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Diagnostic Cytopathology May 2022A 15-year-old male presented to the hospital with a 2-month history of a right parotid mass. Magnetic resonance imaging revealed an encapsulated 3.7 cm mass....
A 15-year-old male presented to the hospital with a 2-month history of a right parotid mass. Magnetic resonance imaging revealed an encapsulated 3.7 cm mass. Fine-needle aspiration suggested a monomorphic adenoma (prior to utilization of the Milan Classification system). Total parotidectomy was performed with dissection and preservation of the facial nerve. Surgical pathology identified the lesion as sclerosing polycystic adenosis (SPA) after examining the histopathological and immunohistochemistry findings. SPA is a rare lesion which leads to inflammatory changes in the salivary gland. The most common site impacted is the parotid gland but also can affect other major or minor salivary glands. The fibrocystic changes are morphologically like the histological developments of sclerosing adenosis of breast tissue. Those changes consist of fibrosis, apocrine metaplasia, and different degrees of proliferation of ducts, acini, and myoepithelial cells. The pathogenesis of SPA is unknown but recent studies suggest that it could be a neoplasm. Treatment with surgical excision is effective and its' recurrence is rare. This case report details the cytomorphology, histology, and immunohistochemical profile of SPA.
Topics: Adolescent; Biopsy, Fine-Needle; Cysts; Female; Fibrocystic Breast Disease; Humans; Male; Parotid Gland; Parotid Neoplasms; Salivary Glands
PubMed: 34965020
DOI: 10.1002/dc.24926 -
Radiology. Imaging Cancer Nov 2021Purpose To determine the upgrade rate for biopsy-proven radial scars and radial sclerosing lesions (RS). Materials and Methods In this retrospective study, radiology and...
Purpose To determine the upgrade rate for biopsy-proven radial scars and radial sclerosing lesions (RS). Materials and Methods In this retrospective study, radiology and pathology databases from two tertiary breast centers were searched to identify patients with biopsy-confirmed RS between March 1, 2012, and December 31, 2017, during which all mammography was performed with digital breast tomosynthesis (DBT). Adjunct modalities such as MRI or US are performed at our centers to better characterize lesions identified at DBT. Patient demographics, imaging, needle and excisional biopsies, and follow-up data were collected at the patient level. Clopper-Pearson interval estimate for upgrade was calculated for 95% confidence using PropCIs package with R version 4.1.0 (R Foundation for Statistical Computing) (1). Results During the study period, a total of 155 885 DBT examinations were performed. From these examinations, 146 biopsy-proven RS were identified in 142 women (median age, 58 years; age range, 26-87 years). A total of 80.1% (117 of 146) of all RS did not have associated atypia or malignancy, and 19.9% (29 of 146) had associated atypia at initial biopsy. A total of 66.7% (78 of 117) of RS without atypia or malignancy were surgically excised, 25.6% (30 of 117) were followed (median, 3 years; range, 1-7 years) with benign findings on imaging, and 7.7% (nine of 117) were lost to follow-up. The rate of malignancy upgrade was 0.9% (one of 117 [95% CI: 0.02, 4.7]); one RS without concurrent atypia or malignancy demonstrated invasive carcinoma at surgical excision. Conclusion RS without atypia had a low upgrade rate. Mammography, Breast © RSNA, 2021.
Topics: Adult; Aged; Aged, 80 and over; Breast Neoplasms; Cicatrix; Early Detection of Cancer; Female; Fibrocystic Breast Disease; Humans; Middle Aged; Retrospective Studies
PubMed: 34766844
DOI: 10.1148/rycan.2021210036 -
Zhonghua Bing Li Xue Za Zhi = Chinese... Nov 2021
Topics: Cysts; Diagnosis, Differential; Female; Fibrocystic Breast Disease; Humans; Molecular Biology; Salivary Glands; Sclerosis
PubMed: 34719182
DOI: 10.3760/cma.j.cn112151-20210629-00465 -
Daru : Journal of Faculty of Pharmacy,... Dec 2021Fibrocystic disease (FCD) of the breast as a very common health problem in women has estrogen-dependent and proliferative features. No effective management strategy has... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND AND PURPOSE
Fibrocystic disease (FCD) of the breast as a very common health problem in women has estrogen-dependent and proliferative features. No effective management strategy has been validated for this disorder, so far. The anti-hyperglycemic agent metformin has both anti-proliferative and estrogen-suppressing effects. Thus, we investigated metformin as a management strategy for FCD.
METHODS
The study was a double-blind placebo-controlled randomized clinical trial. Premenopausal women with FCD according to history, physical exam and ultrasound, who had measurable microcyst clusters on ultrasound (US) were entered the study. Oral placebo and metformin tablets (500 mg) were used twice daily by participants in the intervention and control groups. Size and number of microcyst clusters on US and the subjective pain score were recorded before and after the intervention.
RESULTS
154 participants were randomly allocated into two groups of 77 interventions and 77 controls. The decrease in size of the largest microcyst cluster in each patient and the mean decrease in number of microcyst clusters were not statistically significant (P = 0.310 and P = 0.637, respectively). However, those microcyst clusters which were ≥ 14 mm became significantly smaller after metformin use (P = 0.006). Additionally, in the subset of participants with pain at baseline, a larger proportion in the intervention group experienced at least 50% reduction in pain score (63.8% (30/47) in the intervention vs. 44.2% (19/43) in the placebo groups, P = 0.031).
CONCLUSION
Our study showed that metformin might be effective in the management of FCD. Further studies are proposed for confirmation of this subject.
Topics: Administration, Oral; Adult; Double-Blind Method; Drug Administration Schedule; Female; Fibrocystic Breast Disease; Humans; Metformin; Middle Aged; Premenopause; Tablets; Treatment Outcome; Ultrasonography, Mammary
PubMed: 34719004
DOI: 10.1007/s40199-021-00424-6 -
World Journal of Clinical Cases Sep 2021Breast adenoid cystic carcinoma (AdCC) is a rare invasive carcinoma composed of epithelial and myoepithelial cells. Microglandular adenosis (MGA) is a rare benign...
BACKGROUND
Breast adenoid cystic carcinoma (AdCC) is a rare invasive carcinoma composed of epithelial and myoepithelial cells. Microglandular adenosis (MGA) is a rare benign proliferative lesion consisting of small, uniform, and round glands formed by a single layer of epithelial cells and basement membrane without a myoepithelial cell layer. MGA may progress to atypical MGA and carcinoma arising in MGA. Among various invasive carcinomas from MGA, AdCC has been rarely reported. Here, we report a case of AdCC arising in MGA.
CASE SUMMARY
A 59-year-old woman was diagnosed with a newly developed density on a routine mammogram. The density was similar to or slightly lower than that of the breast parenchyma. Sonography showed an irregular mass with a slightly higher echo than that of fat. Magnetic resonance imaging showed an irregular mass with a similar T1 signal intensity and a slightly higher T2 signal intensity compared to muscles or the breast parenchyma. The lesion showed heterogeneous internal enhancement with an initially slow and delayed persistent enhancing pattern. Microscopically, the tumor was composed of invasive AdCC, AdCC, and MGA. AdCC is composed of basaloid and ductal epithelial cells forming cribriform or solid sheets, or haphazardly scattered small cribriform or tubular glands. MGA showed small glands with a single epithelial lining and retained lumen. S-100 staining was strongly positive in MGA area. The patient underwent breast-conserving surgery with sentinel lymph node biopsy.
CONCLUSION
Breast AdCC arising in MGA showed unique imaging findings that was different from usual invasive cancer.
PubMed: 34616829
DOI: 10.12998/wjcc.v9.i25.7579 -
The Kaohsiung Journal of Medical... Feb 2022
Topics: Adult; Female; Fibrocystic Breast Disease; Granulomatous Mastitis; Humans; Intraoperative Period; Neutrophils; Preoperative Period
PubMed: 34595816
DOI: 10.1002/kjm2.12460 -
Experimental Oncology Sep 2021The infertile women have an increased risk of developing benign and malignant tumors, in particular, breast cancer. Most studies have examined the role of gene variants...
BACKGROUND
The infertile women have an increased risk of developing benign and malignant tumors, in particular, breast cancer. Most studies have examined the role of gene variants in the risk of developing breast cancer, but there is little evidence of genetic risk factors for benign tumors.
AIM
To assess the combined genetic risk of developing mastopathy in women with FSHR (rs6165, rs6166) and ESR1 (rs9340799, rs2234693) gene variants.
MATERIALS AND METHODS
The study included 87 infertile women (45 with concomitant fibrocystic mastopathy and 42 without mastopathy).
RESULTS
For rs9340799 and rs2234693 variants of the ESR1 gene, we did not find any significant differences in the distribution of genotypes in infertile women with or without mastopathy. In patients with mastopathy, there was a reliable increase in the frequency of 307Ala/Ala and 680Ser/Ser genotypes of FSHR gene (χ = 6.39, p = 0.012, OR = 4.49 (1.48-13.65)) as compared to patients without mastopathy. In the presence of 307Thr/Thr and 680Asn/Asn genotypes of the FSHR gene, a 4.88-fold reduction of mastopathy risk (χ = 8.06, p = 0.005, OR = 0.21(0.07-0.59)) was observed. The frequency of the FSHR and the ESR1 genotypes combinations - 307Thr/Thr+680Asn/Asn+351AG+397TC was significantly decreased in patients with mastopathy.
CONCLUSIONS
Our study did not find an association of ESR1 gene variants with the risk of developing of mastopathy in infertile women although heterozygous variants of the ESR1 gene enhanced the "protective" effect of FSHR gene variants and reduced the risk of mastopathy.
Topics: Estrogen Receptor alpha; Female; Fibrocystic Breast Disease; Follow-Up Studies; Genetic Predisposition to Disease; Genotype; Humans; Infertility, Female; Middle Aged; Polymorphism, Single Nucleotide; Prognosis; Receptors, FSH
PubMed: 34591433
DOI: 10.32471/exp-oncology.2312-8852.vol-43-no-3.16468 -
Virchows Archiv : An International... Jan 2022Apocrine change is recognised in benign, atypical and malignant lesions of the breast. Apocrine metaplasia, a frequent finding in the breast of women over the age of... (Review)
Review
Apocrine change is recognised in benign, atypical and malignant lesions of the breast. Apocrine metaplasia, a frequent finding in the breast of women over the age of 25 years, is most commonly seen in benign cysts with a simple or papillary configuration. Apocrine change is also recognised in other benign lesions including sclerosing adenosis, now known as apocrine adenosis. Apocrine atypia usually refers to cytological atypia in which there is at least threefold variation in nuclear size but architectural atypia may also occur. The distinction between atypical apocrine hyperplasia and non-high-grade apocrine ductal carcinoma in situ may be difficult due to the relative rarity of these entities and the lack of validated diagnostic criteria. Lobular carcinoma in situ (LCIS) with apocrine change is considered to be a variant of pleomorphic LCIS. An apocrine variant of encapsulated papillary carcinoma is also recognised. Apocrine change is described in invasive carcinoma, including no special type, lobular, micropapillary and mucinous variants. The recent WHO 2019 update recognises 'carcinoma with apocrine differentiation' as a special type breast carcinoma based on the presence of apocrine morphology in at least 90% of the tumour. Tumours with apocrine morphology are usually but not always hormone receptor negative. Human epidermal growth factor receptor 2 (HER-2) status is variable. Molecular studies have identified breast tumours with apocrine features and high expression of androgen receptor mRNA including 'luminal androgen receptor tumours' and 'molecular apocrine tumours'. The term 'pure apocrine carcinoma' has been proposed to describe an invasive carcinoma with apocrine morphology that is oestrogen and progesterone receptor negative and androgen receptor positive. HER-2 status may be positive or negative. This article reviews the pathology of benign, atypical and malignant apocrine lesions of the breast, with emphasis on diagnostic criteria including an approach to evaluation of apocrine lesions on needle core biopsy, and recent advances in our understanding of invasive apocrine carcinoma.
Topics: Adult; Biopsy, Large-Core Needle; Breast; Breast Neoplasms; Female; Fibrocystic Breast Disease; Humans; Sweat Gland Neoplasms
PubMed: 34537861
DOI: 10.1007/s00428-021-03185-4 -
Pathology, Research and Practice Oct 2021A minority of mixed fibro-epithelial lesions of the breast lacks both fibroadenoma and phyllodes architectural patterns and have been previously labeled with different...
A minority of mixed fibro-epithelial lesions of the breast lacks both fibroadenoma and phyllodes architectural patterns and have been previously labeled with different terms, including "hamartomas", "myoid/muscular hamartomas", "benign fibroadenomatous lesions" or "stromo-epithelial lesions of the breast". This study emphasizes the clinico-pathologic features of 5 cases of mammary benign fibro(stromo)-epithelial lesions sharing as a common morphologic theme the presence of minimally infiltrative margins due to the overgrowth of the stromal component into the surrounding fibro-fatty tissue. Notably the radiological features were suspicious for malignancy in 3 out of 5 cases. The following histologic features were seen in all cases: i) an epithelial component of benign glandular structures exhibiting the morphological spectrum of fibro-cystic disease; ii) a stromal component of bland-looking spindle cell myofibroblasts (vimentin + and α-smooth muscle actin +) set in a variably fibro-myxoid stroma. The present paper contributes to widen the morphological spectrum of the benign fibro-epithelial lesions of the breast, emphasizing the possibility that some cases, exhibiting a predominant myofibroblastic stromal component and minimally infiltrative margins, may be confused with other primary spindle cell mimickers of the breast. Accordingly, we propose the descriptive term "benign myofibroblastic/epithelial lesions of the breast with minimally infiltrative margins" for these previously underrecognized lesions.
Topics: Adult; Breast Diseases; Female; Hamartoma; Humans; Middle Aged; Myofibroblasts
PubMed: 34455362
DOI: 10.1016/j.prp.2021.153577 -
BMC Endocrine Disorders Aug 2021Fibroadenoma (FA) is the most common benign solid breast mass in women, with no definite method of management. Because fibroadenoma is dependent on female sex hormones... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Fibroadenoma (FA) is the most common benign solid breast mass in women, with no definite method of management. Because fibroadenoma is dependent on female sex hormones and comprises hypertrophic changes at cellular levels, we investigated the effects of metformin (MF), a safe hypoglycemic agent with anti-estrogenic and anti-proliferative properties, in the management of fibroadenoma.
METHODS
In this randomized clinical trial study, eligible women with fibroadenomas were assigned randomly to the metformin (1000 mg daily for six months) or the placebo group. Breast physical and ultrasound exam was performed before and after the intervention, and the changes in the size of fibroadenomas were compared in the two groups.
RESULTS
Overall, 83 patients in the treatment, and 92 in the placebo group completed the study. A statistically significant difference in changing size between the two groups was observed only in the smallest mass. In the largest FAs, the rate of size reduction was higher in the treatment group (60.2 % vs. 43.5 %); while a higher rate of enlargement was observed in the placebo group (38 % vs. 20.5 %). In the smallest FAs, the rate of the masses that got smaller or remained stable was about 90 % in the treatment group and 50 % in the placebo group. We categorized size changes of FAs into < 20 % enlargement and ≥ 20 % enlargement. The odds ratio (OR) for an elargemnt less than 20% was 1.48 (95 % CI = 1.10-1.99) in the treatment group in comparison with the placebo group; the odds for an enlargement less than 20% was higher in women with multiples fibroadenomas (OR = 4.67, 95 % CI: 1.34-16.28). In our study, no serious adverse effect was recorded, and the medicine was well-tolerated by all users.
CONCLUSIONS
This is the first study that evaluates the effect of MF on the management of fibroadenoma, and the results suggest a favorable effect. Larger studies using higher doses of MF and including a separate design for patients with single or multiple FAs are suggested in order to confirm this effect.
TRIAL REGISTRATION
This trial (IRCT20100706004329N7) was retrospectively registered on 2018-10-07.
Topics: Adolescent; Adult; Breast Neoplasms; Case-Control Studies; Female; Fibroadenoma; Follow-Up Studies; Humans; Hypoglycemic Agents; Metformin; Middle Aged; Prognosis; Retrospective Studies; Young Adult
PubMed: 34416879
DOI: 10.1186/s12902-021-00824-4