LABORATORY/
RADIOLOGY |
CHARACTERIZATION |
| BENIGN MAMMOGRAMS |
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Benign-Appearing Mammographic Abnormalities in Women Aged 40-49
Murray H. Seltzer, MD,* and Jill R. Glassman, Ph.D.
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Breast J 2002;8:162 Abstract quote
The ongoing debate was addressed concerning the appropriateness of mammographic
screening for women aged 40-49 years, with particular emphasis on those
patients with benign-appearing mammographic abnormalities (BMA), and
whether findings differed from those of successive age decades.
A review was conducted of 2,482 patients presenting for surgical consultation
with a mammographic abnormality as a chief complaint, with particular
emphasis on the 1,632 patients with BMA and more specifically those
aged 40-49 years. Surgical interventions and risk factors for breast
cancer were evaluated. Although 16 of 393 patients with BMAs biopsied
were proven to have breast cancer, only 2.7 of all patients with BMAs
were found to have breast cancer as a result of biopsy or short-term
follow-up. Women aged 40-49 years represented 48 of patients with BMAs,
and only 1.5 of these patients had breast cancer. The finding of breast
cancer in the BMA population was progressive by decade of age, as would
be expected, and in a cut-point analysis of those biopsied, age 60 best
divided patients into high- and low-risk groups.
Women aged 40-49 years with BMAs should not be excluded from mammographic
screening, as they represented part of a continuum when successive decades
were compared. Efforts should be directed at minimizing patient and
physician anxieties as well as diagnostic interventions related to a
BMAs.
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| CALCIFICATIONS |
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Biopsy of amorphous breast calcifications: pathologic outcome and
yield at stereotactic biopsy.
Berg WA, Arnoldus CL, Teferra E, Bhargavan M.
Department of Radiology (W.A.B., C.L.A., E.T.) and Greenebaum Cancer
Center (W.A.B.), University of Maryland, 419 W Redwood St, Suite 110,
Baltimore, MD 21201
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Radiology 2001 Nov;221(2):495-503 Abstract quote
PURPOSE: To assess the pathologic outcome of amorphous breast calcifications
and the success of stereotactic biopsy for such lesions.
MATERIALS AND METHODS: From July 1995 through February 2000, biopsy
of all clustered amorphous calcifications not clearly stable for at
least 5 years or in a diffuse scattered distribution was recommended.
Logistic regression analysis was used to stratify the risk of malignancy
by patient risk factors, calcification distribution, and stability.
RESULTS: Calcifications were retrieved from 150 biopsies; 30 (20%)
proved malignant and included 27 ductal carcinomas in situ and three
low-grade invasive and intraductal carcinomas (2-5 mm). Another 30 (20%)
yielded high-risk lesions, including 21 atypical ductal hyperplasia,
eight atypical lobular hyperplasia, and one lobular carcinoma in situ.
In 150 lesions, stereotactic biopsy was performed on 113 and aborted
in 10. Calcifications were retrieved from all 113 stereotactic biopsies.
Of those with calcification retrieval, there were three histologic underestimates
(accuracy, 97%). Stereotactic biopsy spared a surgical procedure in
57 (46%) of 123 patients. Needle localization was required for 23 (15%)
of 150 patients due to poor conspicuity. Five (45%) of 11 biopsies performed
in women with ipsilateral breast cancer showed malignancy (P =.025).
When multiple lesions of amorphous calcifications were present in one
breast, sampling of one reliably predicted the outcome of others.
CONCLUSION: We found a substantial rate of ductal carcinoma in situ
and high-risk lesions associated with amorphous calcifications. Stereotactic
biopsy can be successfully performed for the majority of subtle amorphous
calcifications; however, only a minority were spared a surgical procedure.
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| HISTOPATHOLOGICAL VARIANTS |
CHARACTERIZATION |
| BIOPSY ARTIFACTS |
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The pathology of breast biopsy site marking devices.
Guarda LA, Tran TA.
From the Department of Pathology, Florida Hospital Medical Center, Orlando, FL.
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| Am J Surg Pathol. 2005 Jun;29(6):814-9. Abstract quote |
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This report presents our experience with 54 cases of patients who had excision of breast lesions after deployment of radiographic biopsy site markers at the time of stereotactic biopsy.
These were of two types: pellets of a resorbable copolymer of polylactic acid/polyglycolic acid (31 cases) and plugs of bovine collagen (23 cases), both containing embedded metallic clips for long-term radiographic marking.
On gross examination, the pellets have a characteristic appearance similar to a soft grain of rice, whereas the collagen plugs are spongiform with variable hemorrhagic changes. Microscopically, there are distinct differences in the morphologic features of these two types of biopsy site markers and the associated tissue reactions. With the pellets, there is an initial cell-poor fibrotic reaction around empty spaces followed by a multinucleate giant cell reaction and penetration of the marker core by eosinophilic fibrinous material. The collagen plugs are recognized as eosinophilic, hyalinized, acellular material, accompanied by an inflammatory infiltrate composed predominantly of lymphocytes, plasma cells, eosinophils and, occasionally, neutrophils, which penetrate the core of the marker with time.
The degradation of the collagen plug appears to be associated with infiltration of the marker by fibrovascular tissue and deposition of native collagen; of note is the absence of a significant multinucleate giant cell reaction. These novel breast biopsy site markers do not interfere with the histologic processing of the tissue or with their histopathologic interpretation.
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| HAMARTOMA |
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Reappraisal of breast hamartomas. A morphological study of 41 cases.
Charpin C, Mathoulin MP, Andrac L, Barberis J, Boulat J, Sarradour B, Bonnier P, Piana L.
Department of Pathology Hopital de la Timone, Marseille, France. |
Pathol Res Pract 1994 Apr;190(4):362-71 Abstract quote
Mammary hamartomas are breast disorders currently underestimated and not well recognized. Forty-one hamartomas diagnosed among 5,834 breast biopsies, histologically examined during the last 7 years, are reported. Hamartomas accounted for 1.2% of benign lesions and 4.8% of benign breast tumors.
Clinically, hamartomas were revealed by breast palpable lump, usually painless. Typically, but inconsistently, mammography showed sharply circumscribed density, separated from adjacent normal breast by a thin radiolucent zone. Macroscopically, hamartomas were slightly larger and softer than common adenofibromas, were well limited, whitish, pinkish and fleshy, with yellow islands of fat tissue. Histologically, hamartomas exhibited pushing borders with a pseudoencapsulation, and consisted of a combination of variable amount of stromal and epithelial components. Stromal components mainly consisted in a prominent fibrohyalin feature usually associated to small islands of adipose tissue and edematous changes. Epithelial structures showed variable features of benign breast disease.
The overall architecture was lobulated but not nodular. The histological diagnosis was mainly a diagnosis of exclusion and hamartomas diagnosis relies on clinical, radiological and pathological criteria. Hamartomas result more from breast dysgenesis than from tumorous process. |
| MENSTRUAL CYCLE CHANGES |
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Morphological Changes in Breast Tissue with Menstrual Cycle
Rathi Ramakrishnan, M.D. (Path.), Seema A. Khan, M.D. and Sunil Badve,
M.D., F.R.C.Path.
Departments of Surgery (RR, SAK) and Pathology (SB), Northwestern University
Medical School, Chicago, Illinois and Department of Pathology, Indiana
University School of Medicine (SB), Indianapolis, Indiana
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Modern Pathology 2002;15:1348-1356 Abstract quote Whether the breast
tissue undergoes morphologic changes in relation to the menstrual cycle
had been a subject of debate. Elegant studies performed in the early
1980s provided conclusive evidence of cyclical changes in the normal
breast lobules. These studies were almost entirely based on autopsy
material and have not been validated in the clinical setting.
In the present study, we examine breast tissues from surgical specimens
from 73 premenopausal women and use morphological criteria to characterize
the stage of the menstrual cycle. Patients taking oral contraceptives
or hormonal therapy were excluded from this study.
The following histological parameters were used to assess the menstrual
stage: number of cell layers in the acini and presence and degree of
vacuolation of the myoepithelial cells, stromal edema, infiltrate, mitosis,
and apoptosis. The morphological stage was then correlated with the
stage of the cycle, as determined by last menstrual period and the usual
menstrual cycle length and in some patients with serum estrogen and
progesterone levels.
The morphologic stage was concordant with dates in 54 of the 73 patients
(74%, P = .001). In 31 of these patients, serum levels of estradiol
and progesterone at the time of surgery were available for correlation.
Twenty-five (80%) of these were phase concordant by morphology and progesterone
levels (P = .01), and 25 (80%), by dates and progesterone levels (P
= .007). Women with a high morphologic score were seven times as likely
to be in luteal phase as were women with a low score (odds ratio, 7.1;
95% confidence interval).
Menstrual phase can be determined by the morphology of the normal lobules
present within the surgically excised breast specimens. This will permit
retrospective analysis of large archival databases to analyze the effect
of timing of surgery in relation to menstrual cycle phase. It will also
aid the design of epidemiological studies for breast cancer risk assessment.
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| NEEDLE BIOPSIES |
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| Practical Considerations in the Pathologic Diagnosis
of Needle Core Biopsies of Breast
Syed A. Hoda, MD, and Paul Peter Rosen, MD
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Am J Clin Pathol 2002;118:101-108 Abstract quote
The success of needle core biopsy procedures and the validity of pathologic
diagnoses made on material from the procedures are key determinants
in planning the optimal management of a wide variety of breast diseases.
The most common diagnostic problems encountered in these biopsy specimens
include lobular and ductal proliferations, sclerosing and papillary
lesions, cellular fibroepithelial tumors, and minimally invasive or
microinvasive carcinoma.
This review provides practical guidance to help narrow the differential
diagnosis of lesions on needle core biopsies and offers guidelines for
the pathologic reporting of these specimens. |
| REDUCTION MAMMOPLASTY |
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Pathologic Findings in Reduction Mammaplasty Specimens
Mona T. Ishag, MD, Dmitry Y. Baschinsky, MD, Irina V. Beliaeva, Theodore H. Niemann, MD, and William L. Marsh, Jr, MD |
Am J Clin Pathol 2003;120:377-380 Abstract quote
Reduction mammaplasty (RM) is a common surgical procedure that yields a variable amount of tissue for pathologic examination. Occult breast carcinomas are detected rarely in these specimens.
We evaluated the pathologic findings in RM specimens performed in our institution during an 11.5-year period (July 1989 to December 2000). A total of 560 patients who had undergone RM were identified, 503 bilateral and 57 unilateral. The average number of blocks submitted per breast was 3.9 (range, 1-23). Pathologic changes were present in 338 cases (60.4%). Unsuspected carcinomas (small invasive carcinomas, 3; ductal carcinoma in situ, 1) were found in 4 cases (0.7%). Atypical ductal and/or atypical lobular hyperplasia were identified in 8 cases (1.4%).
Lesions associated with a mildly increased carcinoma risk (moderate/florid ductal hyperplasia, sclerosing adenosis, and papilloma) were identified in 52 cases (9.3%). Other findings included fibrocystic changes, fibrosis, mild ductal hyperplasia, fibroadenoma, and adenosis. Pathologic examination of RM specimens provides important clinical information and should be performed routinely. |
| Histological findings in breast tissue specimens
from reduction mammoplasties.
Karabela-Bouropoulou V, Liapi-Avgeri G, Iliopoulou E, Agnantis NJ.
Department of Pathology, KAT Regional General Hospital, Kiphissia,
Greece. |
Pathol Res Pract 1994 Sep;190(8):792-8 Abstract quote
Tissue specimens from 55 consecutive reduction mammoplasty operations
were studied histologically for changes considered to be associated
to an increased risk in the development of invasive breast cancer. A
thorough sampling of all removed tissues was performed and nearly all
solid parts were processed for histological evaluation.
We found that in 47 specimens, most of which belonged to women younger
than 40 years of age (39), both breasts presented either no-proliferative
changes or mild hyperplastic lesions of the usual type and thus the
women had no increased risk for breast cancer development.
In 7 breast specimens, all of them from women older than 30 years,
the changes observed ranged from florid hyperplasia to atypical ductal
or lobular hyperplasia, which are lesions considered to be associated
to a relatively increased risk of invasive carcinoma.
Finally we present a case of infiltrative ductal carcinoma with extensive
lesions of atypical hyperplasia and combined ductal and lobular carcinoma
in situ in both breasts, which developed 3 years after reduction mammoplasty
in which changes of atypical hyperplasia were found.
We suggest that reduction mammoplasty specimens should be handled with
particular care and according to the women's age. |
SPECIAL STAINS/
IMMUNOPEROXIDASE |
CHARACTERIZATION |
| PC CELL DERIVED GROWTH FACTOR |
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Expression of PC-cell-derived growth factor in benign and malignant human breast epithelium.
Serrero G, Ioffe OB.
Department of Pharmaceutical Sciences, University of Maryland School of Pharmacy and Program in Oncology, Marlene and Stewart Greenebaum Cancer Center of the University of Maryland, Baltimore, Maryland, USA.
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| Hum Pathol. 2003 Nov;34(11):1148-54. Abstract quote |
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PC-cell-derived growth factor (PCDGF, progranulin) is a novel autocrine growth factor that is overexpressed in human breast cancer cell lines. We have examined immunohistochemical PCDGF expression in 206 paraffin-embedded human breast lesions and investigated its association with clinicopathological variables. PCDGF staining was observed in breast carcinoma, whereas it was almost always negative in benign breast epithelium.
PCDGF expression was more common in invasive ductal carcinoma (80% cases positive) than in invasive lobular carcinoma (53% positive). PCDGF staining was almost never observed in lobular carcinoma in situ. Ductal carcinoma in situ expressed PCDGF in 66% of the cases, and this expression correlated strongly with nuclear grade. Similar correlation was observed between PCDGF expression and histologic grade of invasive ductal carcinoma. Average Ki-67 index of PCDGF-negative/weakly positive invasive carcinomas (30.3) was significantly lower than that of strongly PCDGF-positive tumors (48.8, P=0.01). A larger percentage of tumors that expressed PCDGF with a staining intensity of 2+ or 3+ were p53 positive (44%) than were PCDGF-negative tumors (25%), P=0.02. PCDGF expression was independent of c-erbB-2 overexpression and of ER and PR status. Our study provides the first evidence of high incidence of PCDGF expression in human breast cancer in which it correlates with clinicopathological variables such as tumor grade, proliferation index, and p53 expression.
These characteristics, as well as the virtual absence of expression in benign breast tissue, suggest an important role of PCDGF in breast cancer pathogenesis and make it a potential novel target for the treatment of breast cancer. |
| SURFACTANT PROTEIN A |
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Surfactant Protein A Expression in Human Normal and Neoplastic Breast
Epithelium
Paola Braidotti, DSc,1 Claudia Cigala, MD,1,2 Daniela Graziani,
DSc,1 Barbara Del Curto, DSc,1 Enrico Dessy, MD,3 Guido Coggi, MD,1,2
Silvano Bosari, MD,1,2 and Giuseppe G. Pietra, MD4
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Am J Clin Pathol 2001;116:721-728 Abstract quote
We studied the presence of surfactant protein A (Sp-A) immunoreactivity
and messenger RNA in 62 normal and abnormal breast samples.
Sections were immunostained with polyclonal anti–Sp-A antibody. The
association between Sp-A immunoreactivity and histologic grade of 32
invasive ductal carcinomas was assessed by 3 pathologists who scored
the intensity of Sp-A immunoreactivity times the percentage of tumor
immunostained; individual scores were averaged, and the final scores
were correlated with tumor grade, proliferative index, and expression
of estrogen and progesterone receptors. Strong Sp-A immunoreactivity
was present at the luminal surface of ductal epithelial cells in normal
breast samples and in benign lesions; carcinomas displayed variable
immunoreactivity, inversely proportional to the degree of differentiation.
Sp-A messenger RNA was detected by reverse transcriptase–polymerase
chain reaction in 3 of 3 normal breast samples and 9 of 9 carcinomas.
The significance of Sp-A expression in breast epithelium requires further
study; possibly it has a role in native host defense or epithelial differentiation.
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