A case of extensive ductal carcinoma in situ and sclerosing adenosis with metastasis on sentinel lymph node.

INTRODUCTION: Sclerosing adenosis is a form of adenosis characterized by lobulocentric architecture, glandular and stromal proliferation in which the stromal component compresses and distorts the glandular structures. Atypical epithelial proliferations such as atypical lobular hyperplasia, lobular carcinoma in situ, and ductal carcinoma in situ may accompany areas of sclerosing adenosis. We present a case of ductal carcinoma in situ and sclerosing adenosis with metastatic carcinoma on sentinel lymph node. CASE DESCRIPTION: A 40-year-old woman presented with a palpable mass in her left breast. Radiologic studies showed a lesion suggesting malignancy in the left breast and atypical lymph node in the left axillary region. Left lumpectomy and sentinel lymph node biopsy was performed. Histopathologic examination revealed lobulocentric lesions with glandular proliferation and hyalinizing stroma in between. Foci of high-grade cribriform and solid type ductal carcinoma in situ were observed. Sentinel lymph node biopsy showed micrometastasis in one lymph node section. Based on these findings, the patient was diagnosed with high-grade ductal carcinoma in situ with sclerosing adenosis. However, the presence of micrometastasis in the lymph node suggested occult invasion that we were not able to detect. CONCLUSION: Ductal carcinoma in situ with sclerosing adenosis can mimic invasive carcinoma both radiologically and histologically. It should be kept in mind that there may be occult invasive carcinoma in patients with ductal carcinoma in situ whether the lesion is accompanied by sclerosing adenosis or not. Multiple sections and immunohistochemical studies can be of help.

Breast diseases in women over the age of 65 in Monastir, Tunisia.

As life expectancy is on the rise, it is predicted that a growing number of people will live beyond the age of 65 and therefore a higher number of elderly women will have breast diseases requiring significant health care and services. This study is aimed at investigating the characteristics, the treatment and outcomes of women older than 65 years old treated for breast diseases at our institution. This was a retrospective study covering the period from January 2003 to December 2011. It involved 92 patients aged over 65 and treated for breast disease in the Maternity Center of Monastir, Tunisia. The data included characteristics of patients and tumors, treatment and outcomes that were obtained through data extraction sheets. We reported a study of 92 women over the age of 65 of whom 77 women had malignant breast disease (83.6%) and 15 benign breast diseases (16.4%). Breast cancer was discovered at a mean age of 72.5 ± 6.6 years. Distant metastases were found in 5.3% of cases and infiltrative ductal carcinoma was detected in 85.7% of patients. Hormonal receptors were positive for estrogens in 64.7% of cases. Surgical treatment was performed in 73 patients and adjuvant treatment was prescribed for 67 women (86%). The complication rate was 16.6% among the 73 patients who underwent surgery. Benign breast diseases represented 16.3% of the mammary pathologies. Abscesses and fibrocystic mastopathy were the most frequent histological diagnoses. Despite great interest in geriatric gynecological pathology worldwide, many questions related to how optimally treat this patient population remain unanswered. In this study, a surgical treatment was performed in 94.8% of breast cancer patients and the complication rate was 16.6%.

Ru-Pi en Medicina Tradicional China: diferenciación y tratamiento / Ru-Pi in Traditional Chinese Medicine: differentiation and treatment

La enfermedad fibroquística constituye la afección más frecuente de la mama durante la etapa de la madurez sexual. Más del 30 % de las mujeres en Cuba la padece. En la Medicina Tradicional China esta se corresponde mayoritariamente con la categoría Ru-Pi. Con el objetivo de identificar las características de esta afección desde la perspectiva de la Medicina Tradicional China, se desarrolló una búsqueda a través de la Biblioteca Virtual de la Salud de Infomed, en varias bases de datos internacionales, y en la Biblioteca del Servicio de Referencia Provincial de Medicina Natural y Tradicional de Matanzas. Fueron revisados 32 artículos y 17 libros sin limitación de año y país, seleccionándose 27 de ellos con calidad, los que se ajustaban a los objetivos de la investigación. Ru-Pi se define ampliamente como un nódulo (o nódulos) de apariencia duradera en las mamas, los que no son supurativos. Se diferencian según el diagnóstico sindrómico tradicional en estancamiento de Qi de hígado, estancamiento de Qi de hígado transformado en fuego, estancamiento de Qi de hígado que concomita con Xu (deficiencia) de Yin y estancamiento de Qi que concomita con desarmonía de los canales Chong y Ren, fundamentalmente. Se expusieron los principios de tratamiento de esta enfermedad y los esquemas terapéuticos definidos según el modelo de la Medicina Tradicional China(AU)

The fibrocystic disease is the most frequent mamma disorder during the stage of sexual maturity. More than 30 % of the women in Cuba suffer from that disease. In Traditional Chinese Medicine, it corresponds mainly with Ru-Pi category. With the aim of identifying the characteristics of this disease from the perspective of the Traditional Chinese Medicine, a search was carried out in the Health Virtual Library Infomed, in several international databases and in the Library of the Provincial Reference Service of Traditional and Natural Medicine of Matanzas. 32 articles and 17 books were reviewed without limitation of edition year and country, choosing 27 of them qualitatively adjusted to the research aims. Ru-Pi is widely defined as a long-lasting appearance nodule (or nodules) in the mamma; these nodules are not suppurative. They are differenced according to the traditional syndrome diagnosis mainly as liver Qi stagnation, liver Qi stagnation transformed in fire, liver Qi stagnation concomitant with Xu (deficiency) of Yin, and Qi stagnation concomitant with Chon and Ren canals disharmony. There it were exposed the treatment principles of this disease and the therapeutic schemes defined according to the models of the Traditional Chinese Medicine(AU)

[Management of a breast cystic syndrome: Guidelines]. / Exploration d'un syndrome kystique mammaire: recommandations.

OBJECTIVE: Breast cysts are common, often discovered incidentally or subsequently to pain or palpable mass. The purpose of these recommendations is to describe the sonographic findings for classifying breast cystic lesions, to analyze the value and contribution of various imaging techniques and sampling and to provide a management strategy. MATERIALS AND METHODS: Literature review conducted by a small group and then reviewed and validated by the group designated by the Collège national des gynécologues et obstétriciens français (CNGOF) to make recommendations for clinical practice for benign breast lesions. RESULTS: Breast cysts are classified in 3 categories: simple cysts, complicated cysts and complex cysts. For simple cysts, after ultrasound, no further imaging is necessary, cytology is to consider only as analgesic. For complicated cysts, a control at 4-6 months is recommended; the use of cytology depends on the context (familial risk, difficulty of follow-up). In case of complex cyst, sampling by cytology or biopsy is recommended. More assessments of other imaging tests are reported. CONCLUSION: The sonographic characterization is essential for management of breast cyst.

Comportamiento de la enfermedad fibroquística de la mama según la Medicina Tradicional China, Matanzas, 2012 / Behavior of mamma fibrocystic disease according to Traditional Chinese Medicine. Matanzas, 2012

Se realizó una investigación observacional de tipo transversal, en el período comprendido de agosto de 2011 hasta agosto de 2012, en el Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez, de Matanzas, con el fin de establecer el comportamiento de la enfermedad fibroquística de la mama según la Medicina Tradicional China. El universo estuvo comprendido por la totalidad de las pacientes diagnosticadas con esta enfermedad, remitidas de la consulta provincial del Hospital Ginecobstétrico Provincial Docente Julio R. Alfonso Medina, de la ciudad de Matanzas. Se incluyeron las pacientes mayores de 18 años, dispuestas a participar en la investigación. Se seleccionó una muestra no probabilística constituida por 100 pacientes a las que se les realizó la historia clínica tradicional y el diagnóstico según la Medicina Tradicional China. La descoordinación entre hígado y bazo-estómago fue el síndrome más significativo. La realización de un diagnóstico tradicional chino permite indicar un tratamiento adecuado e individualizado a cada una de estas pacientes(AU)

We carried out a cross-sectional observational research, in the period from August 2011 to August 2012, in the Clinical Surgical Hospital Comandante Faustino Perez, of Matanzas, with the aim of establishing the behavior of mamma fibrocystic disease according to the Traditional Chinese Medicine. The universe covered all the patients diagnosed with this disease, referred from the provincial consultation of the Teaching Provincial Gyneco-obstetric Hospital Dr. Julio R. Alfonso Medina of Matanzas. There it were included the patients aged 18 years who wanted to participate in the research. A non probabilistic sample composed by 100 patients was chosen. The traditional clinical record was filled out and the patients were diagnosed according to Chinese Traditional Medicine. The most significant syndrome was discoordination between liver and spleen-stomach. Achieving a traditional Chinese diagnosis allows indicating an adequate and individualized treatment to each one of these patients(AU)

External Chinese medical therapy for pain associated with hyperplastic disease of the breast: study protocol of a randomized, double-blind, multicenter, controlled trial.

BACKGROUND: Hyperplastic disease of the breast (HDB) is caused by a hormone imbalance experienced among women at a certain age. Slight breast pain is common in women before menstruation without need of treatment; however, if the pain becomes severe, it can cause physical and mental suffering. Therefore, it is of great clinical significance to control this disease. METHODS AND DESIGN: This study will follow the principle of evidence-based medicine and adopt various design methods, being conducted as a randomized, controlled, double-blind and multicenter trial based on the cause of HDB defined in Chinese and Western medicine. According to the cause of HDB in Chinese and Western medicine and its pathogenesis and prognosis, this study will conduct syndrome differentiation, adopt external therapy of Chinese medicine by using Sanjie Zhitong plaster as the intervention, take placebo as the control method and aim at relieving pain. The effectiveness and safety of Chinese medicine therapy will be evaluated. During the design process, some confounding factors will be taken into consideration and prevented with corresponding measures. We will also discuss the side effects of the medicine used and corresponding countermeasures to be taken. DISCUSSION: On the basis of traditional Chinese medicine (TCM) theory, Sanjie Zhitong plaster takes the advantage of external therapy of TCM. According to the main etiology and pathogenesis of HDB, the treatment principles of warming the meridians and activating blood, smoothing circulation and relieving pain, and removing swelling and dissipating stagnation are put forward. The medicine exerts its effects directly on the lesion site by permeating into the skin and stimulating the meridians, thus improving blood supply to the breast and relieving pain.

Paneth cell-like eosinophilic cytoplasmic granules in breast carcinoma.

Prominent coarse eosinophilic cytoplasmic granules reminiscent of those in intestinal Paneth cells are rarely identified in breast carcinomas. In the literature, this phenomenon seems to be associated with acinic cell carcinoma of the breast or microglandular adenosis-related lesions. In this study, we report 3 breast carcinoma cases with such granules. Two of the cases were carcinomas arising in microglandular adenosis, one of which contained areas of acinic carcinoma-like features. The other case was a mammary carcinoma with prominent microglandular adenosis and also acinic cell carcinoma growth patterns. In the latter case, the patient had a history of neoadjuvant chemotherapy; and cells with coarse granules were found in both the pretreatment and posttreatment specimens. Although all 3 tumors were negative for HER2/neu, 2 tumors were estrogen receptor/progesterone receptor negative and one was estrogen receptor/progesterone receptor positive. Follow-up for 2 patients at 12 months and 3 years showed no evidence of disease, and the other patient died of her disease at 34 months. We provide a review of the literature and conclude that prominent coarse eosinophilic granules are a rare and nonspecific feature in breast epithelium. The clinical significance remains to be investigated, given the limited experience.

[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.

Young-aged woman with invasive ductal carcinoma arising in atypical microglandular adenosis: a case report.

Microglandular adenosis (MGA) and atypical microglandular adenosis (AMGA) are extremely rare and unique forms of adenosis of the breast. Both forms of adenosis are strongly associated with carcinoma arising in microglandular adenosis (MGACA) and are recognised as precursor lesions of invasive breast carcinoma. Here we provide a clinical report of a young Taiwanese woman who was diagnosed with MGACA and AMGA by means of echo-guided core biopsy. The subsequent lumpectomy revealed a spectrum of lesions ranging from MGA and AMGA to ductal carcinoma in situ (DCIS) and invasive carcinoma. All of the above lesions have similar immunohistochemical results (expression of S-100 protein, the absence of oestrogen receptors, progesterone receptors and Her2/neu, and the lack of p63 and the smooth muscle myosin-heavy chain) with a rather different Ki-67 labelling proliferation index. This report is of practical interest because the diagnosis of AMGA and MGACA had already been made via needle biopsy.

Hiperplasia intraductal atípica o carcinoma intraductal grado 1 vs. DIN1c / No disponible

Objetivo: La clasificación DIN incluye en el DIN1c la hiperplasiaintraductal atípica (HIA) y el carcinoma intraductal grado1 (CID1). El objetivo de este estudio es ver si esta agrupacióndiagnóstica, con las consecuencias terapéuticas que elloconlleva, implica o no un sobretratamiento de la HIA.Pacientes y métodos: Se ha revisado el tratamiento y laevolución de los casos de HIA y CID1 diagnosticados en nuestrocentro desde 1999 hasta 2008. Se han utilizado los mismoscriterios diagnósticos que utiliza la clasificación DIN paradiferenciar la HIA y el CID1.Resultados: De 117 casos, 49 fueron HIA y 68 CID1. Eltratamiento quirúrgico fue tumorectomía, independientementedel estado del margen, en 47 (96%) HIA y en 53 (78%) CID1consiguiendo siempre un margen libre. En 42 (62%) casos deCID1 el tratamiento se complementó con radioterapia. Uncaso de HIA y otro de CID1 recidivaron tras 24 y 39 mesesen forma de carcinoma ductal infiltrante.Conclusiones: La clasificación DIN simplifica el diagnóstico,no obstante agrupar alguna de estas lesiones puede conllevarsu sobretratamiento. En nuestra serie la simple extirpaciónde una HIA independientemente del estado del margen hasido curativa en la mayoría de casos(AU)

Objective: DIN classification includes into DIN1c the atypicalintraductal hyperplasia (AIH) and intraductal carcinomagrade 1 (IDC1). The aim of this study is to see if this grouping,with its therapeuthical consequences, implies an overtreatmentof AIH.Patients and methods: Treatment and follow-up of allthose cases diagnosed of AIH and IDC1 between 1999 and2008 at our centre have been revised. The diagnostic criteriato differentiate AIH and IDC1 were the same used in DIN classification.Results: Of the 117 studied cases, 49 were diagnosed asAIH and 68 as IDC1. Lumpectomy, independently of the statusof the margin was performed in 47 (96%) AIH, and 53(78%) IDC1 with adequate resection margin. In 42 (62%) casesof IDC1 adjuvant radiotherapy was given. One case of AIHand one case of IDC1 recurred as invasive ductal carcinoma,24 and 39 months later respectively.Conclusions: DIN classification simplifies the diagnosis butgrouping these lesions can result into an overtreatment. In ourserie the surgical excision of AIH independently of the statusof the margin was curative in the majority of the cases(AU)

[Complex treatment of mastopathy patients with concomitant diseases].

Efficiency value of complex treatment of patients with cystic disease during side-illnesses. The aim of the article was to study the efficiency of complex treatment of mastopitia patients with concomitant diseases. The complex therapy of 1044 patients was carried out. Patients with cystic disease who does not suffer concomitant diseases (152 patients) where treated with mastodinon, vitamins, ginsheng, dehidratation, trancvilizators, antihistamines, drugs of K. After 24-26 months of treatment 144 (95%) patients fully recovered. The subjective progress was found in 8 cases (4%). In group with hormonal disorders recovery was in 120 cases (90%) and the subjective progress was in 13 patients (6%). Apart, the hormonal drugs had been used considering hormonal profile. 401 patients with concomitant diseases of genitals were treated with hormones, iodinotherapy and mastodinon. The best result in this group has been shown in patients with uterus fibromiomas - 110 patients and with ovarian micro cists with no need of surgical treatment - 78 patients compared with chronic adneqsitis (213 patients) - 90 (82%) patients; 67 (86%) patients; 162 (76%) patients. In case of concomitant diseases of liver and gold bladder, the treatment was effective in 113 (89%) patients. Ineffective treatment has been discovered in 5% 6 (5%) patients with hepatopathia and 28 (22%) patients with cholecistitis. The L-thyroxin was included in treatment in case of hypothyreosis (66 patients). Positive effect has been reached in 52 (78,5%) patients and progressive recovery was found in 13 (20%) patients. The complex therapy was effective for 648 (62%) of 1044 patients. Positive development was in 238 (27,8%) cases. In the group of patients who did not suffer concomitant diseases 4,9% has shown progress in treatment and 92,6% fully recovered.

The diagnosis and management of diabetic mastopathy.

Sclerosing lymphocytic lobulitis is strongly associated with type one diabetes, when it is then known as diabetic mastopathy. This very rare benign condition tends to present in premenopausal women, often with diabetic complications particularly retinopathy. Patients present with clinically suspicious fibrous breast lumps; these are commonly multiple, bilateral, and recurrent. Mammograms show asymmetric densities and no focal mass and ultrasound investigation tends to show ill-defined hypoechoic attenuation with strong posterior acoustic shadowing. Magnetic resonance imaging can be used to further differentiate the lesion from malignancy. However, a core biopsy or excisional biopsy is essential so that a pathologic diagnosis can be made. The constellation of pathologic findings is: lymphocytic lobulitis and ductitis with glandular atrophy, lymphocytic/mononuclear perivascular inflammation which is predominantly B-cell and dense often keloid-like fibrosis, with or without epithelioid-like fibroblasts. A review of the current literature on diabetic mastopathy was carried out as it was noted that there has been no recent review of the literature. Detailed Pubmed and other medical data base searches were carried out and all publications were considered, irrespective of language and date, wherever possible.

[Observation on therapeutic effects of red-hot needle therapy on nodules of breast of the type of stagnation of liver-qi and phlegm coagulation].

OBJECTIVE: To compare therapeutic effects of red-hot needle therapy and filiform needle therapy on nodules of breast of the type of stagnation of liver-qi and phlegm coagulation. METHODS: Six hundred cases were randomly divided into a treatment group and a control group, 300 cases in each group. The treatment group were treated with red-hot needle pricking at the proliferative parts and Ashi points as main, and the control group with filiform needle therapy. RESULTS: In the treatment group, 240 cases were cured, 58 cases improved and 2 cases were not cured with an effective rate of 99.3%; and in the control group, 113 cases were cured, 165 cases improved and 22 were not cured with an effective rate of 92.7%, with a significant difference between the two groups (P = 0.001). CONCLUSION: The therapeutic effect of red-hot needle therapy is better than that of filiform needle therapy on nodules of breast of the type of stagnation of liver-qi and phlegm coagulation.

Management of benign breast conditions. Part 2--breast lumps and lesions.

This is the second article in a series on breast disorders with an emphasis on diagnosis and management in the general practice setting. This article provides an overview of the investigation of patients with a breast symptom and discusses the assessment and management of benign breast lesions including localised nodularity, fibroadenomas and breast cysts.

Outcomes of sonography-based management of breast cysts.

BACKGROUND: Ultrasound is commonly used during diagnosis of breast lesions. Our purpose was to study the role of sonography for risk stratification of malignancy in the diagnosis and management of palpable breast cysts. METHODS: This was a cohort study of 176 patients with palpable breast cysts. Sonographic findings were correlated with clinical and pathologic outcomes. RESULTS: Mean cyst size was 2.0 +/- 1.8 cm. Cysts were simple, complex and probably benign, and complex and suspicious for neoplasm in 82.25%, 10.25% and 7.5% of patients, respectively. Thick cyst wall (P = 0.0001), mural tumor (P <0.00001), eccentric mass (P = 0.034), and internal septae (P = 0.031) were predictive of neoplasm. Of cysts >3 cm, 33% were cancerous (P = 0.000027). After 378 days of follow-up, 26 % of cysts had recurred. Recurrence was more frequent in patients with bilateral or multiple cysts (P = 0.004). CONCLUSIONS: Sonography is useful in risk stratification of malignancy in breast cysts. There is a high risk of recurrence after cyst aspiration.

Alterações funcionais benignas da mama: aspectos atuais ("displasia mamária") / Benign functional alterations of the breast

A alteração funcional benigna da mama é a patologia benigna mais freqüente e está intimamente relacionada à ansiedade e ao medo do câncer de mama. Acomete cerca de 70(por cento) das mulheres, 54(por cento) de mamas normais a autópsia, 34(por cento) de biópsias mamária e em 40(por cento) de todos cânceres de mama. Tem sido observada maior incidência nas pacientes de alto poder econômico. O diagnóstico é basicamente clínico e está relacionado à história de dor mamária pré-menstrual de caráter progressivo, ocupando todo o cicio, além da presença de vários "nódulos'. Ocorre na idade reprodutiva com pico entre mulheres de 30 e 40 anos. O quadro clínico passa obrigatoriamente por dor e nodularidade. O diagnóstico radiológico se restringe a mamografia e ao ultrasom sem alterações patológicas. A confirmação diagnóstica é dada pelo estudo anatomopatológico, através de punção aspirativa por agulha fína, trocarte e biópsias cirúrgicas. A principal conduta terapêutica é de afastar causa oncológica como responsável pela mastalgia, portanto o exame físico das mamas adicionadas aos exames subsidiáríos é obrigatório. Com a exclusão de processo neoplásico, 60(por cento) a 80(por cento) das pacientes têm remissão espontânea da dor. A presença de nodularidade deve ser tratada de acordo com o resultado anatomopatológico. A indicação de retirada da área somente tem indicação na vigência de díagnóstico duvidoso ou suspeito e até mesmo nos casos de refratariedade ao tratamento clínico. O tratamento medicamentoso utiliza várias drogas, tais como progesterona, drogas antiprolactinas, agentes antigonadotropinas, drogas competidoras com os receptores hormonais para estrogênio, uso de análogo de GNRH (goserelina), ácido gamalinoléico, restrição de metilxantinas, vitamina E, A e complexo 8, diuré- ticos e antiinflamatórios.

Cambios fibroquísticos de la mama. Hiperplasia epitelial / Breast fibrocystic changes. Epithelial hyperplasia

El término cambios fibroquísticos (CF) es un concepto histológico, sin traducción clínica ni radiológica específica, que agrupa diversos cambios y lesiones mamarias benignas, generalmente combinadas entre sí, que no llevan implícita la existencia de un proceso patológico. Esta entidad, a lo largo del tiempo ha recibido diferentes denominaciones, entre ellas la de mastopatía fibroquística y displasia mamaria. Los CF agrupan desde variantes morfológicas de la normalidad, hasta cambios que se consideran marcadores de riesgo para cáncer de mama, que suponen el 30 por ciento de los CF diagnosticados histológicamente. El riesgo para cáncer de mama está relacionado con la presencia de hiperplasia epitelial, de la que como veremos existen varios tipos. Por tanto, en el informe histológico debe constar si existe o no hiperplasia y el grado de la misma (AU)

[Breast cysts--diagnostic and therapeutic management and risk for subsequent development of breast carcinoma]. / Kisti na mlechnata zhleza--diagnostichno-lechebna taktika i riskove ot posledvashto razvitie na kartsinom na gurdata.

Cystic breast disease is a relatively widespread pathological condition in the female sex, it has an incidence of around 7% and predominantly affects women aged between 35 and 50 year old. The diagnosis is based on the standardised protocol including breast examination, mammography, fine-needle aspiration cytology and pneumocystography. While the majority of cysts can be managed by simple aspiration, a small percentage (0.3-1.4%) are malignant. The clinical and pathological features of 7 cases of intracystic carcinoma of the breast which are 0.73% of all cases of cystic breast disease between 1996-2001, are considered in the present article.