Fibrocystic change is the most common disorder of the breast. It is most
frequent during the reproductive years from 20-40 years peaking around menopause.
It may be present in up to 60% of women and may be asymptomatic. The most
common patterns are adenosis, cyst formation and fibrosis. Depending upon
the degree of changes, the breast may have a lumpy bumpy appearance and feel.
Calcifications may form and are identified on mammography. Occasionally the
calcification pattern may be atypical, prompting a biopsy.
The disorder may be related to hormonal imbalance with an excess of estrogens.
Oral contraceptive use may decrease the changes since it usually provides
a balance of progesterone and estrogen. If there are no proliferative changes,
there is no increased risk for developing breast carcinoma. The table below
lists some important precursor conditions for the development of breast cancer.
| PATHOGENESIS |
CHARACTERIZATION |
| RADIAL SCAR |
|
|
Radial scars of the breast and breast carcinomas have similar alterations
in expression of factors involved in vascular stroma formation
Timothy W. Jacobs, MD
Stuart J. Schnitt, MD
Xiaolian Tan, PhD
Lawrence F. Brown, MD
|
Hum Pathol 2002;33:29-38. Abstract quote
We recently reported that radial scars are an independent histologic
risk factor for breast cancer. The reason for this association is not
known. Given the importance of stromal–epithelial interactions in the
pathogenesis of breast cancer, we studied radial scars for the expression
of a number of factors known to be involved in the formation of vascular
stroma in breast cancer.
In situ hybridization was performed on formalin-fixed paraffin sections
using 35S-labeled riboprobes for collagen type 1, total fibronectin,
extra domain A (ED-A)+ fibronectin, thrombospondin 1, vascular permeability
factor (VPF)/vascular endothelial growth factor (VEGF), and one of its
endothelial receptors, kinase insert domain–containing receptor (KDR)
(vascular endothelial growth factor receptor [VEGFR-2]). Expression
levels in radial scars (9 cases) were compared with those in normal
breast tissue (15 cases) and infiltrating ductal breast carcinoma (4
cases). Factor VIII–related antigen immunostaining was used to define
the distribution of microvessels in radial scars, carcinoma, and normal
breast tissue. Compared with normal breast tissue, the radial scars
showed focally increased numbers of blood vessels and focally increased
expression of messenger RNA (mRNA) for collagen type 1, total fibronectin,
ED-A+ fibronectin, thrombospondin 1, VPF/VEGF, and KDR. This pattern
of mRNA overexpression was similar to that seen in the 4 invasive cancers.
We conclude that there are similarities between radial scars and invasive
breast cancers with regard to the level of mRNA expression for several
factors involved in the formation of vascular stroma. These results
suggest that a similar disturbance in stromal–epithelial interactions
is present in both lesions.
|
|
Molecular and genetic abnormalities in radial scar.
Iqbal M, Shoker BS, Foster CS, Jarvis C, Sibson DR, Davies MP.
Clatterbridge Cancer Research Trust, J.K. Douglas Laboratories,
Clatterbridge Hospital, Bebington, United Kingdom.
|
Hum Pathol 2002 Jul;33(7):715-22 Abstract quote
Hyperplasia of usual type (HUT) may be an early precursor of breast
carcinoma and has been shown to contain molecular and genetic abnormalities
previously seen in more advanced breast lesions, such as allelic imbalance
(AI) and coexpression of estrogen receptor-alpha (ER) and the proliferation
marker Ki67.
We have examined hyperplastic and other areas from within radial scar
(RS) for such abnormalities, to explore whether such regions of RS are
similar at the molecular and genetic level to histologically similar
lesions found independent of RS. Abnormal expression of ER and Ki67
in hyperplastic foci and other histologically distinct areas within
RS was detected by dual-label immunofluorescence. Subtle differences
in expression patterns were seen compared to similar lesions outside
RS, with a lower overall level of ER overexpression in HUT within RS
(P = 0.0012) and less evidence of the abnormal ER association with Ki67
(P = 0.004). AI of chromosome 16q and 8p was detected in RS, indicating
that at least some areas of RS are clonal and neoplastic, but no clear
relationship to ER dysregulation was found. Different genetic losses
seen in microdissected areas of the same RS indicated clonal differences
between these areas.
The role of RS as a marker of malignancy and relative risk of breast
cancer remains uncertain. Nonetheless, here we provide evidence that
some molecular and genetic changes that occur to a greater degree in
breast cancer and some premalignant breast lesions are present in a
minority of RS.
|
| HISTOPATHOLOGY |
CHARACTERIZATION |
| GENERAL |
|
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Sampling of grossly benign breast reexcisions: a multidisciplinary
approach to assessing adequacy.
Abraham SC, Fox K, Fraker D, Solin L, Reynolds C.
Department of Pathology, University of Pennsylvania Medical Center,
Philadelphia 55905, USA.
|
Am J Surg Pathol 1999 Mar;23(3):316-22 Abstract quote
The widespread use of breast-conserving therapy in the treatment of
early-stage breast cancer has resulted in increasing numbers of reexcision
specimens requiring histologic assessment for residual disease and margin
status. Because many reexcisions are performed for only microscopically
positive or close margins, reexcision specimens often appear grossly
negative and directed tissue sampling cannot be performed. The issue
of adequate sampling in these specimens has not been addressed in the
literature. A multidisciplinary approach to identifying the clinically
important lesions in breast reexcisions and a cost-effective approach
to tissue sampling are needed.
We reviewed 97 consecutive cases of grossly negative breast reexcisions
in which all tissue had been embedded.
Forty-seven specimens contained residual invasive or in situ carcinoma
and 50 were histologically negative. Detailed histologic findings were
presented to a medical oncologist, a radiation oncologist, and a surgeon,
who assessed the clinical impact of each diagnosis. Of the 47 positive
specimens, 30 resulted in a major change in patient management (recommendation
for additional surgery), 10 resulted in minor changes (alteration in
radiation dose or adjuvant chemotherapy regimen), and 7 did not alter
management. A total of 1867 blocks were submitted. If one block per
centimeter of maximal tissue dimension had been submitted and the remainder
of the specimen examined only if initial sections revealed invasive
or in situ carcinoma, then 901 blocks would have been processed (52%
reduction), but we would have missed an average of 3.7 cases resulting
in a major change in therapy, and 3.3 cases resulting in a minor change.
In contrast, two blocks per centimeter would have missed an average
of less than one case each of diagnoses resulting in major and minor
therapy changes (0.9 and 0.8 cases, respectively), and 315 (17%) fewer
tissue blocks would have been processed.
We recommend submitting two blocks per centimeter in grossly benign
reexcisions, and examining the remainder of the tissue only if carcinoma
is detected on initial sections.
|
| VARIANTS |
|
| ADENOSIS TUMOR |
|
|
Adenosis tumour of the breast--a clinicopathological
investigation of 27 cases.
Nielsen BB.
University Institute of Pathology, Kommunehospitalet,
Aarhus, Denmark.
|
Histopathology 1987 Dec;11(12):1259-75 Abstract quote
Twenty-seven cases of palpable and/or tumour-forming adenosis in the
female breast, called adenosis tumour, have been investigated. It is
a rare lesion, which most often presents as a breast mass that clinically
and histologically is sometimes misinterpreted as carcinoma.
The majority of patients were under the age of 45 years. Grossly, most
tumours were firm or elastic and showed a grey or greyish-white cut
surface. Furthermore, seven (26%) were granular and nine (34%) were
microcystic, whereas none showed chalky streaks.
Microscopically, 20 cases were poorly circumscribed and seven cases
were well circumscribed. In contradistinction to the often uniform growth
pattern of tubular carcinoma, the adenosis tumours characteristically
showed adenosis arranged in a mixture of eight different growth patterns.
The most frequent and also most extensive growth pattern was classical
sclerosing adenosis and the least frequent was tubular adenosis. Another
conspicuous feature in adenosis tumours was patchy growth in contrast
to the stellate configuration of tubular carcinoma which is the most
likely differential diagnosis. Other findings separating adenosis tumours
from carcinomas were microcysts (93%), apocrine metaplasia (63%), luminal
histiocytes (52%) and pseudopapillomas, called glomeruloid structures
(48%). Epithelial changes that could cause anxiety about malignancy
were frequently found and comprised epithelial hyperplasia (44%), epithelial
atypia (26%) and fat or nerve infiltration (30%). Three patients were
subjected to unnecessary mastectomy because of incorrectly diagnosed
adenosis tumours.
Adenosis tumours and non-infiltrating carcinoma were found together
in five cases, but their association is probably over represented due
to selection. None of 18 pure adenosis tumours solely treated by excision
had recurred at follow-up 1-9 years later (mean 3.75 years).
|
| COMPLEX SCLEROSING LESION/RADIAL SCAR |
|
-
Assessment of 142 Stellate Lesions With Imaging Features Suggestive of Radial Scar Discovered During Population-based Screening for Breast Cancer.
Farshid G, Rush G.
From *BreastScreen SA and Division of Tissue Pathology, Institute of Medical and Veterinary Science, Adelaide, South Australia; and daggerBreastScreen SA, Wayville, South Australia.
|
-
| Am J Surg Pathol. 2004 Dec;28(12):1626-1631. Abstract quote |
|
Because some lesions diagnosed as radial scars (RS) on core biopsy have been found to be malignant on excision, core biopsy has not had an established role in the assessment of RS. In our breast cancer-screening program, we have avoided core biopsy if RS is suspected on imaging. Recently, two reports have expanded the experience with core biopsy of RS, prompting this review of our assessment protocols for lesions suspected as being RS.
Between January 1996 and January 2003, stellate lesions with imaging features of RS in which core biopsy was omitted because of a presumptive radiologic diagnosis of RS are included. Demographic, radiologic, and cytologic data were correlated with the histologic findings in the excised specimen. On imaging, 9% (142) of all stellate lesions were suspected to be RS. Only 66.2% (94) were confirmed as RS on histology; 38 cases (28.6%) were carcinomas (36 invasive, 2 in situ) and 7% showed benign fibrocystic changes; 87.1% of the carcinomas required further surgery for positive margins. Axillary staging was also needed for the invasive cancers.
Among the histologically proven RS, 28 of 94 (29.8%) showed areas of atypical ductal hyperplasia, lobular neoplasia, ductal carcinoma in situ, or invasive carcinoma. These proliferations were typically focal and unpredictable and were usually completely excised by the initial diagnostic biopsy.
Core biopsy would be valuable in the assessment of lesions with imaging features suggestive of RS since 28.6% of such lesions are indeed carcinomas that mimic RS. Identification of these cancers would permit one stage breast and axillary surgery to be planned.
The policy of mammographic surveillance for lesions with nonmalignant core biopsies remains controversial because of the paucity of data. Ongoing evaluation is needed as more experience is reported.
|
|
Carcinoma and atypical hyperplasia in radial scars
and complex sclerosing lesions: importance of lesion size and patient
age.
Sloane JP, Mayers MM.
Department of Histopathology, Royal Marsden Hospital,
Sutton, Surrey, UK
|
Histopathology 1993 Sep;23(3):225-31 Abstract quote
One hundred and twenty-six radial scars and complex sclerosing lesions
from 91 women were examined to determine the incidence of and the clinical
and pathological factors associated with the development of carcinoma
and atypical hyperplasia within them.
There was a clear relationship between the presence of carcinoma and
atypical hyperplasia and the size of the lesion. This was not, however,
a progressive relationship, there being a cut-off point about 6-7 mm,
below which carcinoma was very uncommon and above which it was relatively
frequent. A similar relationship was seen with patient age. Carcinoma
was not seen in lesions removed from women under 40, was rare in the
decade 41-50 and was relatively common above this age but with no further
increase in the over 60s.
A significantly higher incidence of carcinoma and atypical hyperplasia
was encountered in scars detected by mammographic screening and could
be explained by lesion size and the ages of the patients from which
they were removed. No relationship was found between the presence of
carcinoma within radial scars and complex sclerosing lesions and the
existence of carcinoma in the residual breast tissue when direct extension
was excluded.
The carcinomas identified in the scars were of variable type and included
small and large cell ductal carcinoma in situ, lobular carcinoma in
situ and invasive carcinoma of tubular and ductal types. In situ carcinoma
and atypical hyperplasia involved a very variable percentage of the
epithelium of the lesions with mean values for ductal carcinoma in situ
of 32%, lobular carcinoma in situ 25% and atypical hyperplasia 25%.
|
|
Metaplastic carcinoma of the breast arising within
complex sclerosing lesion: a report of five cases.
Denley H, Pinder SE, Tan PH, Sim CS, Brown R, Barker
T, Gearty J, Elston CW, Ellis IO.
Department of Histopathology, Nottingham City Hospital,
Nottingham, UK.
|
Histopathology 2000 Mar;36(3):203-9 Abstract quote
AIMS: This study presents a series of five cases in which metaplastic
carcinoma, predominantly low-grade adenosquamous carcinoma, of the breast
is seen arising within a background of a complex sclerosing lesion.
This association has been recognized previously but has not been documented
in detail. This study describes the characteristics of the components
present in each case and discusses the existing literature. This observation
adds further evidence to support an association between some types of
invasive breast carcinoma and sclerosing lesions of the breast.
METHODS AND RESULTS: Four of these cases were received as referral
cases for opinion. The fifth was received as part of the routine surgical
workload within our own institution. Two patients presented following
mammographic screening and three symptomatically; their mean age was
62 years (range 49-68). The mean lesion size was 16 mm (range 7-24).
All five lesions showed features of a complex sclerosing lesion/radial
scar in the form of central sclerosis with elastosis and radiating benign
entrapped tubules. One had associated benign papillary structures and
two had focal benign squamous metaplasia. Four cases showed coexisting
but distinct areas of low-grade adenosquamous carcinoma with glandular
and squamous epithelial differentiation in a spindle cell background.
One case had associated undifferentiated spindle cell carcinoma. Detailed
immunophenotypic characteristics of two cases are presented.
CONCLUSIONS: This series illustrates a postulated but previously unconfirmed
association between an unusual form of metaplastic breast carcinoma
(adenosquamous carcinoma) and complex sclerosing lesions. The mechanisms
of induction of breast carcinoma are poorly understood but these observations
further emphasize the potential for sclerosing lesion of the breast
to be associated with, and possibly give rise to, invasive carcinoma
of different types. The precise nature of the interaction between the
pathological processes remains unclear.
|
| MICROGLANDULAR ADENOSIS |
|
|
Microglandular adenosis. A benign lesion simulating
invasive mammary carcinoma.
Rosen PP.
|
Am J Surg Pathol 1983 Mar;7(2):137-44 Abstract quote
Microglandular adenosis (MGA) is a benign mammary disease in which
small uniform acinar structures seem to grow haphazardly in the mammary
parenchyma. While most often an inconspicuous microscopic lesion, MGA
can cause a palpable tumor.
This report is based on a review of 13 patients who presented with
palpable tumors which were composed in part or entirely of MGA. The
mean age was 53 years. In two cases, the mass was painful; a third patient
described changes in the size of the tumor with menstrual cycles. Four
patients had carcinoma associated with MGA. Two women had MGA coexistent
with in situ lobular and intraductal carcinoma, respectively, when the
carcinoma was diagnosed. Two other patients developed invasive carcinoma
at intervals of 6 and 18 years subsequent to a biopsy of MGA. Both patients
had hyperplastic foci in the MGA prior to developing carcinoma.
These findings suggest that complete excision of MGA is appropriate
and that it is prudent for patients with MGA to seek regular clinical
follow-up.
|
|
Carcinoma of the breast arising in microglandular
adenosis.
James BA, Cranor ML, Rosen PP.
Department of Pathology, Memorial Sloan-Kettering
Cancer Center, New York, New York.
|
Am J Clin Pathol 1993 Nov;100(5):507-13 Abstract quote
Breast carcinoma arose in or in conjunction with microglandular adenosis
(MGA) in 14 of 60 (23%) patients with MGA listed in the authors' files.
This article describes the clinicopathologic and immunohistochemical
features and prognosis of these carcinomas. The median patient age was
47 years (range, 26-68 years). All patients had a mass. Six (43%) had
a family history of breast carcinoma. Lymph node metastases were found
in 3 of 11 axillary dissections. Ten patients treated by mastectomy
were recurrence-free, with a median follow-up of 57 months (range, 3-108
months). Two of three patients treated by excisional surgery were recurrence-free
12 and 105 months later. The third woman had bone metastases at 51 months
and was alive 98 months after treatment. Carcinoma arose in the MGA
in 13 patients.
In these patients, in situ carcinoma was found in expanded MGA glands
composed of cells with vesicular poorly differentiated nuclei. One patient
with benign MGA had carcinoma develop in the opposite breast that was
not associated with MGA. When it arose in MGA, basement membranes were
present in benign MGA and in situ carcinoma but tended to be disrupted
in invasive foci that appeared to be formed by coalescent MGA glands.
Strong immunoreactivity for cytokeratin, S-100, and cathepsin D was
detected in carcinomas. Two carcinomas had nuclear progesterone receptors,
and one of these had estrogen receptors. One carcinoma had positive
findings for HER-2neu, and four had immunoreactivity for p53 protein.
The following conclusions were drawn from these observations: (1) carcinomas
arising in MGA have a distinctive histopathologic pattern; (2) the carcinomas
are composed of epithelial cells (cytokeratin positive, actin negative)
that are strongly immunoreactive for S-100 protein and cathepsin D;
and (3) with a median follow-up of nearly 5 years, patients with these
carcinomas had a relatively favorable prognosis, despite histopathologic
and immunohistochemical features usually associated with a poor prognosis.
|
|
Carcinoma Arising in Microglandular Adenosis: An Immunohistochemical
Analysis of 20 Intraepithelial and Invasive Neoplasms.
Koenig C, Dadmanesh F, Bratthauer GL, Tavassoli FA.
Department of Gynecologic and Breast Pathology, The
Armed Forces Institute of Pathology, Washington, DC.
|
Int J Surg Pathol 2000 Oct;8(4):303-315 Abstract quote
Microglandular adenosis (MGA) of the breast is an uncommon, benign
lesion that may mimic invasive carcinoma and has recently been recognized
as having significant premalignant potential. When carcinomas arise
in MGA, there is often a transition from ordinary MGA to atypical MGA
(AMGA) to carcinoma.
Nineteen cases of carcinoma arising in MGA are reported: 7 invasive
carcinomas, 7 intraductal carcinomas (DCIS), and 5 with both invasive
and intraductal carcinoma. A single case of AMGA without carcinoma is
also reported.
The 20 patients ranged in age from 36 to 81 years (mean 52). The most
common clinical presentation was either a palpable mass (13 patients)
or a mammographic abnormality (4 patients). All 20 cases contained AMGA,
and in some cases AMGA was the predominant lesion. In 18 of the 19 cases
with carcinoma, there was a clear transition from AMGA to the carcinoma.
Twelve cases contained ordinary MGA, but in only 2 cases was MGA a prominent
component of the lesion.
In contrast to ordinary MGA, the glands of AMGA were more irregularly
shaped, closely packed, and cytologically atypical and tended to lack
secretions. A solid, occlusive proliferation of cells in the tubules
was seen in 10 cases. All 12 examples of in situ carcinoma were either
grade 2 or 3 and typically showed a solid proliferation of severely
atypical cells within the glands; a cribrifrom pattern was also present
in 1 case. The invasive carcinomas were morphologically diverse and
included 2 with a basaloid morphology and 2 metaplastic carcinomas.
Various immunostains were performed, and each lesion (AMGA, in situ,
and invasive carcinoma) was separately assessed for immunoreactivity.
As expected, S-100 was positive in the vast majority of AMGA and in
situ carcinomas and in all 12 invasive carcinomas. S-100beta was also
positive in the majority of cases although the staining was weaker.
Laminin and type IV collagen highlighted the basement membrane around
the AMGA and in situ carcinoma and are useful stains in difficult cases.
Except for a single case, ER and PR were negative in all lesions. Cytokeratin
7 (CK 7) was positive, while cytokeratin 20 (CK 20) was negative in
all cases. Immunostains for CK903 showed no reactivity in any of the
invasive carcinomas, in situ carcinomas, or atypical MGA but was focally
present in the associated MGA in 2 of the 8 cases studied. Immunostains
for MIB-1 and p53 were semiquantitatively assessed and both were positive
in AMGA but tended to show a more intense staining in the carcinomas.
Five cases were also studied for immunoexpression of alpha-1 antitrypsin
(AAT), alpha-1 antichymotrypsin (ACTP), lysozyme, and salivary gland
amylase.
All 5 invasive carcinomas were positive for ACTP, though the staining
was very focal in about 10% of the cells in a basaloid carcinoma. The
in situ carcinoma as well as the AMGA in 4 of the 5 cases were positive
for ACTP. Three of the 5 invasive carcinomas were positive for AAT in
10% to 40% of the cells. The most intense positivity for AAT and ACTP
was in cells with coarsely granular apocrine appearance evident in 2
of the 5 cases. Four of the 5 invasive carcinomas were positive for
lysozyme in 10% to 50% of the cancer cells; the in situ carcinoma and
the associated AMGA showed similar immunoreaction in each case. None
of the 5 cases showed convincing positivity for salivary gland amylase.
The MGA in all 5 cases was negative for AAT and ACTP; the MGA in 1 of
the 5 cases was positive for lysozyme.
This study confirms the potential of MGA to develop into an invasive
carcinoma, more clearly defines the features of AMGA, highlights the
importance of AMGA in the evolution of carcinoma from MGA, and expands
our knowledge of the immunophenotype of AMGA and the carcinomas arising
from it. The diagnostic criteria briefly noted previously for diagnosis
of AMGA and carcinoma arising in MGA are expanded and formally proposed.
|
| TUBULAR ADENOSIS |
|
|
Tubular adenosis of the breast. A distinctive benign lesion mimicking
invasive carcinoma.
Lee KC, Chan JK, Gwi E.
Department of Pathology, Queen Elizabeth Hospital, Kowloon, Hong
Kong.
|
Am J Surg Pathol 1996 Jan;20(1):46-54 Abstract quote
Tubular adenosis, a term first coined by Oberman, is an uncommon benign
lesion of the breast that may mimic invasive carcinoma. There is no
formal description of this condition in the literature.
We report the findings on six specimens from five patients (one with
bilateral disease), including three that showed cancerization by intraductal
carcinoma (DCIS). The ages of the patients ranged from 40 to 82 years.
One patient presented with a 3-cm breast mass, and the others were found
in specimens resected for infiltrating ductal carcinoma (two specimens)
or DCIS (three specimens).
The histologic hallmark of tubular adenosis was haphazard proliferation
of elongated tubules that were noncrowded, narrow, and sometimes branching.
There was no lobular arrangement or, at most, vague lobular grouping,
with some tubules often extending into the fat. The tubules contained
basophilic or granular eosinophilic secretion. The stroma was sclerotic
to edematous. The tubules were lined by bland-looking ductal cells and
were surrounded by an intact myoepithelial layer, a phenomenon well
highlighted by immunostaining for muscle-specific actin (HHF-35) or
S-100 protein.
In three specimens, the tubular adenosis was cancerized by noncomedo
DCIS, producing a pattern strongly mimicking infiltrating carcinoma;
the in situ nature of the carcinoma was confirmed by actin immunoreactivity
in the residual myoepithelium as well as by the presence of architecturally
similar tubular adenosis in the vicinity. Tubular adenosis shows an
infiltrative growth similar to microglandular adenosis and adenomyoepithelial
adenosis, but it differs from them by the interdigitating tubular configuration
and also differs from microglandular adenosis by the presence of myoepithelium.
Tubular adenosis can be distinguished from sclerosing adenosis by the
lack of obvious lobular architecture or whorled arrangement and wider
separation of the tubules.
Tubular adenosis appears to be a benign lesion per se, but whether
it has premalignant potential remains to be determined. The importance
of recognizing this entity lies in its being potentially mistaken for
invasive carcinoma, especially at intraoperative frozen section or when
the lesion is cancerized by DCIS.
|
SPECIAL STAINS/
IMMUNOHISTOCHEMISTRY |
CHARACTERIZATION |
| GENERAL |
|
|
Microglandular adenosis, apocrine adenosis, and tubular carcinoma
of the breast. An immunohistochemical comparison.
Eusebi V, Foschini MP, Betts CM, Gherardi G, Millis RR, Bussolati
G, Azzopardi JG.
Department of Anatomic Pathology, University of Bologna, Italy.
|
Am J Surg Pathol 1993 Feb;17(2):99-109 Abstract quote
Four cases of microglandular adenosis (MA), together with four cases
of apocrine adenosis (AA) and 10 cases of tubular carcinoma (TC) of
the breast were studied at the light and immunohistochemical level.
One case of MA was studied with electron microscopy. MA is characterized
by an absence of myoepithelial cells (ME), epithelial membrane antigen
(EMA), and gross cystic disease fluid protein (GCDFP-15). The absence
of EMA in MA makes it unique among benign glandular hyperplasias of
the breast. AA contains myoepithelial cells and a distinct basal lamina.
It is characterized by the presence of GCDFP-15, the specific apocrine
marker, which is not present in MA. TC lacks both myoepithelial cells
and a basal lamina. It is negative for GCDFP-15. Periductal and vascular
elastosis are common and usually prominent, whereas they are not found
in either MA and AA. Other stromal changes further distinguish the three
lesions.
These three distinct entities can be separated objectively and unequivocally
and it is essential that this be done so as to prevent confusion.
|
| MICROGLANDULAR ADENOSIS |
|
|
Microglandular adenosis of the breast. An immunohistochemical comparison
with tubular carcinoma.
Diaz NM, McDivitt RW, Wick MR.
Lauren V. Ackerman Laboratory of Surgical Pathology, Department
of Pathology, Barnes Hospital.
|
Arch Pathol Lab Med 1991 Jun;115(6):578-82 Abstract quote
Microglandular adenosis (MA) of the breast is a benign, disorganized
proliferation of glands lined by a single layer of cells. As such, differential
diagnosis between MA and tubular carcinoma may be challenging in selected
cases.
A panel of antibodies was applied to 10 cases of MA and 10 of tubular
carcinoma to investigate the potential benefit of immunohistochemistry
in the separation of these lesions and the possible role of myoepithelial
cells in MA. The luminal cells in nine cases of MA were surrounded by
a cuff of muscle-specific actin-reactive cells, which also coexpressed
cytokeratin and vimentin. The immunophenotype of these cells is characteristic
of myoepithelial differentiation, which was heretofore thought to be
lacking in MA.
This finding demonstrates that myoepithelial cells are indeed present
in MA subjacent to luminal epithelial cells; moreover, it distinghuishes
MA from tubular carcinoma, all examples of which were actin negative
in this analysis. In addition, circumferential type IV collagen deposition
was observed around constituent glands of MA in nine cases but was lacking
in all tubular carcinomas. Other markers included in this evaluation
(S100 protein, gross cystic disease fluid protein 15, carcinoembryonic
antigen, estrogen receptor protein) were of no differential diagnostic
value.
|
| ELECTRON MICROSCOPY |
|
| MICROGLANDULAR ADENOSIS |
|
|
Microglandular adenosis of the breast. A clinicopathologic study
of 11 cases with ultrastructural observations.
Tavassoli FA, Norris HJ.
|
Am J Surg Pathol 1983 Dec;7(8):731-7 Abstract quote
The clinical and pathologic features of 11 examples of microglandular
adenosis of the breast are presented.
Microglandular adenosis is a rare, benign lesion that is easily confused
with carcinoma. It is characterized by a concentrated proliferation
of round glands with open lumens in a densely homogeneous stroma that
clearly delineates microglandular adenosis from the adjacent uninvolved
breast. The glands are lined by a single layer of cells with distinctly
vacuolated or granular cytoplasm.
Ultrastructurally, the single layer of epithelial cells lacks cytoplasmic
protrusions and is surrounded by a thick multilayered basement membrane.
Light- and electron-microscopic features that help distinguish microglandular
adenosis from well-differentiated (tubular) carcinoma and sclerosing
adenosis, entities with which it is easily confused, are discussed.
|
