores were evaluated by performing the receiver operating characteristic (ROC) analysis. The calibration curve and decision curve analysis (DCA) were used for calibration and evaluation. Leave-One-Out Cross-Validation (LOOCV) was used for the stability of the model.
RESULTS
Three predictors were selected to develop the model, including radiomics score, palpable mass and BI-RADS. In the training cohort, validation cohort and independent validation cohort, AUC of the model and radiomics score were 0.978 and 0.907, 0.946 and 0.886, 0.951 and 0.779, respectively. The model showed a statistically significant difference compared with the radiomics score (<0.05). The Kappa value of the model was 0.79 based on LOOCV. The Brier score, calibration curve, and DCA showed the model had a good calibration and clinical usefulness.
CONCLUSIONS
The model based on radiomics, ultrasonic features, and clinical manifestations can be used to distinguish SA from IDC, which showed good stability and diagnostic performance. The model can be considered a potential candidate diagnostic tool for breast lesions and can contribute to effective clinical diagnosis.
PubMed: 36959807
DOI: 10.3389/fonc.2023.1090617 -
Asian Pacific Journal of Cancer... Feb 2023Early detection and precise diagnosis of breast cancer (BC) plays an essential part in enhancing the diagnosis and improving the breast cancer survival rate of patients...
OBJECTIVE
Early detection and precise diagnosis of breast cancer (BC) plays an essential part in enhancing the diagnosis and improving the breast cancer survival rate of patients from 30 to 50%. Through the advances of technology in healthcare, deep learning takes a significant role in handling and inspecting a great number of X-ray, MRI, CTR images. The aim of this study is to propose a deep learning model (BCCNN) to detect and classify breast cancers into eight classes: benign adenosis (BA), benign fibroadenoma (BF), benign phyllodes tumor (BPT), benign tubular adenoma (BTA), malignant ductal carcinoma (MDC), malignant lobular carcinoma (MLC), malignant mucinous carcinoma (MMC), and malignant papillary carcinoma (MPC).
METHODS
Breast cancer MRI images were classified into BA, BF, BPT, BTA, MDC, MLC, MMC, and MPC using a proposed Deep Learning model with additional 5 fine-tuned Deep learning models consisting of Xception, InceptionV3, VGG16, MobileNet and ResNet50 trained on ImageNet database. The dataset was collected from Kaggle depository for breast cancer detection and classification. That Dataset was boosted using GAN technique. The images in the dataset have 4 magnifications (40X, 100X, 200X, 400X, and Complete Dataset). Thus we evaluated the proposed Deep Learning model and 5 pre-trained models using each dataset individually. That means we carried out a total of 30 experiments. The measurement that was used in the evaluation of all models includes: F1-score, recall, precision, accuracy.
RESULTS
The classification F1-score accuracies of Xception, InceptionV3, ResNet50, VGG16, MobileNet, and Proposed Model (BCCNN) were 97.54%, 95.33%, 98.14%, 97.67%, 93.98%, and 98.28%, respectively.
CONCLUSION
Dataset Boosting, preprocessing and balancing played a good role in enhancing the detection and classification of breast cancer of the proposed model (BCCNN) and the fine-tuned pre-trained models' accuracies greatly. The best accuracies were attained when the 400X magnification of the MRI images due to their high images resolution.
Topics: Humans; Female; Breast Neoplasms; Deep Learning; Carcinoma, Ductal, Breast; Carcinoma, Lobular; Carcinoma, Papillary; Fibroadenoma; Fibroma
PubMed: 36853302
DOI: 10.31557/APJCP.2023.24.2.531 -
Journal of Medical Ultrasonics (2001) Jul 2023There have been several investigations of non-mass-like (NML) lesions on ultrasound (US) since Uematsu first described this approach, and it is a relatively new concept... (Review)
Review
There have been several investigations of non-mass-like (NML) lesions on ultrasound (US) since Uematsu first described this approach, and it is a relatively new concept for breast examination. However, the results have varied, and there have been only a few studies related to the detailed histopathology of NML lesions on US. Here, we review the histopathology of NML lesions. NML lesions are pathologically benign, atypical, or malignant. There are two major findings of NML lesions on US: architectural distortion and calcifications. Architectural distortion pathologically indicates a fibrous change with ductal proliferation, invasive breast carcinoma, and carcinoma in situ. Histopathologically, microcalcifications are seen in both benign and malignant lesions, and it is important to distinguish between these lesions among NML lesions, particularly fibrocystic changes including adenosis and hyperplasia in the case of benign lesions and carcinoma in situ (ductal and lobular) in the case of malignant lesions. The differential major points may be whether NML lesions are associated with abundant hyperechoic foci, which indicate comedo necrosis on histology. They are usually high-grade carcinoma in situ that may be positive for HER2 or triple negativity. A recent report indicated that low-grade carcinoma in situ showed better survival than higher-grade carcinoma in situ, which is often accompanied by comedo necrosis on histology, reflecting visible microcalcification on US. NML lesions are considered to include a certain rate of low-grade carcinoma in situ. Therefore, more caution may be needed when detecting and managing NML lesions to avoid overdiagnosis and overtreatment as a result of this recent "low-risk ductal carcinoma in situ" concept.
Topics: Humans; Female; Breast; Breast Neoplasms; Carcinoma, Intraductal, Noninfiltrating; Carcinoma in Situ; Calcinosis; Fibrosis; Hyperplasia; Necrosis
PubMed: 36773105
DOI: 10.1007/s10396-023-01286-y