Breast Disease

Phyllodes tumor of the breast is rare and often resembles the more commonly seen fibroadenoma at imaging and histologically. As core biopsy cannot always distinguish the two, assessing radiologic-pathologic concordance is essential to guide appropriate clinical management. We review the imaging characteristics of phyllodes tumor at mammography, ultrasound, and MRI to help the interpreting radiologist be aware of key imaging features that should alert him to the possibility of a phyllodes tumor even if not verified by initial core biopsy.

Due to an increasing number of breast cancer diagnoses in younger women anecdotally noted at our institution, we conceived of this study %was to retrospectively review the records of women diagnosed with breast cancer under the age of 40 for potentially alterable versus unalterable risk factors in their history. Between 2007 and 2013, there were 52 patients less than 40 years of age with breast cancer at our institution: 79% (41/52) presented with a clinical abnormality (palpable mass, nipple discharge or inversion) and 21% (11/52) were asymptomatic but diagnosed on early screening mammograms. Seventy-five percent (39/52) of the cancers had an invasive component and 87% (45/52) were intermediate to high grade. Sixty percent (31/52) of subjects had stage 0 or I disease, but 40% (21/52) had later stage disease (stage II or greater). The vast majority of the cancers were ER+ (82%) and PR+ (78%). Fifty-six percent (28/50; 2 unknown) of the subjects had a documented history of hormonal contraception. Fifty-three percent (27/51; 1 unknown) of had no family history of breast cancer whatsoever, and 80% (41/51) had no family history of breast cancer in a first degree relative. Six were positive for BRCA 1, 2, or a variant (6/52 = 12%).

BACKGROUND: Breast cancer is currently the leading cause of cancer morbidity and mortality among Algerian women. Molecular classification of breast cancer is an important factor for prognosis and clinical outcome. There are limited data regarding molecular breast cancer subtypes among Algerian women. The objective of the present study was to analyze the proportion and distribution of molecular subtypes and to determine their associations with some clinical and tumor characteristics: age at diagnosis, menopausal status, histological type and histological grade.

MATERIALS AND METHODS: The study population included 3014 female breast cancers. We analyzed breast cancers from cancer registries of academic medical oncology service of public hospital of Rouiba, anticancer center of Blida, and anticancer center of Batna. Breast cancers were diagnosed between 2008 and 2013. Molecular subtype classification was done based on immunohistochemical surrogates for ER (Estrogen receptor), PR (Progesterone receptor) and HER2 (human epidermal growth factor receptor-2) status obtained from medical records for 3014 breast cancer patients. Breast cancer subtypes definitions were as follow: Luminal A (ER⁺ and/or PR⁺, HER2^-), Luminal B (ER⁺ and/or PR⁺, HER2⁺), TNBC (ER^-, PR ^- , HER2^-), HER2⁺ (ER^-, PR^-, HER2⁺). Molecular subtypes were correlated with the clinicopathological characteristics of the tumors.

RESULTS: The mean age at diagnosis cancer was 48.5 years. Proportions of the luminal A, TNBC, luminal B and HER2⁺ breast cancer subtypes were 50.59%, 20.80%, 19.67% and 8.92%, respectively. We noted a significant difference in the distribution of age at diagnosis among the four cancer subtypes (P= 0.004). Luminal A, Luminal B, TNBC and HER2⁺ subtypes were significantly different by premenopausal and postmenopausal status (P= 0.01). Invasive Ductal Carcinoma was the most common histological type in all breast cancer subtypes. Tumors with histological grade 2 and 3 were more common in patients for the four breast cancer subtypes.

CONCLUSIONS: For the first time, we report the distribution of molecular breast cancer subtypes and their associations with some clinicopathological characteristics in a large cohort of Algerian women. In our current study, the median age of diagnosis for all breast cancer subtypes was younger than the average age in Europe and America. Luminal A was the most common sub- type in our patients followed by TNBC. The proportion of luminal A subtype was lesser than reported in white women with breast cancer in Europe and America. The proportion of TNBC subtype in Algerian women was higher compared with Caucasian women of European ancestry. This study will contribute in developing optimal clinical trial protocols and personalized management strategies for Algerian breast cancer patients.

BACKGROUND: Tubular carcinoma (TC) of the breast is an uncommon, well-differentiated subtype of breast cancer with an excellent prognosis, but ambiguity in how it should be defined and treated.

OBJECTIVE: To determine the clinicopathologic characteristics and survival outcomes of patients with TC.

METHODS: The University of Virginia (UVA) Breast Cancer Database and the Surveillance, Epidemiology and End Results (SEER) databases were queried for patients with either grade 1 TC or grade 1 ductal (G1D) breast cancer.

RESULTS: Nineteen institutional TC cases were identified and compared to 54 G1D cases. Flat epithelial atypia frequently was found with TC and not with G1D. There was no difference in overall or progression free survival. In SEER 18, 9,565 cases of TC were found. Most cases were stage I and patient characteristics were nearly identical. Both cause specific survival and overall survival were significantly longer for TC when compared to G1D.

CONCLUSIONS: This review shows TC to have favorable behavior, with similar features to, but superior survival compared to low-grade ductal carcinoma of the breast. This suggests the adequacy of histopathologic review while reinforcing the designation of TC as a unique subtype.

AIM: To study epithelial mesenchymal transition (EMT) in breast cancer, molecules such as PRL-3, Snail, Cytokeratin and Vimentin involved in EMT were evaluated.

MATERIALS AND METHODS: In this study, m-RNA expression of PRL3 and Snail by RT PCR, protein expression of PRL-3, Snail, Cytokeratin and Vimentin by immunohistochemistry were evaluated on paraffin-embedded tissue sections of 100 patients with breast cancer.

RESULTS: PRL3 m-RNA expression (above cut off level > 2487301.00) and PRL-3 protein expression was noted in 52% and 70% of breast carcinoma patients, respectively. The higher incidence of PRL3 protein than m-RNA expression could be due to post translation modification. Further, Snail m-RNA expression (above cut off level > 1285142.00) and Snail protein expression was noted in 53% and 54% of breast cancer patients respectively and Snail protein expression was found significantly higher in patients with pre-menopausal status. The loss of cytokeratin expression in 32% and gain of vimentin expression in 17% was noted in these patients. Vimentin expression was found significantly higher in patients with stage IV disease, BR score 4 and PR negativity. In multivariate survival analysis, Vimentin expression found as strong indicator of biologically aggressive breast cancer predicting reduced disease free survival (DFS) and overall survival (OS).

CONCLUSION: In our study reveals that Vimentin expression emerged as significant biomarker for predicting reduced DFS and OS in breast cancer. The study proposes routine evaluation of Vimentin with other predictive parameters can allow use of EMT inhibitors with conventional therapy to revert EMT in breast cancer.

BACKGROUND: Breast tuberculosis (TB) is an uncommon condition even in endemic countries. Breast abscess is usually seen in young females. PCR helps in such challenging cases to clinch the correct diagnosis.

OBJECTIVE: The present study was performed to compare FNAC and TB PCR in inflammatory lesions of breast.

METHODS: FNAC cases reported as breast abscess, necrosis, non-specific and granulomatous inflammation on cytology was taken. The material for PCR was obtained from archived MGG smears and PCR for Mycobacterium tuberculosis for insertion sequence IS6110 was performed.

RESULTS: A total of 54 cases were studied. The age ranged from 19-55 years. On FNAC, acute suppurative inflammation without granulomas and negative AFB staining was noted in 18 cases; granulomatous inflammation/mastitis in 26 cases and granulomatous inflammation with necrosis with AFB positivity confirming tuberculosis in 10 cases. PCR for Mycobacterium tuberculosis for insertion sequence IS6110 was performed. None of the 18 cases of acute suppurative inflammation had positivity for PCR. 13/26 [53.3%] cases of granulomatous inflammation/ mastitis with AFB negativity were positive for PCR. 10/10 cases of granulomatous inflammation with necrosis with AFB positivity showed PCR positivity. Therefore, proven cases of TB after FNAC were only 10/54 [17.24%] and the sensitivity increased to 23/54 [42.6%] after performing PCR on FNA aspirate.

CONCLUSION: PCR helped in identifying 13/26 [50%] cases reported as granulomatous inflammation on cytology as tuberculosis. FNAC acted as an efficient modality for collection of material for PCR. This study shows how PCR aids in diagnosis of breast TB.

In this case series, we present the history and imaging of several male patients with breast complaints. Given the rise in men presenting with breast cancer, from 1 in 100,000 in the 1970s to 1.5 in 100,000 in 2012 [1,2], these cases presented here together provide the useful reminder that a comprehensive clinical history and focal physical examination is critical when assessing the symptomatic male (as well as female) patient with a breast complaint.

Phyllodes tumor of the male breast is an extremely rare entity with only a few reports available in the literature. Though exact etiology for development of phyllodes tumor in the male breast is unknown, hormonal imbalance with excess of estrogen action relative to androgen appears to have significant association. This report describes recurrence of phyllodes tumor with malignant features developing in the background of gynaecomastia in a male breast.

BACKGROUND: Mammary myofibroblastoma is a rare and benign neoplasm of the breast stroma, showing features of fibroblasts and myofibroblasts. It has also been noted to exhibit smooth muscle cell characteristics.

OBJECTIVE: The aim of this study was to describe the clinical and pathological features of mammary myofibroblastoma reported at our institution.

METHODS: Cases of mammary myofibroblastoma reported in our laboratory were retrieved by electronic search. H&E slides were reviewed and clinico-pathologic features were noted. Immunohistochemistery was performed by Envision method. Only CD34 and CKAE1/AE3 were performed in all 6 cases. ASMA, desmin and S-100 were performed in 5, 4 and 2 cases, respectively. Vimentin and Bcl-2 were performed in one case.

RESULTS: A total of 6 cases were identified. Five were female and one was male. The mean age of patients was 45.5 years. The mean size of tumors was 7.7 cm in the largest dimension. Histologically, four cases showed clusters of uniform bipolar spindle shaped cells separated by broad bands of hyalinized collagen. Mitotic figures ranged from none to 3 mitoses/10 HPFs. One case showed combined features of cellular and fibrous areas. Another case was epithelioid-cell type. On immunohistochemistry, CD34 stain was positive in 5/6 cases, ASMA in 3/5 cases, desmin in 2/4 cases, S-100 in none and vimentin and Bcl-2 in 1/6 cases. None of the cases stained positive for CKAE1/AE3.

CONCLUSIONS: Due to the varying degree of fibro-myofibroblastic differentiation, myofibroblastoma shows multiple morphologies and several intratumoral and intertumoral types. It is essential to distinguish each variant from the other to avoid inaccurate diagnosis of other benign or malignant breast conditions, becoming a noteworthy diagnostic dilemma for histopathologists.

INTRODUCTION: Pseudoaneurysm of the breast is a very rare complication, which may occur after breast biopsy with a large core needle. We report a case of pseudoaneurysm of the breast that occurred after biopsy of a breast mass.

CASE REPORT: The patient underwent core biopsy of a breast mass, progressing with extensive hematoma after the initial firing of the biopsy gun. Regression of the hematoma occurred but a nodular area persisted. A pseudoaneurysm was detected on ultrasonography and magnetic resonance imaging.

DISCUSSION: An extensive breast hematoma following core needle biopsy usually regresses completely within a few weeks. The persistence of a vascularized lesion on ultrasound should draw attention to the diagnosis of pseudoaneurysm. This condition may be managed by endovascular procedure or surgical resection of the lesion.

Florid papillomatosis (FP) of the nipple, or nipple adenoma, is a rare benign proliferative lesion originating from the lactiferous ducts of the nipple. It most commonly affects women in their fourth and fifth decades of life. Clinically, in most cases FP presents with serous or serosanguinous nipple discharge while in many cases an erythematoid or eroded lesion, a nodule or a swelling of the nipple may coexist thus resembling Paget's disease. We describe a case of FP with a very unusual clinical presentation. Diagnostic evaluation and management of the patient are discussed along with a review of the relevant literature. We conclude that FP should be always considered in the differential diagnosis of patients presenting with a rapidly enlarging nipple nodule even in the absence of any skin lesions or nipple discharge. Early diagnosis and prompt treatment are essential. Simple complete excision in order to eliminate the risk of recurrence is the treatment of choice for FP. Although in rare cases a coincidental ipsilateral or contralateral breast cancer has been reported, FP is considered as an entirely benign clinical entity associated with excellent prognosis.