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1.
Adv Exp Med Biol ; 1252: 9-16, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32816257

RESUMO

Physical exam of the breast is a very important part of breast assessment both for breast cancer screening, and when approaching breast lesions. Examination during pregnancy and breastfeeding follows exactly the same method as non-pregnancy periods. However, physical changes that occur in the breast during these times due to hormonal effects cause alterations that can on one hand conceal some pathologic disorders, and may on the other hand appear as pathologic findings while being purely physiologic. This chapter focuses first on some key points for an accurate breast examination, and then reviews some challenging controversial findings that may be noticed during breast exam in a pregnant or lactating woman.


Assuntos
Doenças Mamárias/diagnóstico , Mama/anatomia & histologia , Mama/patologia , Lactação/fisiologia , Exame Físico , Mama/fisiologia , Doenças Mamárias/patologia , Aleitamento Materno , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/patologia , Feminino , Humanos , Gravidez
2.
Adv Exp Med Biol ; 1252: 27-32, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32816259

RESUMO

Breast tissue reveals some physiologic changes during pregnancy and lactation due to hormonal alterations. Whole range of breast diseases including inflammatory, benign and malignant neoplasms can be seen in pregnancy but due to concurrent physiologic changes, may lead to diagnostic challenges. This chapter reviews sampling methods and histologic features of common benign breast lesions in pregnancy and lactation periods.


Assuntos
Doenças Mamárias/patologia , Mama/citologia , Mama/patologia , Lactação/fisiologia , Complicações na Gravidez , Gravidez/fisiologia , Neoplasias da Mama/patologia , Feminino , Humanos
3.
Adv Exp Med Biol ; 1252: 33-39, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32816260

RESUMO

The breast tissue undergoes significant physiological change during pregnancy and lactation. These changes can give rise to some unique disorders during pregnancy , puerperium and lactation or exaggerate pre-existing conditions. Clinical examination becomes less reliable due to textural change and density of breast tissue as a result of hormonal changes. The main symptoms during pregnancy and lactation are breast pain, mastitis, lactational abscess, breast lump, and blood- stained nipple discharge.Lactational mastitis/ abscess must be treated without delay. Open incision and drainage of lactational abscess is rarely required, any lactational abscess should be treated with appropriate antibiotics and ultrasound guided aspiration of the pus.Any breast lump during pregnancy and lactation should be investigated with triple assessment. Pregnancy associated breast cancer (PABC ) must be ruled out. The choice of investigations and treatment needs careful consideration. While ultrasound is the investigation of choice, mammography can be performed with abdominal shielding if malignancy is suspected. Core biopsy is necessary for evaluation of any breast pathology but it comes with risk of infection, bleeding, hematoma and even milk fistula.The treating clinical specialist must be aware of certain unusual unique clinical conditions in pregnancy and lactation including accessory axillary breast tissue, gigantomastia and Raynaud's phenomenon.


Assuntos
Doenças Mamárias/diagnóstico , Doenças Mamárias/fisiopatologia , Lactação , Complicações na Gravidez , Abscesso , Mama , Doenças Mamárias/patologia , Aleitamento Materno , Feminino , Humanos , Mastite , Gravidez
4.
Medicine (Baltimore) ; 99(27): e21063, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629735

RESUMO

BACKGROUND: Overflow breast disease (OBD), also known as breast nipple discharge, refers fluid or liquid that comes out of nipple. Many patients with breast cancer experience such condition. However, it is not easy to detect it at early stage, especially for pathological OBD. Previous study found low-dose CT combined mammography (LDCTMG) could help in diagnosis of OBD. However, there is no systematic review investigating this issue. Therefore, this study will examine the accuracy of LDCTMG in diagnosis of OBD. METHODS: This study protocol will search literature sources in electronic databases and other sources. The electronic databases will be retrieved in The Cochrane Library, the Cochrane Register of Diagnostic Test Accuracy Studies, PUBMED, EMBASE, Web of Science, CINAHL, CNKI, and WANGFANG from inception to the present. We will also search other sources. All literature sources will be sought without restrictions to the language and publication status. Two researchers will independently carry out study selection, data extraction, and study quality assessment. Statistical analysis will be performed using RevMan 5.3. RESULTS: This study will exert a high-quality synthesis of eligible studies on the analysis of LDCTMG in diagnosis of OBD. CONCLUSIONS: The results of this study may provide evidence to help judge whether LDCTMG is accurate in diagnosis of OBD. STUDY REGISTRATION: INPLASY202050116.


Assuntos
Doenças Mamárias/diagnóstico por imagem , Mamografia/métodos , Derrame Papilar/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Doenças Mamárias/epidemiologia , Doenças Mamárias/patologia , Estudos de Avaliação como Assunto , Feminino , Humanos , Imagem Multimodal/métodos
6.
Anticancer Res ; 40(4): 2185-2190, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32234913

RESUMO

BACKGROUND/AIM: The study aimed at investigating the correlation between ductoscopic and histopathological findings and clarify whether the former allow for accurate prediction of malignancy. PATIENTS AND METHODS: The prospective national multi-center study covered a sample of 224 patients with pathologic nipple discharge. A total of 214 patients underwent ductoscopy with subsequent extirpation of the mammary duct. The ductoscopic findings were categorized according to shape, number, color and surface structure of lesions and vascularity and compared to the histological results and analyses. RESULTS: Ductoscopy revealed lesions in 134 of 214 patients (62.2%). The criteria "multiple versus solitary lesion" differed significantly between malignant and benign lesions. All other criteria were not statistically significant. Malignant tumors were more frequently presented as multiple lesions, benign lesions or masses as solitary lesions (80% vs. 24.8%; p=0.018). CONCLUSION: The ductoscopic criterion "solitary vs. multiple lesion" appears to have a low diagnostic prediction of malignancy or benignity.


Assuntos
Doenças Mamárias/diagnóstico , Neoplasias da Mama/diagnóstico , Carcinoma Intraductal não Infiltrante/diagnóstico , Endoscopia/métodos , Derrame Papilar , Mamilos/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Mamárias/metabolismo , Doenças Mamárias/patologia , Neoplasias da Mama/metabolismo , Neoplasias da Mama/patologia , Carcinoma Intraductal não Infiltrante/metabolismo , Carcinoma Intraductal não Infiltrante/patologia , Diagnóstico Diferencial , Feminino , Alemanha , Humanos , Pessoa de Meia-Idade , Mamilos/metabolismo , Estudos Prospectivos , Adulto Jovem
8.
Br J Radiol ; 93(1110): 20190932, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32216631

RESUMO

OBJECTIVE: This study aimed to compare the diagnostic performance of contrast-enhanced ultrasound (CEUS), MRI, and the combined use of the two modalities for differentiating breast lesions of different sizes. METHODS: A total of 406 patients with 406 solid breast masses detected by conventional ultrasound underwent both CEUS and MRI scans. Histological results were used as reference standards. The lesions were categorized into three groups according to size (Group 1, ≤ 20 mm; Group 2, > 20 mm, Group 3: total lesions). Sensitivity, specificity, accuracy, and receiver operating characteristic (ROC) curve analysis were used to assess the diagnostic performance of these imaging methods for breast lesions. RESULTS: There were 194 benign and 212 malignant breast lesions according to the histological diagnosis. Compared with MRI, CEUS demonstrated similar sensitivity in detecting breast cancer (p = 1.0000 for all) in all the three groups. With regard to specificity, accuracy, and the area under the ROC curve (Az) values, MRI showed a better performance than that shown by CEUS (p <0.05 for all), and the combination of the two modalities improved the diagnostic performance of CEUS alone significantly (p <0.05 for all) in all the three groups. However, the diagnostic specificity and accuracy of the combined method was not superior to that of MRI alone except for Group 2. CONCLUSION: CEUS demonstrated good sensitivity in detecting breast cancer, and the combined use with MRI can optimize the diagnostic specificity and accuracy in breast cancer prediction. ADVANCES IN KNOWLEDGE: Few studies have compared the diagnostic efficacy of CEUS and MRI, and this study is the first attempt to seek out the diagnostic values for breast lesions of variable sizes (lesions with ≤20 mm and >20 mm).


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Meios de Contraste , Imagem por Ressonância Magnética/métodos , Ultrassonografia Mamária/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Mamárias/diagnóstico por imagem , Doenças Mamárias/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Imagem Multimodal/métodos , Curva ROC , Estudos Retrospectivos , Sensibilidade e Especificidade , Carga Tumoral , Adulto Jovem
9.
Mymensingh Med J ; 29(1): 48-54, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31915335

RESUMO

One-fourth of all women suffer from breast disease in their lifetime. World Health Organization estimated that over 508,000 women died in 2011 due to breast cancer worldwide.For several years, fine needle aspiration cytology (FNAC) was the most practiced method for the pathological diagnosis of breast lump specially differentiation of benign from malignant. The advent of core needle or True-Cut biopsy (TCB) in the new millennium has resulted in many surgeons switching to TCB since it provides a sufficient amount of tissue for pathologists to make an accurate histological diagnosis.During the study period, patients present with clinically palpable breast lump admitted in different surgicalunits of MMCH, among them 100 patients selected purposively. Then a prospective comparative study was carried out in the Department of Surgery, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from September 2017 to February 2018. Out of a total of 100 patients, who presented with suspicious breast lump, as clinically diagnosed 68 patients had benign breast lump and 32 patients had malignant breast lump. FNAC confirmed the diagnosis of breast carcinoma in 27 patients with sensitivity 89.65% and specificity 66.66%. True-cut biopsy confirmed the diagnosis of breast carcinoma in 29 patients with sensitivity 96.66% and specificity 100%. It also gave the definitive histological type and grade which correlated with the final histopathology report in 29 out of the 30 patientsTCB also provides adequate tissue for the evaluation of molecular markers which have extreme therapeutic value.


Assuntos
Biópsia por Agulha/métodos , Biópsia/métodos , Doenças Mamárias/patologia , Neoplasias da Mama/patologia , Mama/patologia , Carcinoma/patologia , Adulto , Bangladesh/epidemiologia , Biópsia por Agulha Fina , Neoplasias da Mama/epidemiologia , Carcinoma/epidemiologia , Feminino , Humanos , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Sensibilidade e Especificidade
10.
AJR Am J Roentgenol ; 214(2): 276-281, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31825259

RESUMO

OBJECTIVE. Historically, management recommendations for multiple bilateral circumscribed breast masses encountered with breast imaging have varied. This article reviews the evidence and provides best-practice recommendations for managing these masses. CONCLUSION. Meticulous imaging technique and interpretation are required to correctly diagnose multiple bilateral circumscribed breast masses. Radiologists should classify such masses identified at mammography, digital breast tomosynthesis, or bilateral whole-breast sonography as benign and recommend annual follow-up. Elucidating the significance of these masses on MRI, contrast-enhanced mammography, or nuclear breast imaging requires further study.


Assuntos
Doenças Mamárias/diagnóstico por imagem , Neoplasias da Mama/diagnóstico por imagem , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Biópsia com Agulha de Grande Calibre , Doenças Mamárias/patologia , Neoplasias da Mama/patologia , Diagnóstico Diferencial , Feminino , Humanos , Neoplasias Primárias Múltiplas/patologia
11.
Clin Imaging ; 59(2): 144-147, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31816541

RESUMO

Delayed onset breast implant-associated reactions range widely in symptomatology and underlying etiology. With increasing reports of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), findings such as unilateral breast swelling, capsular thickening, and peri-implant fluid raise concern. Synovial metaplasia is a benign histologic finding commonly associated with implant capsules and can be an unusual cause of such symptoms. Though the clinical significance of synovial metaplasia is unknown, it is important to consider this entity in the differential diagnosis for delayed onset breast symptoms, with signs otherwise concerning for BIA-ALCL or infection.


Assuntos
Implantes de Mama , Neoplasias da Mama , Mama/diagnóstico por imagem , Mama/patologia , Linfoma Anaplásico de Células Grandes , Doenças Mamárias/diagnóstico por imagem , Doenças Mamárias/patologia , Diagnóstico Diferencial , Feminino , Humanos , Imagem por Ressonância Magnética , Mamografia , Metaplasia , Pessoa de Meia-Idade , Ultrassonografia Mamária
12.
Am J Surg Pathol ; 44(1): 68-76, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31403965

RESUMO

Papillary lesions of the male breast (PLMB) are uncommon. To date, PLMB have been reported as individual case reports and in relatively small series. We reviewed cases of PLMB diagnosed at our medical center over a 19-year (2000-2019) period. A total of 117 cases were identified, with an age range of 7 months to 88 years. These cases included 3 of papillary ductal hyperplasia, 5 intraductal papillomas, 1 adenomyoepithelioma, 5 atypical papillomas (ie, papillomas with atypia), 51 papillary ductal carcinoma in situ, 14 encapsulated papillary carcinomas, 38 solid papillary carcinomas, and 8 invasive papillary carcinomas. Malignant papillary neoplasms, including invasive and noninvasive ones, had a mean size of 1.3 cm (range: 0.3 to 4.4 cm), and all were ER and HER2. Fifty-four percent (19/35) of carcinomas were treated with excision alone, 46% (16/35) underwent mastectomy, and 63% (22/35) had axillary lymph node sampling. Only one case had metastatic involvement of axillary lymph nodes. Of the cases with follow-up, no (0/8) invasive carcinoma showed distant metastasis or proved fatal, and no (0/23) noninvasive papillary carcinoma recurred. Two notable cases of PLMB were encountered: one of a 7-month-old boy with NF1 mutation and florid papillary hyperplasia, and another of a 57-year-old man with Klippel-Feil syndrome and bilateral solid papillary carcinoma, invasive and oligometastatic on one side and noninvasive on the other. On the basis of this study of PLMB cases, the largest to date, and review of literature, we conclude that PLMB span a broad clinicopathologic spectrum, and that both invasive and noninvasive papillary carcinomas have relatively good prognosis.


Assuntos
Doenças Mamárias/patologia , Neoplasias da Mama Masculina/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Mamárias/cirurgia , Neoplasias da Mama Masculina/cirurgia , Criança , Pré-Escolar , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
14.
Breast Cancer Res ; 21(1): 136, 2019 12 04.
Artigo em Inglês | MEDLINE | ID: mdl-31801635

RESUMO

BACKGROUND: Available data proving the value of DWI for breast cancer diagnosis is mainly for enhancing masses; DWI may be less sensitive and specific in non-mass enhancement (NME) lesions. The objective of this study was to assess the diagnostic accuracy of DWI using different ROI measurement approaches and ADC metrics in breast lesions presenting as NME lesions on dynamic contrast-enhanced (DCE) MRI. METHODS: In this retrospective study, 95 patients who underwent multiparametric MRI with DCE and DWI from September 2007 to July 2013 and who were diagnosed with a suspicious NME (BI-RADS 4/5) were included. Twenty-nine patients were excluded for lesion non-visibility on DWI (n = 24: 12 benign and 12 malignant) and poor DWI quality (n = 5: 1 benign and 4 malignant). Two readers independently assessed DWI and DCE-MRI findings in two separate randomized readings using different ADC metrics and ROI approaches. NME lesions were classified as either benign (> 1.3 × 10-3 mm2/s) or malignant (≤ 1.3 × 10-3 mm2/s). Histopathology was the standard of reference. ROC curves were plotted, and AUCs were determined. Concordance correlation coefficient (CCC) was measured. RESULTS: There were 39 malignant (59%) and 27 benign (41%) lesions in 66 (65 women, 1 man) patients (mean age, 51.8 years). The mean ADC value of the darkest part of the tumor (Dptu) achieved the highest diagnostic accuracy, with AUCs of up to 0.71. Inter-reader agreement was highest with Dptu ADC max (CCC 0.42) and lowest with the point tumor (Ptu) ADC min (CCC = - 0.01). Intra-reader agreement was highest with Wtu ADC mean (CCC = 0.44 for reader 1, 0.41 for reader 2), but this was not associated with the highest diagnostic accuracy. CONCLUSIONS: Diagnostic accuracy of DWI with ADC mapping is limited in NME lesions. Thirty-one percent of lesions presenting as NME on DCE-MRI could not be evaluated with DWI, and therefore, DCE-MRI remains indispensable. Best results were achieved using Dptu 2D ROI measurement and ADC mean.


Assuntos
Doenças Mamárias/diagnóstico por imagem , Doenças Mamárias/patologia , Meios de Contraste , Imagem de Difusão por Ressonância Magnética , Aumento da Imagem , Adulto , Idoso , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Imagem de Difusão por Ressonância Magnética/métodos , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
15.
BMJ Case Rep ; 12(12)2019 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-31843777

RESUMO

Mondor's disease (MD) is a rare disease characterised by thrombophlebitis of superficial veins in the body. We describe a case of a 28-year-old woman with a painful cord-like lesion of the right breast (3 cm) overlying the right upper quadrant. The patient was recently prescribed metformin and oral contraceptive pills for symptomatic polycystic ovarian syndrome. Right breast ultrasound showed a tubular anechoic structure with several areas of narrowing, resembling a beaded appearance. The patient was diagnosed with MD associated with use of oral contraceptive pills. We recommended the patient to discontinue oral contraceptive because discontinuation of the causative drug is important. The patient was started on topical non-steroidal anti-inflammatory drugs and a therapeutic dose of enoxaparin. The patient showed significant clinical improvement after 5 days. At 6-week outpatient follow-up, complete resolution of the disease was noted.


Assuntos
Doenças Mamárias/induzido quimicamente , Anticoncepcionais Orais Combinados/efeitos adversos , Tromboflebite/induzido quimicamente , Adulto , Anti-Inflamatórios não Esteroides/administração & dosagem , Doenças Mamárias/diagnóstico por imagem , Doenças Mamárias/tratamento farmacológico , Doenças Mamárias/patologia , Anticoncepcionais Orais Combinados/farmacologia , Feminino , Heparina de Baixo Peso Molecular/administração & dosagem , Humanos , Tromboflebite/diagnóstico por imagem , Tromboflebite/tratamento farmacológico , Tromboflebite/patologia , Ultrassonografia
16.
Arch Pathol Lab Med ; 143(12): 1497-1503, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31765251

RESUMO

CONTEXT.­: Cellular spindled histiocytic pseudotumor (CSHPT) is an exuberant, dense histiocytic proliferation seen in the setting of mammary fat necrosis. CSHPT has a broad histologic differential diagnosis, including benign, malignant, and inflammatory etiologies. OBJECTIVES.­: To highlight the most important histologic and immunohistochemical findings of CSHPT and provide comparisons to entities within the broad differential diagnosis. DATA SOURCES.­: Recently published literature regarding CSHPT and other diagnostic considerations. CONCLUSIONS.­: CSHPT is a benign histiocytic proliferation with a broad differential diagnosis, for which comprehensive ancillary studies may be required to exclude malignant and infectious entities.


Assuntos
Doenças Mamárias/diagnóstico , Doenças Mamárias/patologia , Neoplasias da Mama/diagnóstico , Necrose Gordurosa/patologia , Histiócitos/patologia , Neoplasias da Mama/patologia , Diagnóstico Diferencial , Feminino , Humanos
17.
Tokai J Exp Clin Med ; 44(4): 73-79, 2019 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-31768994

RESUMO

A 49-year-old woman, with a medical history of rheumatism, was admitted to our hospital with chief complaints of bilateral enlargement and redness of breasts. She underwent weekly breast examinations. Mammography findings were reported as category 3 for both breasts. Breast ultrasonography, magnetic resonance imaging, and chest contrast computed tomography revealed a massive tumor in the left BD region, however, there were no findings for suspected malignancy. Needle biopsy did not yield histologically malignant cells in both breasts. Mammary interstitium was edematous, and capillary-like slit structures were observed. The stroma stained with alcian blue and destained with hyaluronidase treatment. Since the stroma tested positive for vimentin, calponin, and CD34 and negative for CD31, the patient was diagnosed as (PASH). Because both breasts had similar diagnosis based on histopathologic findings, bilateral mastectomy was performed. Details about the origin of bilateral PASH are unknown but it may be related to the development of rheumatoid arthritis. Additionally, systemic autoimmune diseases like rheumatism may be the reason for repeated contraction and enlargement of PASH.


Assuntos
Angiomatose/diagnóstico por imagem , Angiomatose/patologia , Doenças Mamárias/diagnóstico por imagem , Doenças Mamárias/patologia , Hiperplasia/diagnóstico por imagem , Hiperplasia/patologia , Angiomatose/complicações , Angiomatose/cirurgia , Artrite Reumatoide/complicações , Doenças Mamárias/complicações , Doenças Mamárias/cirurgia , Feminino , Humanos , Hiperplasia/complicações , Hiperplasia/cirurgia , Imagem por Ressonância Magnética , Mamografia , Mastectomia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Ultrassonografia Mamária
18.
An Bras Dermatol ; 94(5): 549-552, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31777355

RESUMO

BACKGROUND: Nipple eczema is a less common presentation of atopic dermatitis. No studies in the literature have correlated nipple eczema in pregnancy as a manifestation of atopic dermatitis. OBJECTIVE: To evaluate whether nipple eczema presenting in pregnancy is a manifestation of atopic dermatitis. METHODS: This was a prospective observational study including 100 women who presented with nipple eczema for the first time during pregnancy. The exclusion criteria were any patient with previous history of nipple eczema, those already on oral or topical treatment for atopic dermatitis or nipple eczema, and other disorders mimicking eczema. Patients were divided into two groups ‒ nipple eczema with atopic dermatitis and without atopic dermatitis. Demographic data, clinical features, total leukocyte count, differential leukocyte count, absolute eosinophil counts, and serum IgE levels were compared between the two groups to detect association between nipple eczema in pregnancy and atopic dermatitis. RESULTS: Out of 100 patients, 39 were diagnosed with atopic dermatitis, whereas 61 were ruled out to have any features suggestive of atopic dermatitis. There were no statistically significant differences in mean age, mean duration of symptoms, and serum IgE levels. In patients with atopic dermatitis, bilateral symptoms were noted more commonly than in patients without the disease, but this was statistically insignificant. STUDY LIMITATIONS: Lack of long term follow-up and no large studies in literature to compare results. CONCLUSION: Nipple eczema in pregnancy follows a similar pattern as in other age groups. The clinical profile of patients is similar in cases with and without atopic dermatitis.


Assuntos
Doenças Mamárias/patologia , Dermatite Atópica/patologia , Eczema/patologia , Mamilos/patologia , Complicações na Gravidez/patologia , Adulto , Doenças Mamárias/sangue , Doenças Mamárias/diagnóstico , Dermatite Atópica/sangue , Dermatite Atópica/diagnóstico , Eczema/sangue , Eczema/diagnóstico , Feminino , Humanos , Imunoglobulina E/sangue , Índia , Contagem de Leucócitos , Neutrófilos , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/diagnóstico , Trimestres da Gravidez , Estudos Prospectivos
19.
Pathol Res Pract ; 215(12): 152699, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31708371

RESUMO

Amyloidosis is characterized by extracellular deposition of insoluble protein fibrils in a beta-pleated sheet configuration. Breast amyloidosis is a rare entity which has previously been reported to present with localized involvement, or as a late manifestation of systemic amyloidosis. However, descriptions of the clinicopathologic features of localized breast amyloidosis remain limited. A retrospective search for breast amyloidosis diagnosed at our institution yielded 10 cases of breast amyloidosis. All patients were female, with a mean age of 69. Median follow-up for survival or progression was 13 months. Indications for breast or axilla biopsy included mammographic calcifications, mass, and axillary lymphadenopathy. Amyloid showed positive staining with Congo red in all cases, and amyloid typing revealed light chain lambda in 3 cases, amyloid transthyretin in 2 cases, light chain kappa in 1 case, and iatrogenic insulin-derived amyloidosis in 1 case. Amyloid occurred within axillary lymph nodes and alongside both benign and neoplastic breast tissue, including atypical ductal hyperplasia, lobular carcinoma in situ and ductal carcinoma in situ. Most cases were associated with predisposing clinical conditions, including autoimmune disease in 4 cases, B cell lymphomas in 2 cases, and diabetes mellitus treated with insulin in 1 case. In contrast to previously published case series, no patient had clinical evidence of systemic amyloidosis. Amyloidosis of the breast should be considered in the differential diagnosis of all mammographic calcifications and masses of the breast or axilla. When recognized correctly on biopsy, the diagnosis of amyloidosis can not only prevent further unnecessary surgical interventions due to radiology-pathology discordance, but initiate the necessary amyloidosis work-up. Although rare, an awareness of the clinicopathologic characteristics of this easily overlooked entity is of great importance for every practicing pathologist reviewing breast biopsies.


Assuntos
Amiloidose/patologia , Doenças Mamárias/patologia , Neoplasias da Mama/patologia , Calcinose/patologia , Linfadenopatia/patologia , Idoso , Idoso de 80 Anos ou mais , Amiloide/análise , Amiloidose/etiologia , Amiloidose/metabolismo , Biópsia , Doenças Mamárias/etiologia , Doenças Mamárias/metabolismo , Calcinose/etiologia , Calcinose/metabolismo , Diagnóstico Diferencial , Feminino , Humanos , Linfadenopatia/etiologia , Linfadenopatia/metabolismo , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
20.
Ann Diagn Pathol ; 43: 151407, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31634810

RESUMO

Core needle biopsy (CNB) is the most common sampling technique for the histologic evaluation of breast abnormalities. Diagnosing benign proliferative, borderline and some in-situ lesions in CNB is challenging and subject to a significant degree of interobserver variability. In addition, due to the inherent limitations of CNB, "upgrading" to a more significant pathology at excision is an important consideration for some lesions. Pathologists carry a major responsibility in patient diagnosis, risk stratification and management. Familiarity with the histologic features and the clinical significance of these common and problematic lesions encountered in CNB is necessary for adequate treatment and patient follow-up. This review will focus on benign, atypical and in-situ epithelial proliferations, papillary lesions, radial sclerosing lesions, adenosis and cellular fibroepithelial lesions. Highlights of histologic features, useful strategies for accurate diagnosis, basic immunohistochemistry and management will be presented.


Assuntos
Biópsia com Agulha de Grande Calibre/normas , Doenças Mamárias/patologia , Neoplasias da Mama/patologia , Mama/patologia , Imuno-Histoquímica/métodos , Adulto , Assistência ao Convalescente , Idoso , Idoso de 80 Anos ou mais , Mama/ultraestrutura , Doenças Mamárias/metabolismo , Neoplasias da Mama/metabolismo , Neoplasias da Mama/ultraestrutura , Carcinoma Intraductal não Infiltrante/metabolismo , Carcinoma Intraductal não Infiltrante/patologia , Carcinoma Intraductal não Infiltrante/cirurgia , Diagnóstico Diferencial , Feminino , Doença da Mama Fibrocística/patologia , Indicadores Básicos de Saúde , Humanos , Hiperplasia/patologia , Pessoa de Meia-Idade , Variações Dependentes do Observador , Patologistas/ética , Prognóstico
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