Lesiones histológicas de riesgo de carcinoma de mama. Guía de supervivencia para el patólogo general / Histological lesions of risk of breast carcinoma. Survival guide for the general pathologist

Las lesiones histológicas de riesgo de cáncer de mama son lesiones epiteliales proliferativas. Constituyen un grupo heterogéneo de lesiones con distinta magnitud de riesgo, en relación con la presencia de atipia. Plantean el diagnóstico diferencial con lesiones benignas, carcinoma ductal in situ y carcinoma infiltrante. El diagnóstico histológico correcto es importante, ya que plantea distintas opciones terapéuticas, incluyendo biopsias asistida por vacío y cirugía. Revisamos los criterios diagnósticos y el diagnóstico diferencial de la hiperplasia ductal usual, la cicatriz radial y las lesiones esclerosantes complejas, las adenosis de distinto tipo, las lesiones papilares, la hiperplasia ductal atípica, la atipia epitelial plana y la neoplasia lobulillar in situ. Asimismo, recogemos la magnitud de riesgo asociada a las diversas entidades y las posibles opciones de manejo

Proliferative epithelial lesions are risk factors for breast cancer. They are a heterogeneous group of lesions in which the presence of atypia is related to varying degrees of risk. They should be considered in the differential diagnosis with benign lesions, in situ ductal carcinoma and infiltrating carcinoma. An accurate histopathological diagnosis is important in choosing the best therapeutic option, including vacuum assisted biopsy and surgery. We revise diagnostic criteria and the differential diagnosis of usual ductal hyperplasia, radial scar and complex sclerosing lesions, distinct types of adenosis, papillary lesions, atypical ductal hyperplasia, flat epithelial atypia and lobular neoplasia in situ. Furthermore, we summarize the degree of risk associated with the different conditions and management possibilities

[Histological lesions of risk of breast carcinoma. Survival guide for the general pathologist]. / Lesiones histológicas de riesgo de carcinoma de mama. Guía de supervivencia para el patólogo general.

Proliferative epithelial lesions are risk factors for breast cancer. They are a heterogeneous group of lesions in which the presence of atypia is related to varying degrees of risk. They should be considered in the differential diagnosis with benign lesions, in situ ductal carcinoma and infiltrating carcinoma. An accurate histopathological diagnosis is important in choosing the best therapeutic option, including vacuum assisted biopsy and surgery. We revise diagnostic criteria and the differential diagnosis of usual ductal hyperplasia, radial scar and complex sclerosing lesions, distinct types of adenosis, papillary lesions, atypical ductal hyperplasia, flat epithelial atypia and lobular neoplasia in situ. Furthermore, we summarize the degree of risk associated with the different conditions and management possibilities.

Changes in breast cancer reports after pathology second opinion.

Breast cancer pathology reports contain valuable information about the histologic diagnosis, prognostic factors and predictive indicators of therapeutic response. A second opinion may be requested by medical oncologists and surgeons, when a patient is referred from another institution for treatment. We report the experience with pathology second opinion in selected patients referred to the Breast Oncology Unit. 205 cases referred to the Breast Oncology Unit were selected for second opinion after clinical evaluation, between 2002 and 2012. The cases reviewed included 102 core needle biopsies, 88 surgical specimens from the breast and 18 lymphadenopathies, 14 from the axillary region. Pathology second opinion was based on a review of hematoxylin-eosin preparations, recuts of submitted paraffin blocks and written external pathology reports. Immunohistochemical studies for hormone receptors, HER2, myoepithelial cells, and other markers were performed in selected cases. A case was reclassified as showing major change when second opinion showed a potential for significant change in prognosis or treatment. Otherwise, it was considered to represent minor change or to be concordant. In 52 cases (25.4%), the pathology review showed changes. Thirty-three (16%) patients were reclassified for major changes and 19 (9.2%) as minor changes. In six patients, more than one major change was identified. The major discrepancies identified were related to the histologic classification (12 cases), the presence or absence of invasion in ductal carcinoma (15 cases), the results of hormone receptors (5 cases), and HER2 (7 cases). Major changes in histologic classification included two cases diagnosed as invasive ductal carcinoma and reclassified as benign, four cases with diagnosis of breast cancer reclassified as metastatic lung cancer, one case diagnosed as small cell carcinoma of lung metastatic in the breast, reclassified as primary carcinoma of the breast, and three cases with diagnosis of breast cancer in the axilla reclassified as primary cutaneous adnexal carcinomas (2) and metastatic melanoma (1), respectively. In two cases, the histologic type of the primary breast tumor was changed. Second opinion in breast pathology may uncover significant discrepancies that impact on patient management and prognosis. Major discrepancies are most frequently related to the assessment of the presence or absence of invasion in ductal carcinoma, the results of predictive makers of therapeutic response, and the differential diagnosis of breast cancer and nonmammary tumors in the breast, the axilla, and at distant sites.

Atypical inguinal malignant peripheral nerve sheath tumour with arteriovenous fistula of the left femoral nerve in a child.

We report a 9-year-old girl who developed a malignant peripheral nerve sheath tumour (MPNST) with an arteriovenous fistula arising from the left femoral nerve and adjacent to the iliofemoral vessels in the ipsilateral groin, but without infiltrating them. We describe the MRI and MRA findings. Although MPNST is relatively well known and widely studied, the location of this mass is unique in a child. The mass was surgically removed.

Hidrocistoma apocrino sobre nevus sebáceo / Apocrine hidrocystoma arising from a sebaceus nevus

Una mujer de 41 años que tenía un nevus sebáceo congénito de cuero cabelludo desarrolló un hidrocistoma apocrino. Éste, también denominado cistadenoma apocrino o, más recientemente, quiste de la glándula apocrina, es una lesión quística infrecuente, casi siempre solitaria, que en ocasiones puede aparecer sobre un nevus sebáceo. Los tumores que se desarrollan sobre nevus sebáceos suelen aparecer en la edad adulta, con un porcentaje de tumores agresivos muy bajo. Por esta razón actualmente se desaconseja la exéresis profiláctica de los nevus sebáceos y sólo se recomienda un seguimiento para tratar aquellos casos que desarrollen lesiones asociadas (AU)