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[Histological diagnosis and therapy of rare breast neoplasms].

Occasional rare benign and malignant breast tumours present diagnostical difficulties, how a report on 8 rare forms of tumours among 564 breast rumors (351 benign, 213 malignant) of the years 1965--1972 at the Universitäts-Frauenklinik Greifswald shows. We found among 351 benign breast tumours 2 rare forms: 1 tubular adenoma and 1 nodular lymphoreticulosis. We diagnosed among 213 malignant breast tumours 6 rare tumour-types: one at a case an unilateral respectively a bilateral noninvasive lobular carcinoma from the carcinoma-in-situ-type, 1 spindlecell- and 2 reticulosarcoma, which in one case the starting-point of the heterogeneous differentiated reticulosarcoma was obvious situated in a teratoid tumour. Last case dealt with a real cystosarcoma phylloides, of which oncological and terminological problems were additional discussed.

Adenoma↗

Echographic characteristics and ultrasonic tissue characterization in breast tumor.

Early detection and correct diagnosis of breast cancer is necessary and an important determinant of prognosis. Clinical echography is increasingly being used as it offers a high degree of diagnostic accuracy and no physical hazards such as x-ray mammography. Ultrasonic tissue characterization study is an important factor in determining and refining diagnostic criteria and for developing new ultrasonic diagnostic equipment in clinical breast echography. Therefore, various echographic characteristics and their ultrasonic tissue characterization were analysed in various types of breast tumors such as medullary carcinoma, papillary carcinoma, scirrhous carcinoma, malignant lymphoma, lymphatic infiltration, benign cyst, fibroadenoma, cystosarcoma phylloides, gynecomastia and nodular fibrosis with fat necrosis, in routine clinical echograms.

Adenofibroma↗

[Giant cystosarcoma phylloides: mammographic and sonographic findings in an unusual case].

Cystosarcoma phylloides (also called phylloides tumour) is a rare fibroepithelial mixed tumour which accounts for 0.3 to 1% of all breast neoplasms. Diagnosis can be strongly suspected after clinical, mammographical and especially sonographical findings. Neither mammography nor sonography and even not aspiration cytology can be reliably used to differentiate between benign and malignant tumours. In the following a patient is presented in whom cystosarcoma phylloides attained, even for this kind of tumour, an unusually large dimension.

Breast Neoplasms↗

Multinucleated stromal giant cells in mammary fibroepithelial neoplasms. A study of 11 patients.

Multinucleated stromal giant cells (MSGCs) found in otherwise-banal breast tissue have only rarely been mentioned in specific lesions. We describe unilateral fibroepithelial tumors with MSGCs in 11 women who were 23 to 60 years old (mean age, 42 years). The tumors ranged from 1.7 to 9.0 cm in greatest dimension (mean, 3.7 cm) and were classified on the basis of stromal cellularity, infiltration at the margin, cellular pleomorphism, and mitoses independently of MSGCs. Using these criteria, there were four fibroadenomas, one benign cystosarcoma, and four low-grade and two high-grade malignant cystosarcomas. The MSGCs had hyperchromatic or vesicular nuclei, many with clear nuclear inclusions. The nuclei were often arranged in a semicircular or florette pattern. The MSGCs, although widely distributed, tended to cluster. They accounted for most of the stromal cellularity in the fibroadenomas, numbering focally up to 10 per high-power field. The benign and low-grade malignant cystosarcomas had fewer MSGCs. The MSGCs contributed least to the cellularity in the high-grade cystosarcomas. Five patients had no further therapy. Five patients underwent wide excision and one patient had a mastectomy. Follow-up extended to 8 years (median follow-up, 4 years). There were no recurrences, and all patients were alive with no evidence of disease. The results of this study lead us to conclude that the diagnosis and grading of fibroepithelial tumors of the breast depend on the cellularity and pleomorphism of the stroma, exclusive of MSGCs. Cystosarcomas that have MSGCs do not have an especially malignant clinical course.

Adult↗

Metastatic tumor of the hand from malignant cystosarcoma phylloides of the breast. A case report.

In this case report, a malignant cystosarcoma phylloides of the breast metastasized to the pulp of the little finger in a 47-year-old woman. It initially masqueraded as a whitlow. The diagnosis was helped by radionuclide bone scanning, which showed multiple areas of increased focal uptake including the terminal phalanx of the fifth finger, and the diagnosis was established by a frozen section biopsy of the tumor. The patient underwent a palliative fifth ray resection. She died within six weeks of surgery from extensive pulmonary and osseous metastases. Review of literature revealed only one other case of malignant cystosarcoma phylloides of the breast that metastasized to the hand and was initially misdiagnosed as a whitlow.

Breast Neoplasms↗

Immunohistochemical detection of a cross-reacting virus antigen in mouse mammary tumors and human breast carcinomas.

An indirect immunoperoxidase method was first used to localize mouse mammary tumor virus (MMTV) antigens in paraffin sections of mammary tumors of Paris RIII and CD8F1 mice. By using the same method, an antigen with cross-reactivity to a group-specific antigen (gp52, a 52,000 dalton glycoprotein) of MMTV was detected in paraffin sections of human breast carcinomas. The specificity of this reaction with antibody against MMTV was examined by absorption of the IgG with: a) purified gp52; b) several relevant and irrelevant viral preparations; c) normal human plasma, leukocytes, breast tissue, milk, actin, collagen, and hyaluronic acid; d) sheep erythrocytes, bovine mucin and fetal calf serum. Only MMTV and prufied gp52 eliminated the immunohistochemical reaction in human breast tumors. Positive reactions were seen in 73 of 191 (38%) breast carcinomas of various histopathologic types, while negative reactions were obtained in all 137 normal and benign cases tested. A positive reaction of uncertain specificity was observed in foci of apocrine metaplasia. With one exception, 99 carcinomas from 13 organs other than breast and eight cystosarcomas were negative.

Adenocarcinoma↗

Cystosarcoma phylloides of the breast: a new therapeutic proposal.

An analysis of forty cases of cystosarcoma phylloides of the breast was undertaken to clarify the relationship between histology, surgical treatment and prognosis of this fibroepithelial tumor. Thirty-eight female patients 12 to 85 years of age, treated for this diagnosis over a 17-year period, were studied retrospectively. Histologically malignant lesions were diagnosed in 17 cases: six were treated by local excision, one by subcutaneous mastectomy with prosthetic implant, four by simple mastectomy, three by modified, two by radical mastectomy, and one by biopsy only. Of the 23 histologically benign tumors, 18 were treated by local excision, three had simple mastectomy, and one had subcutaneous mastectomy with prosthetic implant. Three recurrences, observed (7.5%) among patients with benign tumors, were locally excised. Wide local reexcision has controlled the disease to date after average follow-up of 32 months. In the malignant group, metastases developed in four patients (10%). Three of these patients are dead of disease and one is being treated by chemotherapy. Malignant histology seemed to correlate directly to the presence of pain (46.6%), size of the tumor (average 7 cm in diameter), and older age (average 52 years), but there was no correlation with prognosis. Recent reports on the subject advocate wide local excision for small benign lesions and simple mastectomy for larger or malignant ones. Our data indicates that the histologic appearance does not correlate with the clinical behavior of this neoplasm, and the choice of the procedure does not alter the long-term result, provided that the tumor is completely excised. More radical procedures than wide local excision are not justified for cystosarcoma phylloides which behaves more like a soft tissue sarcoma than a breast gland tumor.

Adolescent↗

[The expression of proliferating cell nuclear antigen in breast phylloides cystosarcoma and its significance].

OBJECTIVE: To investigate the expression of proliferating cell nuclear antigen (PCNA) in breast phylloides cystosarcoma and its clinicopathological signification. METHODS: Immunohistochemistry (SP method) with monoclonal antibodies PC10 against PCNA was performed in 100 cases of phylloides cystosarcoma and 39 cases of adenofibroma. RESULTS: The positive rate of PCNA in phylloides cystosarcoma was 86%. The average PCNA index (PI) of phylloides cystosarcoma was significantly different among every histologic grading (F = 85.33, P < 0.01). The degree of differentiation was lower, the PI was higher. The PI was closely correlated with histologic grading (r's = 0.77). The PI in grade I phylloides cystosarcoma was higher than that in the group of adenofibroma with abundant mesenchymal cells (t = 3.42, P < 0.01). There was only a low correlation between PI and mitotic figures in phylloides cystosarcoma (r = 0.39). CONCLUSIONS: These findings suggest that the detection of PCNA has considerable practical value in reflecting the proliferation of activity of phylloides cystosarcoma, assisting the pathologists to make histologic grading; distinguishing the malignancy from benign ones (differential diagnosis) and evaluating the prognosis.

Adenofibroma↗

Adenomyoepithelioma of the breast: report of a case initially examined by fine-needle aspiration.

This report describes the morphologic features of an adenomyoepithelioma of the breast that was first examined by fine-needle aspiration. On retrospective review of the cytology, the stromal elements of this adenomyoepithelioma showed extensive metachromasia on Diff-Quik stain, had elongated nuclei, and on Papanicolaou stain showed elongated, pale, wispy cytoplasm. Clusters of stromal cells were usually intimately associated with epithelial elements. While the main differential consideration, cystosarcoma phylloides, can show similar features, it may be possible to distinguish the two lesions in some instances.

Aged↗

Ultrasound, x-ray mammography, and histopathology of cystosarcoma phylloides.

Ultrasound and x-ray mammograms were obtained in 8 patients with palpable breast masses, which were subsequently proven to be cystosarcoma phylloides. Histopathologic examination of the 8 tumors showed benign cystosarcoma phylloides in 5, recurrent benign tumor in 1, coexistent invasive papillary carcinoma in 1, and coexistent in situ duct cancer and in situ lobular cancer in 1. A retrospective review of the B-scan images was undertaken to list the descriptive ultrasound features of cystosarcoma phylloides. The ultrasound findings included low-level internal echoes, smooth walls, and good through transmission. The carcinomas were indistinguishable from the benign lesions, although ultrasound was able to distinguish the cystosarcoma phylloides lesions as predominantly solid lobulated masses.

Adolescent↗