[Radio-histological correlation of ACR4 microcalcifications in breast lesions: about 181 cases and literature review]. / Corrélation radio-histologique des lésions mammaires ACR4: à propos de 181 cas et revue de la littérature.

The Bi-RADS (Breast Imaging Reporting and Data System) classification developed by the ACR (American College of Radiology) is the classification system for radiological images recommended for breast cancer screening. The ACR 4 microcalcification is an indeterminate or suspected abnormality with 2-95% probability of malignancy, according to studies. This disparity pushed us to conduct this retrospective study of 181 patients in the Department of Obstetrics and Gynecology I at the Hassan II University Hospital, Fez, over a period of 5 years. This study aimed to report the histological results of breast lesions radiologically classified as ACR4 in order to assess their radio-histological correlation and to improve therapeutic approach. All patients underwent breast imaging examinations and then anatomopathologic examination was performed using different techniques. There was a clear predominance of benign lesions with a rate of 62% versus 29% of malignant lesions and only 9% were intermediate lesions. Adenofibroma was the most common histological finding (30% of cases), invasive ductal carcinoma was the most frequent malignant lesion (17% of cases). We performed a literature review which showed that our results were in line with findings of other studies, with a positive predictive value of 29%. Nevertheless, ACR classification divided into subcategories 4a, b and c should be used due to the significant number of unnecessary surgical interventions.

Benign and malignant breast tumours: epidemiological similarities.

Reproductive risk factors were estimated for 783 cases of cystic disease of the breast, 155 fibroadenoma, 94 miscellaneous breast conditions, and 284 breast cancers. Controls were matched for age, race, ever-married status, time of hospitalization and pay status. The most consistent attributes are a tendency to be still premenopausal, to have had her first pregnancy beyond the age of twenty-five years (or to have had none), and to have had fewer total pregnancies than the control. All are associated with a longer menstrual life prior to onset of the disease than the controls. Findings for cystic disease are compared with other studies. Patients with benign breast disease share some of the demonstrated risk factors for breast cancer.

Cigarette smoking and benign breast disease.

The association between cigarette smoking and the occurrence of benign breast disease was assessed in a hospital-based case-control study conducted in Connecticut during 1979-81. Current smokers, but not former smokers, were at reduced risk for all benign breast diseases. The odds ratios associated with current smoking were 0.7 (95% confidence intervals = 0.6, 0.9) for fibrocystic breast disease, 0.6 (95% confidence intervals = 0.5, 0.9) for fibroadenoma, 0.6 (95% confidence intervals = 0.4, 1.0) for fibrocystic breast disease concomitant with fibroadenoma, and 0.6 (95% confidence intervals = 0.5, 0.9) for other benign breast disease. Adjustments for potentially confounding variables, including indices of medical care utilisation, affected these odds ratios only slightly. There was no convincing evidence of an association, either negative or positive, between current cigarette smoking and the degree of epithelial atypia of the fibrocystic lesions. However, the negative association between fibrocystic disease and current cigarette smoking was strongest for atypical lobular hyperplasia, which in turn has been associated with a particularly elevated risk of subsequent breast cancer.

Breast masses in adolescent patients in Trinidad.

In our study, fibroadenoma was the most common breast mass found in adolescent girls. The frequency of mammary dysplasia seems to increase with age. There was one case of granular cell tumor of the breast and an unusual case of metastatic ovarian carcinoma presenting as a breast mass.

Analysis of benign breast lesions in blacks.

A clinicopathologic analysis of 202 benign breast lesions in black women is presented. The study shows that the peak incidence of fibroadenoma occurs at an earlier age in black than in white patients. Fibrocystic disease is most frequent in both black and white patients between 25 and 45 years of age. It is noteworthy that nulliparous adolescent blacks have a higher risk of fibroadenoma developing and our findings confirm the observation made by Funderburk et al [5] and Nigro and Organ [6] that the incidence of fibroadenoma in blacks is high. The low incidence of fibrocystic disease in our patients does not reflect the clinical incidence of the disease because most patients with fibrocystic disease do not undergo biopsy. We are unable to draw any conclusions about the relation between the use of oral contraceptives and the incidence of benign breast disease. In conclusion, a review of the literature and an analysis of our data suggest a relatively higher incidence of fibroadenoma among black patients. In contrast to the finding in the white population, it appears that in blacks fibroadenoma is more common than carcinoma of the breast.

PIP: The pathologic diagnosis of 282 consecutive breast lesions seen in 255 black patients over a 3-year period (January 1975-December 1977) at Harlem Hospital Center were reviewed and analyzed. The most common lesion was fibroadenoma, accounting for 34.7% of all lesions and 48% of benign breast lesions, followed by carcinoma (28%) and fibrocystic disease (17%). Other major benign breast lesions in order of frequency were intraductal papilloma, sclerosing adenosis, chronic mastitis, and fat necrosis. One each of the following rare lesions was observed: papillomatosis, ducatal ectasia, cystosarcoma phylloides, and granular cell tumor. Multiple lesions were found in 1 or both breasts in 15% of all benign breast disease cases, with fibroadenoma being the most common lesion. 94% of the patients presented with a breast mass, 5% with nipple discharge, 5% with pain, and 2% with a history of trauma to the breast. The lesions varied in size from 0.5-10 cm, and had been present for a few days to 20 years before medical treatment was sought. The upper quadrant of the breast was the most common site for lesions. Peak age incidence for all benign breast lesions was 20-35 years; for fibroadenoma, peak age incidence was 16-25 years and for fibrocystic disease, 40-50 years. The surgical literature shows that in a predominantly white population, peak age of incidence for benign lesions is 30-49 years; this disparity in age distribution may be due to the high percentage of adolescent patients with fibroadenoma in the Harlem Hospital series. Median age of patients with breast carcinoma in this series is 61 years. 24 patients (13.7%) with benign breast disease had taken oral contraceptives before the breast biopsies were performed. However, the study population is to small and follow-up time to short to draw any conclusion regarding the relation of oral contraceptive use to the subsequent development of breast cancer. This study shows that compared to the white population, fibroadenoma is more frequent than cancer in black women while cancer is more frequent than fibroadenoma in white women.

Adolescent breast masses.

A retrospective experience with breast masses in 143 female and 22 male adolescents is reviewed: 104 females (71.7 per cent) had fibroadenomas and 1 (0.7 per cent) adenocarcinoma; all 22 males had gynecomastia. The significance of these findings is related to surgical therapy.

Adolescent breast masses in Nigerian Igbos.

In the Igbos of Nigeria, most adolescent breast masses were due to gynecomastia in males and to fibroadenoma in females. The peak ages for both diseases differed from those reported in a recent American series. An exotic finding was a mammary mass due to onchocerca worms. Curiously, there were as many as two cases of a rare tumor, namely, alveolar soft part sarcoma.

Fibroadenomatosis (fibroadenomatoid mastopathy): a benign breast lesion with composite pathologic features.

A benign breast lesion with the composite histologic features of a fibroadenoma and fibrocystic changes has been referred to previously as fibroadenomatosis or fibroadenomatoid mastopathy; this lesion is distinct from the typical well circumscribed fibroadenoma that may have fibrocystic changes. The purpose of our study was to ascertain the frequency of this change among 200 consecutive breast biopsies and excisions with a coded pathologic diagnosis of fibroadenoma and/or "fibrocystic disease"; we identified these changes in 23 (11.5%) specimens. The lesion was characterized by microscopic fibroadenomatoid foci intermingled with dilated ducts, epitheliosis, and adenosis. It is suggested that fibroadenomatosis is yet another pattern in the complex morphologic spectrum known as benign proliferative breast disease. From our experience, this particular lesion was often appreciated as a unique finding, but the appropriate diagnostic designation was in question. The natural history of fibroadenomatosis is essentially unknown. It may represent a morphologic stage in the development of fibroadenoma(s).

[Signal characteristics of malignant and benign lesions in dynamic 2D-MRT of the breast]. / Signalverhalten maligner und benigner Läsionen in der dynamischen 2D-MRT der Mamma.

In a retrospective study of 400 dynamic MR examinations of the breast the signal/time ratio of 62 histopathologically correlated lesions (19 benign, 42 malignant) was evaluated. Points of evaluation were initial signal enhancement (1st and 2nd minute), post-initial signal appearance (2nd to 5th minute) and signal distribution (homogeneous, marginal). Based on these criteria, a point system was defined to help in the assessment of lesions in dynamic breast-MR imaging. The overall sensitivity of this method was 95.3%, the specificity to 89.5% and the accuracy to 93.5%. Pitfalls resulted in two cases of non-invasive carcinoma and in two patients with fibroadenoma.

[Whole body positron emission tomography in breast cancer]. / Ganzkörper-Positronen-Emissions-Tomographie beim Mammakarzinom.

The value of whole body positron emission tomography using F-18 2-deoxy-2-fluoro-d-glucose in primary work-up and follow-up was prospectively evaluated in 37 patients with primary or metastatic breast cancer. From 20 primary breast masses 15 from 16 malignant and 4 from 4 benign lesions confirmed by biopsy, were detected. In 3 out of 21 patients in correlation to morphologic imaging, respectively biopsy, no metastatic disease was not identified. Generally speaking, whole body positron emission tomography appears to be a suitable diagnostic staging tool in breast cancer.

Occurrence of breast carcinoma within a fibroadenoma. A review.

Sixty-two cases of carcinoma within a breast fibroadenoma are adequately documented in the literature, including the present case. All are found in women. The mean age of occurrence is 42.4 years. This corresponds to the peak age of lobular in situ breast cancer but is much higher than the peak age for breast fibroadenomas. Sixty-five percent of patients harboring cancer within a fibroadenoma have lobular in situ malignant neoplasms. In 42% of the cases the surrounding breast tissue is also involved by cancer, a fact that dictates generous surgical margination of all fibroadenomas excised, especially in older women. The data indicate that the presence of the fibroadenoma is a parameter independent of the development of cancer in either the ipsilateral or contralateral breast and does not influence the clinical course of the malignant neoplasm, other than that it contributes to its earlier detection. Treatment should follow the general principles of therapy for the in situ or infiltrative breast cancers.

Papillary and metanephric adenomas of the kidney.

Papillary renal adenomas are the commonest neoplasms of the renal tubular epithelium, occurring in up to 40% of adults. If these criteria are met, the diagnosis of adenoma can be made with confidence: (1) papillary, tubular, or tubulopapillary architecture; (2) diameter less than or equal to 5 mm; and (3) does not histologically resemble clear cell, chromophobe, or collecting duct renal cell carcinomas. They are composed of epithelial cells with variable amounts of cytoplasm with variable tinctorial qualities including clear. Metanephric adenoma and metanephric adenofibroma are closely related neoplasms that appear to be benign. Although they have a morphological resemblance to Wilms' tumor, there is some genetic evidence relating them to papillary adenoma and papillary renal cell carcinoma. Metanephric adenoma and metanephric adenofibroma occur at all ages, have a 2:1 predominance of female patients, and are associated with polycythemia. No instance of malignant behavior has been reported. The adenomatous component is composed of uniform small cells arranged in tubular or papillary architectural patterns. The fibromatous component is moderately cellular and composed of bland spindle cells.

Fibroadenoma of the female breast: a critical clinical assessment.

In a study of 70 patients with 75 histologically proven fibroadenomas of the breast, a biphasic peak incidence was recorded, initially in their late 20s to early 30s with a second unexpected peak in their late 40s to early 50s. These lesions averaged 2.8 cm in diameter, two thirds were located in the lateral quadrants of the breast, and 10 percent were multiple. There was a significantly higher incidence among nonwhite than white women when compared to census figures and hospital admission data. The corrected recurrence rate was 17 percent. An inordinately high number of patients under 40 years of age in this series were nonwhite. Family history demonstrates a significantly high incidence of breast disease of all types in first-degree relatives.

Benign breast lesions.

A review of 52 unselected cases of benign breast masses operated on at the University College Hospital Ibadan, showed that fibroadenoma was the most common benign lesion found, followed by fibrocystic disease of the breast. Fibroadenoma is most common in the second and third decades of life, usually in nulliparous young women, whereas fibrocystic disease is most common in the fifth decade, usually in parous women. Benign breast lesions are more common in the left breast than the right, and the most common location is the upper outer quadrant.

Clinical diagnosis of breast cancer.

Breast cancer is the most common malignant neoplasm in women, and 6% will develop it during their normal life expectancy. There is a group who have a high risk of developing breast cancer. The recent improvement in cure rates seems to be jue chiefly to earlier diagnosis rather than to improved methods of therapy. The physician, by careful periodic breast examinations and by the judicious use of diagnostic aids such as mammography and thermography, especially in the high risk group, has a golden opportunity to pick up cancer in a localized stage where the prognosis for cure with appropriate therapy is excellent. A tentative diagnosis of breast cancer (Table XI) can be made with a fair degree of accuracy by taking a careful history, utilizing and combining available statistics about the frequency, median age, characteristic symptom complexes of the common breast lesions and factors related to a high mammary carcinoma risk, and by a systematic and thorough breast examination supplemented with diagnostic aids when appropriate. However, biopsy and histologic examination is mandatory in all patients with a) true, three dimentional, dominant lumps even if diagnostic aids are negative except for cysts which can be safely aspirated under controlled conditions; b) suspicious lesions found by diagnostic aids even though there are no clinical findings; c) serous, serosanguineous, bloody, or watery nipple discharge; and d) other signs of cancer, i.e. eczema of the nipple, axillary adenopathy, etc., in order to determine with absolute accuracy whether the lesion is benign or malignant.

Multiple fibroadenomas of the breast: a problem of uncertain incidence and management.

A case is presented of multiple fibroadenomas of the breasts in a young Caucasian woman followed over a period of 10 years. A total of 22 individual lesions have been identified. Review of the literature gives little guidance regarding incidence, natural history and management of this condition. It is proposed that a register be set up to obtain basic data on this rare condition. The authors would be willing to collate cases submitted to such a register.

Fibroadenomatoid mastopathy: another distractive breast lesion?

Although most anatomical pathologists have encountered breast lesions with the composite histological features of fibroadenoma (FA) and fibrocystic change (FC), referred to as fibroadenomatosis or fibroadenomatoid mastopathy (FAM), little is known about its prevalence or clinico-pathological significance. In a retrospective histological review of 400 consecutive breast lesions, among both East and West Malaysians, coded either as FA or FC in the files of the Department of Pathology, University of Malaya, we found 45 (11.3%) cases of FAM. Typically, FAM lesions showed fibroadenomatoid foci in a background of fibrocystic change. The finding of FAM among lesions coded as FC was higher (18.5%) than among FA (4%). The mean age of patients with FAM (32.1 years) was similar to FC (35.1 years) but significantly older than that of FA (26.1 years). The notion that FA and FC are lesions at two ends of a spectrum of growth disorder of breast related to oestrogen-progesterone interplay, and that FAM occupies a position intermediate between the two, may explain its morphological and age patterns, but remains speculative. It is hoped that increasing awareness of this condition will lead to better understanding of breast pathophysiology. Nevertheless, until its biological nature, histogenesis and malignant potential are more clearly understood, defining FAM as a distinct form of breast disease may not be meaningful to patient management.

[The effect of low-frequency electromagnetic fields on the development of experimental mammary tumors]. / Vliianie nizkochastotnykh élektromagnitnykh polei na razvitie éksperimental'nykh opukholei molochnoi zhelezy.

The paper discusses the effect of low-frequency electromagnetic fields on the development of nitrosomethylurea-induced breast cancer in rats. The occurrence, mean latency period and morphological pattern of breast malignancy was shown to depend upon duration of exposure to variable and static magnetic fields.