[Lobular carcinoma in situ of the breast, a dilemma].
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Adult↗
Biomedical subjects
M Mravunac
Publications and source records attributed to M Mravunac.
[Early stomach carcinoma mimicking gastric ulcer].
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Adult↗
Mammographically occult breast cancer. A pathologic and radiologic study.
Fifteen mammographically occult breast cancers, 3 of which were preinvasive and 12 invasive, and 52 breast cancers, which presented only microcalcifications mammographically without an associated tumor shadow (33 preinvasive and 19 invasive), were reviewed pathologically and radiologically. This study suggests that most of the preinvasive cancers, without mammographically significant calcifications, are, and some of the invasive cancers situated in dense breasts may be, mammographically occult. The mean diameter of the five mammographically occult invasive ductal carcinomas and the five invasive lobular carcinomas was 20 mm and 50 mm, respectively. Histologic characteristics, which may explain why invasive lobular carcinomas could be occult mammographically, even in an advanced stage, include a diffuse invasive pattern and, frequently, a poor desmoplastic reaction in contrast to the invasive ductal carcinomas. The implications of mammographically occult cancers on management of symptomatic and asymptomatic patients are discussed.
Breast Neoplasms↗
So-called interval cancers of the breast. Pathologic and radiologic analysis of sixty-four cases.
Within a population-based breast cancer screening programs, 209 cancers were detected by regular mammographic screening. Additionally, 66 cancers were discovered between two consecutive screenings after one, two, or three negative screening examinations (interval cancers). The study group consisted of 25,920 women who have been participating since 1975 in a breast cancer screening program in Nijmegen, the Netherlands. In this program, single view mammography (lateromedial projection) was administered as the sole screening examination every two years. Physical examination was not part of the screening program. All previous histologic and radiologic material from 64 of those "interval" patients was available and was reviewed. In 19 of the 64 patients, direct or indirect signs of tumor were seen on the previous screening mammogram on review (observers error). In four cases the site of the tumor lay outside the imaging field (technical error). In 41 cases, no signs of tumor could be seen on the mammograms even on review. By calculated tumor doubling times, 20 of these 41 cases were probably too small to be detected at the last screening ("real" interval cancers). However, 21 cases were probably large enough but were somehow masked from radiologic detection. The mean reasons for this "masking" proved to be: 1) dense breast, 2) poorly outlined tumor mass of diffuse infiltrative type, mainly invasive lobular carcinomas, and 3) intraductal localization. The authors suggest that women with dense breasts be screened more frequently, using more views and modalities and with broader criteria for advising surgical biopsy. They also note that in general the two-year interval between screenings is probably longer than the optimal interval.
Aged↗
Gastric leiomyoblastoma: three interesting cases.
The leiomyoblastoma of the stomach has emerged as a separate entity different from the well known benign and malignant gastric tumours of smooth muscle origin. The histologic picture is very typical but has puzzled many pathologists in the past. It is important to consider the possibility of this tumour at operation because it will influence the type of operation to be carried out. Even with seeminly hopeless spread a curative resection is often possible. Per-operative frozen section diagnosis is imperative. Enucleation alone is inadequate. Wide local excision without removal of the regional lymph nodes is often sufficient. More radical operations have no apparent effect on survival. A total gastrectomy is only indicated in cases of multiple localisations or recurrences. Primary and secondary excision of metastases should be considered. Prognosis is relatively good and is best evaluated by a combination of clinical and histologic criteria.
Aged↗
Granulomatous angiopanniculitis of the breast. A case report.
BACKGROUND: Granulomatous angiopanniculitis (GAP) is a rare benign condition of the breast of unknown etiology. Clinically and by fine needle examination, GAP may simulate breast carcinoma. The cytologic characteristics have not been described before. CASE: A 63-year-old female exhibited a palpable mass in her left breast. The fine needle aspirate contained both epithelioid and stromal elements. The epithelioid component consisted of dissociated individual cells and small groups and clusters of atypical cells. The stromal component showed a uniform, not-atypical pattern. The lumpectomy specimen showed nonnecrotizing granulomatous panniculitis and lymphoid angiitis without involvement of ducts or lobules. CONCLUSION: Granulomatous lesions should be borne in mind in the differential diagnosis of breast cancer in fine needle aspiration cytology. GAP must be histopathologically distinguished from granulomatous inflammation in the breast of autoimmune or infectious origin as specific medical therapy may be available for these latter diseases.
Breast↗
Interpreting microbiopsies in cervical smears. A cytohistologic approach.
OBJECTIVE: To assess interobserver variation in the diagnosis of thick tissue specimens (microbiopsies) in cytology smears and histologic sections taken from them, to evaluate the applicability of MIB-1 in histologic sections from microbiopsies and to evaluate whether processing microbiopsies in inconclusive smears has additional diagnostic value. STUDY DESIGN: Cytologic smears were selected in which there were diagnostic disagreements between pathologists and cytologists and microbiopsies were present. Interobserver variation among three pathologists and three cytologists in the diagnosis of these microbiopsies was investigated. The smears were processed for histologic sections, and interobserver variation between pathologist diagnoses were analyzed. An additional histologic slide stained for MIB-1 was used for consensus diagnosis. The consensus diagnosis was compared with available follow-up and its sensitivity and specificity determined. The value of applying the microbiopsy technique in slides diagnosed as inadequate or atypical squamous cells of undetermined significance (ASCUS) was analysed. RESULTS: From a series of 62,334 cervical smears, 49 with microbiopsies were selected. It was possible to derive histologic slides from 38 cases. Interobserver variability in the diagnosis of microbiopsies and histologic sections from them was moderate--kappa = .44 (SE = .06) and kappa = .44 (SE = .09), respectively. In the consensus meeting for all cases, a conclusive diagnosis was reached. The Pearson correlation coefficient between the consensus diagnosis and MIB-1 staining was r = .62. The sensitivity of the consensus diagnosis for the follow-up diagnosis was 71% and the specificity 60%. Diagnosis on approximately 50% of slides diagnosed as inadequate or ASCUS could be made. CONCLUSION: The histotechnical workup of microbiopsies is not difficult; however, their diagnosis can be a problem. Adequate diagnostic criteria are not available. Aided by MIB-1 staining, histologic sections from microbiopsies can be diagnosed, and the diagnoses correlated with follow-up in most cases. Processing of microbiopsies in smears with an inconclusive cytologic diagnosis or a diagnosis of ASCUS allowed correct diagnosis in 50% of cases in this study.
Biopsy↗
Histologic processing of thick tissue specimens from cytology slides. A novel technique.
OBJECTIVE: To describe a novel method by which small tissue fragments found in routine cytology specimens can be processed for histologic slides without destroying or damaging the cytologic specimen. STUDY DESIGN: To develop a method by which small tissue fragments (microbiopsies) are removed from cytologic slides and processed through paraffin or plastic, after which histologic slides can be prepared. RESULTS: In all cases described, the histologic sections from the microbiopsies were of excellent quality. Microscopic examination gave additional important information. Furthermore, immunochemistry could be performed on paraffin-processed microbiopsies. CONCLUSION: This method can be of great value in cytologic specimens in which microbiopsies are present, not only in those cases in which cytologic information is insufficient for diagnosis, but also in cases with conclusive diagnostic information. Routinely applied, this method could make biopsies unnecessary in some cases.
Adult↗
Ultrastructural and immunohistochemical study of epithelioid hemangioendothelioma of bone: coexpression of epithelial and endothelial markers.
Four cases of epithelioid hemangioendothelioma of bone--a borderline malignant tumor of vascular origin--were studied ultrastructurally and immunohistochemically. The epithelioid tumor cells were positive for vimentin, polyclonal and monoclonal cytokeratins, and the endothelial markers factor VIII-related antigen (FVIII:RAg) and Ulex europaeus agglutinin I. The coexpression of polyclonal cytokeratin and FVIII:RAg was demonstrated by means of step sections in the same tumor cells. The endothelial origin of epithelioid tumor cells was supported ultrastructurally by identification of Weibel-Palade bodies.
Adult↗