Breast Disease

The national breast cancer screening program has been introduced in Croatia in the second half of 2006 with mammography as the screening method. We investigated the impact of screening mammography on the basic pathohistological characteristics of breast cancers retrieved from the database of large community hospital. The data were collected in the period following the initiation of national mamographic screening program (2007–2011), and compared with the data collected in the period before the program introduction (2002–2006) to explore the possible changing trends. In the screening period 1,320 breast cancers were diagnosed, while in the prescreening period 1,204 breast cancers were diagnosed (p = 0.02). We found the reduction of mean tumor size (p = 0.039), decrease of the diagnosed non-invasive cancers (p = 0.001), and the higher percentage of the diagnosed ductal (p = 0.0003) and grade 3 (p = 0.038) invasive cancers in the screening period. We also noticed higher percentage of diagnosed advanced breast cancers with unknown tumor size in the screening period (p = 0.027). We concluded that the implementation of national screening program did not improve the pathohistological features of breast cancers in our region probably due to low response rate to screening invitation.

Breast tuberculosis an uncommon form of tuberculosis and it usually presents as a lump in the breast. Tuberculosis of the breast can masquerade many breast diseases including malignancy and idiopathic granulomatous mastitis. The varied presentation poses a diagnostic and therapeutic dilemma for the clinicians. We report a case of a 56 year old lady who presented with a lump in the breast and overlying skin ulceration, which resembled a malignancy on clinical examination and radiological investigations. Histo-pathology confirmed the diagnosis of tuberculosis and the patient responded to anti tubercular drugs.

Breast cancer presenting in the midline of the chest and without a primary focus in the breast is extremely rare. A 48 year old post-menopausal lady presented with a rapidly enlarging lump over the middle of her chest along with bilateral axillary lymph nodes. Clinical and imaging tests failed to demonstrate a focus of cancer in either of the breasts. Incisional biopsy of the lesion revealed it to be an infiltrating ductal carcinoma.

As no guidelines exist to manage such patients, she was started on neo-adjuvant chemotherapy. Following a good response to chemotherapy, she underwent wide local excision of the lesion with bilateral axillary lymphadenopathy. She subsequently received adjuvant chemotherapy, radiotherapy and hormonal therapy.

Pulmonary sclerosing hemangioma (PSH) is a rare tumor accounting for 0.2–1% of all primary lung tumors. Simultaneous occurrence of PSH with breast cancer has very rarely been reported in the literature. We describe here a case of simultaneous occurrence of PSH with breast cancer. A pathological diagnosis of PSH was confirmed by computed tomography (CT)-guided biopsy. Due to the patient's poor performance status and the benign nature of PSH, surgical excision was not considered and the patient was managed conservatively with regular follow-up. Although surgical excision is the preferred treatment for PSH, conservative management may be a reasonable option in carefully selected patients.

Breast hamartomas (BH) or Fibroadenolipoma are extremely rare breast lesions. They are benign, focal malformations that resemble a neoplasm in the tissue of its origin. We describe a case of a 48 year old woman with bilateral breast lumps for the past 18 months and 6 months which were gradually increasing in size. FNAC smears revealed only clusters of benign ductal epithelial cells. Lumps were excised and histopathology revealed predominantly stromal smooth muscle bundles (proved by immunohistochemistry) along with scattered intact terminal duct-lobular units, dilated ducts and entrapped islands of mature fibroadipose tissue. A diagnosis of Bilateral Myoid hamartoma of breast was given.

To the best of our knowledge till date no case of bilateral MH of breast has been reported in the literature. We report the first case of bilateral MBH highlighting its morpho-immunophenotypic features.

Metastases to the breast from non-mammary sites are rare and pose a diagnostic and therapeutic challenge. They can be mistaken for primary breast malignancy, which is much more common. In this case report we describe the clinical, radiological and pathological features of a patient who developed breast metastases from an adrenocorticotropic hormone (ACTH) secreting thymic neuro-endocrine carcinoma. Patient was initially felt to have a primary breast malignancy, however, after further ancillary testing a diagnosis of metastatic thymic neuro-endocrine tumor was made.