Examining the Associations among Fibrocystic Breast Change, Total Lean Mass, and Percent Body Fat.

Fibrocystic breast change (FBC) is extremely common and occurrs in 90% of women during their lives. The association between body composition and risk of breast cancer is well established. We hypothesized that the effect might exist during the development of FBC. Our aim was to examine the relationships of total lean mass (TLM) and percent body fat (PBF) with FBC in a general female population. In total, 8477 female subjects aged 20 years or older were enrolled in the study at the Tri-Service General Hospital in Taiwan from 2011 to 2016. Comprehensive examinations including biochemical data, measurements of body composition and breast ultrasound were performed. PBF was positively associated with the presence of FBC (OR = 1.039, 95%CI: 1.018-1.060), and TLM showed the opposite result (OR = 0.893, 95%CI: 0.861-0.926). Condition of metabolic syndrome (MetS), diabetes (DM) and fatty liver modified the association between PBF and FBC (P < 0.001, P = 0.032 and P = 0.007, respectively). Female subjects diagnosed with MetS, DM, and fatty liver had higher risk of developing FBC than control subjects (OR = 1.110, 95%CI: 1.052-1.171; OR = 1.144, 95%CI: 1.024-1.278; OR = 1.049, 95%CI: 1.019, 1.080). Those with higher PBF (for highest quartile versus lowest, OR = 2.451, 95%CI: 1.523-3.944) or lower TLM (for highest quartile versus lowest, OR = 0.279, 95%CI: 0.171-0.455) had increased risk of developing FBC. In conclusion, increased PBF and reduced TLM were likely to predict the risk of the presence of FBC in a general female population.

THE ROLE OF E2/P RATIO IN THE ETIOLOGY OF FIBROCYSTIC BREAST DISEASE, MASTALGIA AND MASTODYNIA.

- The aim of the study was to assess the role of the estradiol and progesterone relationship during the late luteal phase and the occurrence of fibrocystic breast disease (FBD). The concentration of estradiol/progesterone was measured in the group of women with FBD as study group (n=50) and control group of women without FBD (n=40). All women had regular ovulation cycles. Blood samples for estradiol (E2), progesterone (P) and prolactin determination were obtained in the morning at 8 am on days 21 and 24 of menstrual cycle. Significant mastalgia and mastodynia history in women with FBD was obtained with yes or no questionnaire. FBD diagnosis was confirmed with ultrasound (size and number of simple cysts). In the control group, a reduced E2/P ratio was noticed from day 21 to day 24 of the cycle (from 14.8±11.5 pg/mL to 9.1±6.1 pg/mL; p<0.05), which was not recorded in the group of women with FBD (study group). Even the slightest disturbance of the E2/P ratio may contribute to the occurrence of FBD with clinical manifestations of mastalgia and mastodynia.

A Study of Using Massage Therapy Accompanied with Stretching Exercise for Rehabilitation of Mammary Gland Hyperplasia.

PURPOSE: To apply massage therapy accompanied with stretching exercises for treatment of mammary gland hyperplasia, evaluate the clinical outcome in patients, and estimate the therapy as a novel treatment method for mammary hyperplasia. METHODS: 28 adult female patients were selected and treated with massage therapy and stretching exercises focusing on skeleton muscles of chest, abdomen, and axilla. The mammary gland oxyhemoglobin (OxyHb) and deoxyhemoglobin (DeoxyHb) levels were detected before and after treatment after 15, 30, and 45 days. RESULTS: In this cohort, pretreatment OxyHb (mean ± SD) is 1.32 ± 0.14 (medium-high), and DeoxyHb is 0.87 ± 0.13 (normal). All patients were clinically diagnosed with benign mammary gland hyperplasia and mastitis. The posttreatment OxyHb levels are 1.23 ± 0.09 (normal-medium, 15-day), 1.16 ± 0.08 (normal, 30-day), and 1.05 ± 0.04 (normal, 45-day), and DeoxyHb levels are 0.90 ± 0.11 (normal, 15-day), 0.94 ± 0.18 (normal, 30-day), and 0.98 ± 0.12 (normal, 45-day). Patients were diagnosed with decreased hyperplasia 15 and 30 days after treatment and with no symptom of hyperplasia in mammary gland 45 days after treatment. CONCLUSION: Mammary gland hyperplasia is closely correlated with pathological changes of skeletal muscles and could be significantly improved by massage therapy and stretching exercises targeting neighboring skeletal muscles.

Adenopatía pigmentada por tinta de tatuaje como hallazgo accidental en cirugía de mama. Caso clínico / Pigmented adenopathy by tattoo ink as an accidental finding in breast surgery. Case report

Damos a conocer el hallazgo de una adenopatía axilar pigmentada durante la realización de una mastectomía bilateral profiláctica en una paciente de 35 años. El estudio anatomopatológico reveló pigmento compatible con tinta en el interior del ganglio. Esto, junto con la presencia de un tatuaje próximo a la axila de la paciente, permitió identificar el tatuaje como causa de la coloración de la adenopatía. Discutimos el diagnóstico diferencial a realizar en casos similares. Hasta un tercio de la población joven en España se ha realizado algún tatuaje, y las series de autopsias muestran la alta incidencia de presencia de pigmento en ganglios próximos a esos tatuajes. Creemos necesario realizar un correcto diagnóstico diferencial con melanoma y otras etiologías en pacientes tatuados para llevar a cabo una adecuada indicación quirúrgica (AU)

We report the finding of an axillary pigmented adenopathy during a bilateral profilactic mastectomy in a 35- year-old patient. The anatomopathologycal analysis revealed pigmentation compatible with ink inside the lymphatic node. The presence of a tattoo close to the axillary region of the patient made us identify the tattoo as the cause of the adenopathy coloration. We discuss the differential diagnosis to be considered in this cases. Around one third of the spanish population wears a tattoo, and series of autopsies show an elevated incidence of the presence of pigment in nodes adjacent to tattoos. The correct differential diagnosis with melanoma and other etiologies in tattooed patients is necessary to establish an adequate surgical indication (AU)

Microglandular adenosis: a non-obligate precursor of triple-negative breast cancer?

Microglandular adenosis is a rare glandular lesion of the breast, which can mimic well-differentiated invasive carcinoma, and is characterized by a haphazard proliferation of uniform small round glands with open lumina and lacking a myoepithelial cell layer. This lesion has a rather unique immunohistochemical profile characterized by expression of cytokeratins and S-100, and lack of estrogen receptor (ER) and progesterone receptor (PR). The role of microglandular adenosis as a potential precursor of invasive breast cancer has long been a matter of controversy; however, recent molecular analyses have demonstrated that these lesions are heterogeneous at the genetic level, and that at least a subset of microglandular adenosis are clonal and display gene copy number alterations. Importantly, the pattern of genetic aberrations found in microglandular adenosis differs from that of other non-obligate precursors of ER-positive breast cancer. Carcinomas arising in microglandular adenosis are mostly of triple-negative phenotype (i.e. lack of ER, PR and HER2) and express S100, similar to microglandular adenosis. Genetic alterations found in microglandular adenosis have been shown to be similar to those found in synchronous invasive carcinomas. Here we review the clinical, morphological, and molecular features of microglandular adenosis, with an emphasis on its role as a non-obligate precursor of triple-negative breast cancer, and discuss areas for future research endeavors to clarify the clinical and biological significance of these fascinating lesions.

Breast disorders in the female adolescent.

Breast disorders in the adolescent female can cause significant anxiety for the patient and her family and pose a clinical challenge for her health care provider. Care and consideration given to the emotions of the patient and family, as well as minimizing trauma and injury to the developing breast, are paramount. This article addresses the gamut of concerns that involve the adolescent breast. As benign breast disease is the most common breast disorder, conservative management should be entertained whenever possible. Patients should be referred to providers comfortable in treating the adolescent patient with breast disease or concerns.

Papilomatosis múltiple: presentación clínica y radiológica / No disponible

La papilomatosis múltiple (PM) de mama es una entidad poco frecuente que se ha asociado a un potencial premaligno. Se caracteriza por la presencia de proyecciones papilares con un centro revestido por células epiteliales y mioepiteliales que ocupan la luz dilatada de los ductos terminales. Puede encontrarse de manera aislada, asociada a atipia o a procesos neoplásicos. Se asocia con mayor frecuencia que el papiloma solitario a transformación maligna, en especial carcinoma ductal in situ (en algunas series hasta el 40%). Pese a este hecho, no está consensuado el manejo de esta entidad, siendo frecuente la recomendación de extirpación cuando existe algún grado de atipia en el diagnóstico histológico. Se presenta el caso de una paciente de 44 años que consulta por una historia de telorrea unilateral muy abundante de larga evolución. La realización de una galactografía puso de manifiesto un área extensa de defectos de replección pseudonodulares que ocupaba casi la mitad de la mama. Pese a tratarse de una enfermedad benigna, la opción de tratamiento propuesta fue la realización de una mastectomía(AU)

Multiple Papillomatosis (MP) of the breast is uncommon and often associated with premalignant potential. MP is restricted to papillary projections characterized by a fibrovascular core lined by epithelial and myoepithelial cells occupying the dilated lumina of terminal ductules. It is found to occur either in isolation or associated with other types of proliferative lesions such atypia, hyperplasia or malignant conditions (some series report 40% of ductal carcinoma in situ). Despite of this fact, MP is open to debate in terms of clinical management. Wide excision is often suggested when atypia is found in the pathologic tissue. We present a case of a 44-year-old woman with a long copious unilateral nipple discharge. Galactography showed an extensive replection defects area occupying almost half breast. Although this is a benign disorder, the real extent can entail the performance of a mastectomy(AU)

Increased bone mineral density in aged rats with spontaneous mammary dysplasia.

Spontaneous mammary tumors were seen in seven of the 12 breeding female rats aged 2 years. All mammary tumors were diagnosed as mammary dysplasia (MD). Bone mineral contents (BMC) and bone mineral density (BMD) of their lumbar vertebrae and femur were determined using dual energy X-ray absorptiometry (DXA). In rats with MD, body weight (BW), BMD of the lumbar vertebrae and BMC of the femur were significantly higher than in the rats without MD. Although corpus luteum (CL) and follicles were seen in the ovaries of all animals, the number of CL in rats with MD was significantly lower than the rats without MD. It was suggested that high BMD, BW and decreased CL promoted mammary tumors.

Lhermitte-Duclos disease and Cowden's syndrome. Report of two cases.

OBJECTIVE AND IMPORTANCE: Lhermitte-Duclos disease, or dysplastic cerebellar gangliocytoma is a rare entity characterized by a hamartomatous lesion in the posterior fossa. Cowden's syndrome, or hamartoma-neoplasia syndrome is a rare underdiagnosed autosomal dominant genodermatosis with high incidence of malignant tumors. Several recent reports suggest that Lhermitte-Duclos disease may be a component of Cowden's syndrome. CLINICAL PRESENTATION: We report two cases of Lhermitte-Duclos and Cowden disease occurring in adult patients. A 40-year-old woman had symptoms of raised intracranial pressure and macrocephaly. She displayed the stigmata of fibrocystic breast disease, thyroid goitre. Clinical examination showed mucocutaneous lesions. Her mother, brother and uncle had manifestations of Cowden's disease. An asymptomatic 38-year-old male had bilateral optic nerve drusen related to a cerebellar neoplasm. He exhibited manifestations of Cowden's syndrome and his familial history confirmed this hypothesis. INTERVENTION: The first patient was operated on for Lhermitte-Duclos disease. A conservative strategy was performed for the second patient and the clinical and imaging follow-ups were uneventful over 5 years. CONCLUSION: We stress the possibility that Lhermitte-Duclos and Cowden disease might be a peculiar form of phakomatosis. A conservative strategy can be chosen without neurological signs because of slow tumor growth. However, these patients should be carefully examined and followed up because of the risk of future malignancy.

Enfermedad inflamatoria mamaria asociada con los conductos / No disponible

No disponible

Fibromatosis mamaria en paciente con tumorectomía previa / Breast fibromatosis in a patient with prior tumorectomy

La fibromatosis (tumor desmoide) es un tumor benigno de origen mesenquimal. La localización mamaria es excepcional y su etiología es desconocida. La fibromatosis mamaria parece, tanto clínica como radiológicamente, un carcinoma. El diagnóstico es hitológico y el tratamiento de elección es la exéresis quirúrgica. Se presenta uncaso en que el estudio histológico mostró un tumor desmoide extraabdominal, de localización mamaria, en una paciente de 23 años con antecedente de tumorectomía mamaria ipsolateral (AU)

Fibromatosis (desmoid tumors) is a rare benign mesenchytomatous proliferative process. The breast is an excepcional site. Etiology is still unknown. Fibromatosis of the breast mimics carcinoma clinically as well as radiographically. Diagnosis is made by histological studies. The treatment of choice is wide excision. We report the case of a 23-year-old woman with a previous ipsilateral breast tumorectomy (AU)

Time-domain optical mammography SoftScan: initial results.

RATIONALE AND OBJECTIVES: Near-infrared (NIR) technology appears promising as a noninvasive technique for breast cancer screening and diagnosis. The technology capitalizes on the relative transparency of human tissue in this spectral range and its sensitivity to the main components of the breast: water, lipid, and hemoglobin. In this study, the authors report quantitative measurements of these components and the functional contrast between healthy and diseased tissue. MATERIALS AND METHODS: A four-wavelength time domain optical imaging system was used to perform noninvasive NIR measurements in the breast of 49 women both pre- and postmenopausal, ages 24-80. Algorithms based on a diffusive model of light transport provided absolute bulk and local values of breast constituent concentrations. RESULTS: Important variations in the functional and structural NIR properties of the breast were observed. Demographics trend were noticed in accordance with breast physiology. In the 23 cases imaged with suspicious masses, the optical images were consistent with the mammographic findings. Substantial contrast between masses and adjacent tissue is observed. Moreover, consistent differences between malign and benign cases are found with optical imaging. CONCLUSION: The results of this pilot study illustrate the sensitivity of optical techniques to the composition of the breast. In addition, preliminary data suggest that benign and malignant tumors can potentially be noninvasively differentiated with optical imaging. Moreover, statistically significant discrimination based on deoxy-hemoglobin content between malign and benign cases was found with optical imaging (P = .0184, one-tailed t test).

Upregulation of focal adhesion kinase (FAK) expression in ductal carcinoma in situ (DCIS) is an early event in breast tumorigenesis.

Focal adhesion kinase (FAK) is a protein tyrosine kinase that is overexpressed in a subset of invasive breast cancers. FAK transmits signals that mediate several functions including tumor cell proliferation, migration, adhesion and survival. We used immunohistochemical techniques to assess FAK expression in patients with fibrocystic disease (FCD), atypical ductal hyperplasia (ADH), ductal carcinoma in situ (DCIS) and infiltrating ductal carcinoma (IDC). Formalin-fixed, paraffin-embedded (FFPE) tissue sections were obtained from 119 patients (12 FCD, 38 ADH, 51 DCIS and 18 IDC). The anti-FAK 4.47 monoclonal antibody was used to detect FAK expression. FAK expression was scored as high (3 or 4 intensity and > or =90% positive cells) or low. The DCIS tissue sections demonstrated high FAK expression in 34/51 (66%) of the sections. High FAK expression was demonstrated in 6/18 (33%) of the IDC tissue sections and 8/38 (21%) of the ADH tissue sections. None (0/12) of the FCD tissues sections stained high for FAK. The pattern of FAK expression in DCIS was significantly higher than ADH (p < 0.0001) and IDC (p = 0.02). We conclude that FAK overexpression in preinvasive, DCIS tumors precedes tumor cell invasion or metastasis, suggesting that FAK may function as a survival signal and be an early event in breast tumorigenesis.

The usefulness of Doppler angiography in differential diagnosis of benign and malignant breast lesions.

OBJECTIVE: To estimate the usefulness of Doppler angiography in differential diagnosis of benign and malignant breast tumors. SETTING: District special hospital, 1997-2000. PATIENTS: 195 women with breast lesions detected by mammography or palpation in the out-patient clinic; 120 (average age 40 years) had benign lesions, and 75 (average age 54 years), malignant tumors, all confirmed by histopathology. There were 125 healthy controls, both pre- and postmenopausal. METHODS: Areas of tumor in vivo and healthy breast tissue were scanned using the Doppler angiography option of an Acuson 128XP sonograph, with a 7-MHz transducer. The signals were recorded on videotape and transferred with a QuickCapture frame grabber board for PC analysis by HLImage 97 software (256 gray scale). Signal strength was given per 1 cm2. This result was taken as semi-quantitative perfusion of the tissue section. RESULTS: In malignant breast lesions perfusion was significantly greater than in benign ones. Furthermore, perfusion of malignant lesions was not dependent on the phase of the menstrual cycle (1st vs. 2nd phase). The maximum sensitivity and specificity were 72% and 72.5%, respectively, based on ROC curves. CONCLUSIONS: This computerized Doppler angiography system is useful for differentiating between benign and malignant breast lesions in combination with other findings. It would also be useful for surveillance of apparently benign lesions. A limitation is the complicated computer analysis.

Expression of c-kit protein in proliferative lesions of human breast: sexual difference and close association with phosphotyrosine status.

PURPOSE: The c-kit gene which codes transmembrane tyrosine kinase receptor protein plays an important role in several types of normal and/or neoplastic human tissues. We examined the expression patterns of c-kit protein in proliferative lesions of human breast tissues in both sexes. METHODS: The localization of c-kit protein was examined immunohistochemically in human breast, consisting of 366 normal tissue, 156 benign lesions (fibroadenoma, fibrocystic change, intraductal papilloma, benign phyllodes tumor, and gynecomastia), 13 borderline diseases (atypical ductal hyperplasia, atypical lobular hyperplasia, and borderline malignant phyllodes tumor), and 197 malignant lesions (non-invasive and/or invasive ductal carcinoma and malignant phyllodes tumor). RESULTS: In normal tissues and benign proliferative lesions, c-kit product was consistently detected on epithelial cell membranes and/or cytoplasms regardless of gender difference. In contrast, we failed to find c-kit product in female borderline epithelial lesions, including atypical lobular hyperplasia, or in female malignant lesions, except for two carcinomas. In situ hybridization analysis of c-kit mRNA in female tissues gave results comparable to those obtained by immunohistochemistry. On the other hand, c-kit product was consistently detected in male benign and malignant proliferative lesions. Apart from the female breast carcinomas which lacked c-kit, c-kit expression was almost always accompanied by positivity for phosphotyrosine in the breast tissues examined, suggesting possible phosphorylation of tyrosine residues of the c-kit receptor protein. CONCLUSIONS: Loss of c-kit product was related to malignant transformation in female breast, but not in the case of male breast. We suggest that the oncogenesis pathway of breast epithelium is different between males and females in terms of c-kit expression.

Mastopatía fibrosa diabética: descripción de un caso con afectación bilateral y regresión espontánea evolutiva / Diabetic fibrous breast disease: description of a case with bilateral involvement and gradual spontaneous regression

Describimos los hallazgos clínicos, radiológicos e histopatológicos de esta rara enfermedad benigna de la mama en una paciente de 28 años de edad con diabetes mellitus insulino-dependiente de larga evolución. La paciente presentó tumoraciones mamarias bilaterales. La mamografía demostró mamas densas, y el examen ecográfico puso de manifiesto masas bilaterales anecoicas de bordes irregulares con sombra acústica posterior. Mediante punción aspiración con aguja fina se obtuvo un material hialino amorfo y acelular. Se practicó biopsia quirúrgica extrayendo muestras en ambas mamas, objetivando en el análisis histológico una fibrosis queloide con lobulitis linfocítica. Los hallazgos clínicos e histológicos sugirieron el diagnóstico de mastopatía fibrosa diabética. En el seguimiento clínico en un período de ocho años, se constató la regresión espontánea de las masas mamarias. Confirmamos los hallazgos publicados previamente en la bilbiografía, sugiriendo que aquellos pacientes que cumplan los criterios clínicos, citológicos y de imagen de mastopatía fibrosa diabética puedan ser controlados clínicamente, evitándose la biopsia quirúrgica. (AU)

[Hormonal abnormalities in women with breast cysts]. / Zaburzenia hormonalne u kobiet z makrotorbielami gruczolów sutkowych.

OBJECTIVES: Increased estrogen activity and prolactin hypersecretion is a hormonal reason for Benign Breast Diseases. DESIGN: To evaluate hormonal disorders in women with gross breast cysts. MATERIAL AND METHODS: 30 women with gross breast cysts (over 10 mm in diameter) have been investigated. Cytohormonal vaginal swabs and serum levels of prolactin, estradiol and gonadotropins were evaluated. RESULTS: Normal prolactin levels were found in 96.7% of cases, but in 8 women with recurrent breast cysts after repeated FNA-biopsies prolactin secretion stimulated by metoclopramide was significantly increased. Low progesterone activity in all women and low estrogen activity in 65.3% were shown. Absolute high estrogen activity was diagnosed only in 8.7% women with gross breast cysts. CONCLUSIONS: Nearly all patients with gross breast cysts have normal prolactin and low progesterone levels. High estrogen levels appear very seldom and in most cases these patients are hypoestrogenic.

Cambios mamográficos asociados a tratamiento hormonal sustitutivo: hallazgos infrecuentes. A propósito de dos casos / Mammographic changes associated to hormone replacement treatment: rare findings. Based on two cases

Presentamos dos casos de mujeres posmenopáusicas sometidas a tratamiento hormonal sustitutivo (THS) que experimentaron cambios mamográficos inusuales en pacientes con este tratamiento, cambios que simularon en ambos casos lesiones tumorales. A una de las pacientes se le realizó una punción citología con el resultado de hallazgos compatibles con mastopatía fibroquística. En ambos casos la retirada del THS condujo a la total desaparición de las imágenes mamográficas, obteniendose mamografías de control con tejido glandular normal (AU)

Intracellular pH regulation in a nonmalignant and a derived malignant human breast cell line.

Tumor cells in vivo often exist in an ischemic microenvironment that would compromise the growth of normal cells. To minimize intracellular acidification under these conditions, these cells are thought to upregulate H(+) transport mechanisms and/or slow the rate at which metabolic processes generate intracellular protons. Proton extrusion has been compared under identical conditions in two closely related human breast cell lines: nonmalignant but immortalized HMT-3522/S1 and malignant HMT-3522/T4-2 cells derived from them. Only the latter were capable of tumor formation in host animals or long-term growth in a low-pH medium designed to mimic conditions in many solid tumors. However, detailed study of the dynamics of proton extrusion in the two cell lines revealed no significant differences. Thus, even though the ability to upregulate proton extrusion in a low pH environment (pH(e)) may be important for cell survival in a tumor, this ability is not acquired along with the capacity to form solid tumors and is not unique to the transformed cell. This conclusion was based on fluorescence measurements of intracellular pH (pH(i)) on cells that were plated on extracellular matrix, allowing them to remain adherent to proteins to which they had become attached 24 to 48 h earlier. Proton translocation under conditions of low pH(e) was observed by monitoring pH(i) after exposing cells to an acute acidification of the surrounding medium. Proton translocation at normal pH(e) was measured by monitoring the recovery after introduction of an intracellular proton load by treatment with ammonium chloride. Even in the presence of inhibitors of the three major mechanisms of proton translocation (sodium-proton antiport, bicarbonate transport, and proton-lactate symport) together with acidification of their medium, cells showed only about 0.4 units of reduction in pH(i). This was attributed to a slowing of metabolic proton generation because the inhibitors were shown to be effective when the same cells were given an intracellular acidification.