[Radiological trap and oncological precautions in a patient who has undergone a permanent withdrawal of PIP breast implants]. / Piège radiologique et précautions carcinologiques chez une patiente ayant subi un retrait définitif de prothèses mammaires PIP.

We report the case of a 57-year-old patient who presented radiological images similar to ruptured breast implants one year after the supposed withdrawal of the latter. This woman had benefited for the first time from cosmetic PIP breast implants in 2000. Early in 2014, she requested the removal of the implants without renewal because she was feeling pain and functional discomfort. A few months after the operation, she consulted for breast swelling in the upper pole of the breast. Radiological assessment showed liquid formations compatible with the presence of implants. At our request, the rereading of the MRI by the radiologist definitively concluded on a bilateral seroma within the persistent fibrous capsule. In the absence of symptoms, clinical monitoring had been decided. But at the recrudescence of anaplastic large cell lymphoma cases associated with breast implants, a cytological sampling was intended. In case of cytological abnormality or recurrence of the seroma, a surgical procedure should be performed. In conclusion, the removal of a breast implant without capsulectomy may result in the formation of a seroma whose images resemble those of an implant. It is always worthwhile to provide precise clinical data to the radiologist in order to help him to make informed interpretations. Every serous effusion in a breast lodge having contained a silicone implant must evoke the diagnosis of anaplastic large cell lymphoma.

[Unilateral gigantomastia of pregnancy: case-report of a giant breast hamartoma]. / Gigantomastie unilatérale gravidique: à propos d'un cas d'hamartome géant.

Breast hamartoma is a benign tumour consisting of fat, fibrous and glandular tissue. A young woman in her 19th week of pregnancy underwent exceptional surgery for a unilateral gigantomastia secondary to a rapid-growth giant hamartoma during her second pregnancy. Rigourous clinical and ultrasonographic examinations were performed followed by multiple biopsies. The decision to perform surgery was guided by the risk to skin integrity and of tumour infarct. Our report provides detailed information on gestational benign breast tumours, on the specificities of medical imaging and breast surgery in pregnant patients.

[MRI-guided breast microbiospy or macrobiopsy: which is the best option for a small tumor?]. / Micro- ou macrobiopsie mammaire guidée par IRM : quel est le meilleur choix pour une petite tumeur ?

The choice of the optimum therapeutic strategy for breast cancer depends on the histological diagnosis of the sample obtained by biopsy. The microbiopsy is the preferred method as it provides an accurate diagnosis of the histological type as well as the main prognostic factors, whilst being simple, fast and inexepensive. However, some infraclinic breast tumors are not accessible by conventional guidance due to excessive depth inside the breast, their small size or technical inability to image them by mammography or ultrasonography. In those cases, the MRI guidance may help to perform the biopsy. Most MRI biopsies are made by large-core needle that are known to alter the histological structure of the tumor and to disturb the anatomopatholgical analysis (size and surgical margin). Those are very important elements to know before treatment. Our case report details an original technique of MRI microbiopsy of a deep 4mm opacity found on the occasion of a patient's mammography. The operative specimen revealed an invasive ductal carcinoma of 4mm diameter which scored III on the Elston and Ellis scale (oestrogen and progesterone receptors tested negative and HER-2 was over-expressed). It was associated with a high grade in situ ductal carcinoma. No systemic treatment was prescribed due to the small size of the carcinoma. The development of partially or totally amagnetic microbiopsy pistols would help perform microbiopses guided by MRI.

[Diabetic mastopathy: a recurrent benign breast disease]. / La mastopathie diabétique : une lésion mammaire bénigne sujette à récidive.

Diabetic mastopathy is an uncommon benign entity occurring in young women with type 1 diabetes. Its clinical and radiological signs are not specific and often mimic a breast carcinoma. However, the benign nature of this lesion is easily recognized on histological examination, visualizing dense keloid-like fibrosis, lymphocytic lobulitis and ductitis with lymphocytic perivascular inflammation, with or without epithelioid-like fibroblasts. Surgery can generally be avoided. The evolution of this entity is characterized by the risk of local growth, bilateralisation or recurrence after surgical treatment. We present a case in which the core biopsy allowed the diagnosis of a diabetic mastopathy and we discuss its clinical, diagnostic, pathological and therapeutic particularities.

[Most common benign epithelial breast diseases: diagnosis, treatment and cancer risk]. / Les principales lésions mammaires épithéliales bénignes et à risque. Prise en charge diagnostique et thérapeutique.

As a consequence of breast imaging development and increased interventional radiology, benign epithelial breast diseases (BEBD) represent a growing percentage of breast pathology diagnoses. BEBD include numerous entities such as cysts, fibrosis, adenosis, duct ectasia, which require neither surgery nor follow-up. Some BEBD have to be individualized (radial scars, papillomas, complex sclerosing adenosis, lobular intraepithelial neoplasia, flat epithelial atypia, atypical hyperplasia), being preinvasive lesions or markers of increased breast cancer risk, or being associated with suspect radiological aspect. BEBD should be managed in a pluridisciplinar way and correctly diagnosed by percutaneous biopsies or surgical specimens. The goals of surgery vary according to lesions. It always allows a complete surgical specimen analysis and therefore a search for atypical or cancerous cells. Surgery can also have a preventive role by reducing the risk of potential malignant transformation. Finally, it enables in some cases the excision of a radiologically suspect mass. So the aim of this review is to give a clinical and morphological description of most common BEBD, underlying their cancer risk, specific diagnosis, therapeutic, follow-up and psychological repercussions.

Stereotactic vacuum biopsy of calcifications with a handheld portable biopsy system: a validation study.

To prospectively evaluate a compact portable 10-gauge handheld battery-operated biopsy system for stereotactic biopsy of microcalcifications. The ethics committee of the hospital approved this prospective multicentric study, and informed consent was obtained. Biopsy under stereotactic guidance was performed in 215 patients for 219 lesions consisting of microcalcifications without mass. The feasibility and the tolerance of the procedure were evaluated. The mean weight of the specimen was calculated. In patients with surgical diagnoses, the underestimation rate in biopsy diagnoses of atypical ductal hyperplasia and ductal carcinoma in situ were evaluated. The sampled specimens were separated according to the presence of calcifications on magnified specimen radiographs and to the probe the rotation number in order to evaluate the contribution of each rotation and the contribution of the specimen with and without calcifications on the radiographs. The macrobiopsy was feasible in 98.5% of the patients and was well tolerated in 82% of patients. It identified 4.6% invasive carcinomas, 18.5% ductal carcinomas in situ, 14.8% atypical ductal hyperplasias, 22.2% benign proliferative mastopathies and 39.8% benign non-proliferative mastopathies. The underestimation rate was 26.6% when an atypical ductal hyperplasia was diagnosed at biopsy, and 7.7% when a ductal carcinoma in situ was diagnosed. In the 77 patients with surgical correlation, the accurate diagnosis was obtained in specimens sampled during the first, second, and third in 69%, 9%, and 4% of the biopsies, respectively, and the analysis of specimens without microcalcification had an added value in 8% of patients. The compact portable battery-operated biopsy system can be used successfully for stereotactic biopsy of microcalcifications and constitutes a valid alternative to current systems.

[Non-invasive lesions of the cervical glands. Apropos of a study of 431 conization specimens]. / Lésions non invasives des glandes cervicales. A propos de l'étude de 431 pièces de conisation.

431 cone biopsy specimens referred for CIN2 and CIN3 between 1984 and 1993 were reviewed with a peculiar attention paid to the possible associated endocervical glandular changes. The following features could be demonstrated: microglandular hyperplasia (17 cases), tubal metaplasia (15 cases), mesonephric hyperplasia (10 cases), in situ adenocarcinoma (7 cases), tunnel clusters (5 cases), and ectopic endometrium (4 cases). Cervical glandular atypia could not be found. A classification of the glandular lesions in uterine cervix has been proposed for an accurate diagnostic approach of lesions who could simulate carcinomatous changes.