IgM plasma cell myeloma with amyloidosis presenting as mammary microcalcifications.

We report the case of an otherwise healthy 67-year-old woman who presented with bilateral breast masses and calcifications. Bilateral mammary biopsies showed infiltration by monoclonal neoplastic plasma cells and diffuse osseous metaplasia. Congo red stains and immunohistochemistry showed amyloid deposits. This case illustrates why multiple myeloma should be kept in mind in the diagnosis of mammary calcifications.

Expression of cathepsin D and galectin 3 in tubular carcinomas of the breast.

Tubular carcinoma (TC) is a distinctive type of grade I (G1) ductal carcinoma with particularly favourable outcome and low rate of axillary metastases. To the best of our knowledge, few data are available in the literature concerning the expression of molecules mediating intercellular and cell-matrix interactions in TC. We examined with immunohistochemical methods the expression of galectin 3 and cathepsin D in 17 TC and in 33, 31 and 28 ductal carcinomas of G1, grade II (G2) and grade III (G3), respectively. Results were compared using Chi-square test. Galectin 3 expression was higher in TC than in G1 carcinomas (p<0.05). The pattern of immunostaining was also different with a focal cytoplasmic apical reinforcement in TC. However, cathepsin D stromal and epithelial expression was similar in TC and G1 cases (p>0.05), and lower than in G2 and G3 patients at a stromal level. The higher expression of galectin 3 in TC and its focal staining (apical) pattern suggests that within the group of G1 carcinomas, galectin 3 expression varies according to histological type, and may correlate with prognosis and metastatic potential. We also suggest that cathepsin D could not be involved in neoplastic progression and metastasis in low-grade (G1) ductal breast carcinomas.

[Malignant phyllodes tumor of the breast with osteoclast-like giant cells: a case report]. / Tumeur phyllode maligne du sein avec cellules géantes de type ostéoclastique: à propos d'un cas.

Breast tumors, particularly of stromal origin, containing multinucleated osteoclast-like giant cells (OLGC) are rarely reported in the literature. We report here the first case of a malignant phyllodes tumor associated with OLGC occurring in a 43 year-old African woman who presented with a painful palpable mass of the outer upper quadrant of the right breast. After surgical excision, histological examination showed a malignant phyllodes tumor in which the stromal component displayed evident sarcomatous changes and was densely populated with benign multinucleated OLGC. These cells expressed the CD68 histiocytic marker. No evidence of osseous or cartilaginous differentiation was seen throughout the lesion. This lesion ressembles giant cell tumor of bone. However, the nature of the OLGC is not well precised yet.

Proliferating activity in columnar cell lesions of the breast.

With the introduction of mammographic screening, columnar cell lesions (CCLs) are observed more and more frequently because they are often associated with microcalcifications. Until now, the proliferative activity of these lesions has not been previously evaluated. Ki67 index was performed by immunohistochemistry in CCLs without atypia [columnar cell change (CCC) n = 20 and columnar cell hyperplasia without atypia (CCH without atypia) n = 20], flat epithelial atypia (FEA DIN1A n = 20), low-grade intraductal carcinoma (DIN1C n = 20), high-grade intraductal carcinoma (DIN 2-3 n = 20). Adjacent terminal duct-lobular unit (TDLU) of normal breast tissue served as control. Ki-67 index is extremely low and close in CCLs without atypia (CCC mean 0.1% and CCH mean 0.76%) and paradoxically is lower than in normal TDLU (mean 2.4%) (p < 0.001). In the FEA, in comparison with normal TDLU and CCLs without atypia, the Ki67 is higher (mean 8.2%) (p < 0.001) but extremely close to those of DIN1C (mean 8.9%) (p = 0.6 NS). Lastly, the Ki67 index is higher in DIN 2-3 (mean 25.4%) than in CCLs without atypia and FEA (p < 0.001). CCLs are disparate lesions having in common cells with columnar configuration but different proliferative characteristics. These data represent findings of biological interest which could help us to better understand these controversial lesions.

Microvessel and lymphatic density in tubular carcinoma of the breast: comparative study with invasive low-grade ductal carcinoma.

Tubular carcinoma (TC) of the breast is an uncommon variant of ductal carcinoma, which has an extremely low metastatic potential and an excellent prognosis. Studies concerning the vascular and lymph vessel status in TC are not numerous and hampered by a lack of specific markers. We immunohistochemically analysed the expression of CD31 and D2-40 antibodies in 15 TC measuring less than 2cm in diameter. We compared the results with those observed in 30 low-grade ductal breast carcinomas (LGDC) of no specific type with similar dimensions. Neither microvascular density (MVD) nor lymphatic vessel density (LVD) was statistically different in the groups: MVD was 26.5+/-28.2 and 32.1+/-17.9 vessels/mm(2) in TC and LGDC, respectively (P=0.08). LVD, low in both tumour types, was 0.5+/-0.3 and 0.6+/-0.4 vessels/mm(2), respectively (P>0.1). These data suggest that the favourable prognosis and the low rate of lymph node metastases in TC are not explained by lymphangiogenetic and angiogenetic potential and are supported by recent analyses in the literature.

Tubular carcinoma of the breast and associated intra-epithelial lesions: a comparative study with invasive low-grade ductal carcinomas.

Ductal intra-epithelial lesions of the breast are associated with invasive neoplasms and comprise a large spectrum of histological patterns. We have examined 23 cases of pure tubular carcinomas (TCs) of the breast and 53 cases of invasive ductal low-grade carcinomas to determine the relationship and distribution of intra-epithelial lesions, mainly of ductal in situ carcinoma type, but including also lobular intra-epithelial neoplasia (LIN) in both entities. Eleven cases of TC showed flat epithelial atypia (FEA) (47.8%), and, in 14 and 6 cases, micropapillary and cribriform low-grade ductal carcinoma in situ (DCIS) were present (60.7 and 26.1%, respectively). On the opposite, in ductal grade I invasive carcinomas, the most frequent architectural pattern was low-grade DCIS growing in arcades in 26 cases (49%). While absent in TCs, low-grade DCIS of solid type was found in five (9.4%) cases of ductal invasive carcinomas, where FEA were present in seven (13.2%) cases. LIN lesions were present in four (17.4%) cases of TC, whereas they represented 7.5%, as reported by Carstens et al. (Am J Clin Pathol 58:231-238, 1972), of cases of low-grade carcinomas. These results suggest that invasive pure TC and low-grade ductal carcinomas of the breast are different lesions, and support the fact that TC, of low histopathological grade, is a particular distinct tumoural entity.

Is complete axillary lymph node dissection neccessary in T1 stage invasive pure tubular carcinomas of the breast?

The purpose of this study was to evaluate the frequency of axillary lymph node metastasis in invasive pure (not mixed) tubular carcinomas of the breast and to compare our results to other series published in the literature. We analyzed 16 cases of pure tubular carcinoma measuring 2 cm or less in diameter from our database from 1988 to 2004 diagnosed in lumpectomy and mastectomy specimens with associated axillary lymph node dissection. Histopathologic features were reviewed in all patients. In all cases, no axillary lymph node metastasis was observed (0%). These data slightly differ from the results of some studies recently published in the literature, in which the overall nodal involvement in pure tubular carcinomas ranges from 0% to 20%. We conclude that in invasive pure tubular carcinomas of the breast measuring less than 2 cm in diameter, complete axillary lymph node dissection should be avoided, and we propose a sentinel lymph node analysis instead.

[Placental lesions in human Trypanosoma cruzi infection]. / Las lesiones placentarias en la infección humana por Trypanosoma cruzi.

This histopathological study analyzes placentas of babies congenitally infected with T. cruzi (M+B+), or babies not infected but born from infected- (M+B-), or non infected-mothers (M-B-). Placentas M+B+ showed lesions of chorionitis, chorioamnionitis and cord edema with lymphocyte infiltration, whereas such lesions were infiltrated only with polymorphonuclear cells in M+B- and M-B- placentas. Parasites were found in M+B+ placentas, in fibroblasts and macrophages of chorion, membranes, chorionic plate, mainly in the area of membrane insertion, as well as in cells of Wharton jelly and myocytes of umbilical cord vessels. These results suggest that the materno-fetal transmission of parasites occurs mainly through the marginal sinus, spreading into the chorionic plate infecting fibroblasts and macrophages so far as to found a fetal vessel, inducing a fetal infection by hematogenous route.

[P63 protein in the diagnosis of breast tubular carcinoma]. / Apport de la protéine p63 dans le diagnostic du carcinome tubuleux mammaire.

AIMS: To study and compare the expression of p63 protein and smooth muscle actin in breast tubular carcinoma (TC) and its main differential diagnoses, radial scar (RS)/complex sclerosing lesion (CSL). MATERIALS AND METHODS: Immunohistochemistry techniques were used to search for p63 protein and smooth muscle actin antibodies in 10 patients with TC and fifteen with RS/CSL. RESULTS: Myoepythelial cells were diffusely positive for both actin and p63 protein with a cytoplasmic (actin) or nuclear (p63) pattern in all patients with RS/CSL. Inversely, all TC were negative for p63. Actin antibodies failed to label myoepithelial cells in TC, but both vessels and stromal myoblasts were actin-positive, creating difficult interpretation situations. By contrast, p63 was consistently negative in these structures. CONCLUSION: For the differential diagnosis between TG and CR/LSC, smooth muscle actin and p63 protein demonstrate equivalent sensitivity for the detection of myoepithelial cells. However, the nuclear pattern of p63 labeling gives a "cleaner" stain. In addition, p63 enables distinction between myoepithelial cells and myofibroblasts/vascular smooth muscle cells, offering increased specificity.

Respiratory epithelial adenomatoid hamartoma associated with nasal polyposis.

Hamartoma is a rare, non-neoplastic tumor characterized by an abnormal mixture of tissues, which are indigenous to the region. They are rare in the nasal cavity. We report a 79-year-old woman with an adenomatoid hamartoma in the left nasal cavity associated with nasal polyposis. This association supports the hypothesis that inflammation is one of the factors that induce the development of a hamartoma. Functional endoscopic sinus surgery was performed to completely remove it, and this lesion was found to have arisen from the lateral nasal wall. It is an unusual localization because the most common site in the nasal cavity is the nasal septum, particularly the posterior aspect. Limited but complete surgical resection is the treatment of choice. Although adenomatoid hamartoma arising from the sinonasal tract is very rare, head and neck surgeons should be aware of this pathological entity as a differential diagnosis for inverted papilloma and adenocarcinoma. Misinterpretation of these lesions as a true neoplasm may result in unnecessarily aggressive surgery for this benign lesion.

Benign phyllodes tumor associated with Maffucci's syndrome.

Reports of breast tumors together with Maffucci's syndrome are extremely rare in the literature. Maffucci's syndrome is an uncommon congenital disease characterized by the association of multiple enchondromas and different types of hemangiomas. To the best of our knowledge, this is the first well-documented case of a benign phyllodes tumor of the breast occurring in a patient with Maffucci's syndrome. The patient was an 18-year-old woman who had been diagnosed with Maffucci's syndrome at the age of 8 months when multiple enchondromas with subcutaneous hemangiomas of the toes were diagnosed. The tumor presented as a rapidly growing, painful mass of the right breast, which was removed by a wide resection with no apparent recurrence 10 months later. Our data, in addition to those on two other cases of fibroadenomas with this disease that have already been described in the literature, suggest that Maffucci's syndrome is probably a generalized mesodermal disorder that can also affect the connective tissue component of the breast.

Spindle cell vulvar hemangiomatosis associated with enchondromatosis: a rare variant of Maffucci's syndrome.

Spindle cell hemangioma is a rare vascular tumor that most frequently involves the distal extremities, especially the hand. We report a case of spindle cell hemangiomatosis of the vulva in an 18-year-old woman with Maffucci's syndrome, the first report of such a case, to the best of our knowledge. The vascular lesions, present from the age of 2, were located in the right olecranon, the third left toe, and the vulva. Spindle cell hemangiomas are either benign neoplasms or hamartomatous malformations.

Neuroma of the clitoris after female genital cutting.

BACKGROUND: Nerve tumors of the clitoris and particularly neuromas are extremely rare. CASE: A 27-year-old infibulated African woman suffering from chronic vulvar pain increasing with sexual intercourse presented for gynecologic care. Examination revealed a painful clitoral tumor. The tumor was surgically excised. The diagnosis of amputation neuroma of the clitoris was made by microscopic examination. CONCLUSION: This is the first well-documented case of clitoral amputation neuroma occurring after female genital cutting. Considering the high number of genital cuttings practiced, these tumors are probably under-reported in the literature.