Benign Proliferative Changes Research Articles

The benign mimickers of carcinoma on breast MRI

The similarity between benign and malignant pathologies on magnetic resonance imaging (MRI) and a wide-ranging variability of the lesions from benign proliferative changes to invasive breast carcinoma cause a lower and wide-ranging specificity of breast MRI relative to its surpass sensitivity. A wide range of tissue components such as the skin, the adipose tissue, vascular and neural tissues, connective tissues, glandular tissues, ducts, and muscle tissues are found here all together. This pictorial review was aimed at deliberating benign mimickers of breast carcinoma on MRI and trying to call attention to the overlapping and distinctive features.

Magnetic Resonance Mammography in the Diagnostics of Intraduсtal Cancer in situ (DCIS)

The improvement of methods of radiation diagnostics has led to an increase in the frequency of detection of breast cancer in the early stages. According to our study (a retrospective analysis of data from 195 MRM with DKU), the results of studies of women with a histologically verified diagnosis of intra-ductal carcinoma in situ (DCIS). For formations of more than 5 mm in 60 %, we obtained reliable criteria for the malignant process (contrast capture of more than 100 % for type II-III, the presence of feeding arteries). Various contrast zones without / or with the presence of less than 5 mm formation in 10–20 % of in situ carcinomas had a pattern of accumulation similar to benign proliferative changes, a statistically significant criterion was the strengthening of the vasculature on MIP reconstruction around the contrast zone, which in 31 % of cases coincided with the areas of accumulation of atypical microcalcinates detected in mammography (BI-RADS 4). MR mammography with dynamic contrast enhancement, having a high sensitivity in detecting vascularized areas, allows us to assess their nature with a high degree of probability against the background of any types of breast tissue structure.

Algorithm for management of patients of the period of menopausal transition with recurrence of anomalous uterine bleeding associated with beneficial proliferative changes of endometry

Aim. To compile an algorithm for managing patients during the menopausal transition with a relapse of abnormal uterine bleeding associated with benign proliferative changes in the endometrium and evaluate its outcomes.
 Materials and methods. The observation of 150 patients aged 4555 years who had recurrence of abnormal uterine bleeding due to benign proliferative changes of the endometrium. All patients underwent hysteroresectoscopic ablation of the endometrium according to the monopolar coagulation-vaporization technique using Olympus equipment (Japan). The patients were divided into two groups. One group was formed by 98 women who, before hysteroscopic ablation of the endometrium, received hormonal preparations for 14 months, with the help of which suppressive changes in the uterine mucosa up to 34 mm were achieved. The other group consisted of 52 patients of the menopausal transition who did not receive preoperative drug therapy, and the thinning of the endometrium before hysterectomy was performed instrumentally. After hysteroresectoscopy, the period of clinical and instrumental observation was 2 years.
 Results. Based on the results of the study, an algorithm has been compiled for the treatment of women during the menopausal transition with abnormal uterine bleeding, including at the first stage a clinical, laboratory and instrumental examination with the selection of a group of patients to be treated by endometrial ablation, and at the second stage, measures for the preoperative thinning of the uterine mucosa, at the third stage performing hysteroresectoscopic ablation of the endometrium; and at the fourth stage dynamic monitoring during ie 2 years. The preoperatively achieved medical atrophy of the endometrium, followed by hysteroresectoscopy, contributes to an improvement of 20.3% in the results of treatment of patients in comparison with mechanical thinning of the endometrium before hysteroresectoscopy. In general, the developed algorithm increases the effectiveness of anti-relapse treatment to 92.8%.
 Conclusion. In practical health care, the proposed algorithm should be used, including successive steps. Following the algorithm, a differentiated approach to the choice of therapeutic tactics is carried out, taking into account not only morphological changes in the endometrium, but also the associated gynecological and somatic pathology of the patient, as well as justifying the conduct of preoperative preparation for hysteroresectoscopic ablation of the endometrium and determining the order of subsequent dynamic observation.

Pseudoangiomatous Stromal Hyperplasia (PASH) of the Breast

Pseudoangiomatous stromal hyperplasia (PASH) of the breast is a benign lesion that can present as a palpable nodule or as an incidental finding in breast biopsies. The study comprised 79 cases diagnosed at Loyola University Medical Center from 2002 to 2009. The pathology slides were reviewed to document the distribution, type, and association with preneoplastic or neoplastic epithelial lesions. Z-test for independent proportions is used for analysis. A total of 76 patients were female and 3 were male. In all, 59.8% of patients presented with a breast mass and in 40.2% the lesion was an incidental finding. Classical PASH morphology was seen in 97.6% and proliferative PASH in 2.4%. Associated epithelial lesions were benign proliferative changes in 60.4%, atypical ductal and atypical lobular hyperplasia in 25.6% and infiltrating carcinoma in 11% of cases. Based on these results, extensive sampling of biopsy specimen with PASH and appropriate clinical and radiologic follow-up is recommended.

Study of the expression of Tn antigen in different types of human breast cancer cells using VVA-B4 lectin

VVA-B4 lectin was used to investigate the differences in Tn antigen expression in tissues of different types of human breast cancer (benign lesions, carcinoma in situ, invasive carcinoma) and in normal tissues neighboring lobular carcinoma. Locations in which Tn antigen was expressed were identified using the avidin-biotin-peroxidase labeling system. Tissues collected during cosmetic procedures and classified as normal were completely negative, except for one case. Benign proliferative changes including fibroadenoma, apocrine and cylindrical metaplasia showed a very weak positive reaction, although strongly positive cells were also observed. The reaction in non-invasive cases of atypical hyperplasia was diversified depending on site. Intralobular hyperplasia was characterized by a particularly high percentage of labeled cells. A majority (up to 80%) of ductal and lobular carcinoma in situ showed very strong or moderate staining. In invasive cancers, there were conspicuous differences between stage of cancer development and tendency towards a decrease in intensely labeled cell count in the most advanced stages. In normal tissues in the direct neighborhood of carcinoma in situ, the cytoplasm of 40% of cells was strongly labeled. However, the findings for normal tissues in the close vicinity of invasive cancer were the most surprising, since there was either no or only very weak positive reaction. It can be concluded that glycosylation modifications during carcinogenesis, as demonstrated by the presence of Tn epitope, develop very early, before any destructive changes in proliferation/apoptosis or cell differentiation become discernible.

Breast disorders in the adolescent patient

Although breast cancer is rare in childhood and adolescence, breast concerns among patients in this age group are common. Benign proliferative changes and benign masses such as fibroadenomas are the most common entities encountered in the adolescent patient. Evaluation of breast complaints includes a careful history and physical examination. Ultrasonography is the best adjunctive radiologic modality to assess the adolescent breast. Surgical intervention usually is contraindicated in prepubertal patients. In the postpubertal patient, discrete breast masses, which are not suspicious on clinical examination, may be observed. Additionally, FNA and surgical removal are also safe diagnostic and therapeutic alternatives in this patient population.

Loss of heterozygosity in normal breast epithelial tissue and benign breast lesions in BRCA1/2 carriers with breast cancer

Loss of heterozygosity (LOH) of the wild-type BRCA1/2 allele is a reproducible event in breast tumors of BRCA1/2 mutation carriers, but it is unknown if this allelic loss occurs only in association with recognizable histopathologic abnormalities. We evaluated the early genomic changes that occur in the mammary glands of patients with increased predisposition to breast cancer due to germline mutations in the BRCA1/2 genes. We tested the hypothesis that these genomic changes may be detected, not only in histologically abnormal and malignant breast tissues, but also in morphologically normal tissues and in areas with pathologically benign changes. Samples were obtained from five breast cancer patients: four BRCA1 carriers and one BRCA2 carrier. In each case, nontumor tissue areas surrounding the tumor or from other locations of the breast were isolated using laser capture microdissection. We evaluated 29 areas showing normal terminal ductal lobular units (TDLUs) or histopathologically benign changes (in particular, sclerosing adenosis), using a panel of polymorphic dinucleotide microsatellite markers for the BRCA1 gene and other chromosome 17 loci, for the BRCA2 gene and other chromosome 13 loci, and for the FHIT gene on 3p14.2. Overall, we analyzed a total of 105 samples of nontumor tissues; LOH was detected in 59 of the 105 (56%). In the normal TDLUs, 15 of 30 samples (50%) showed LOH; in the tissues with benign proliferative changes, such as sclerosing adenosis, 44 of 75 samples showed LOH (59%). Our results suggest that there is a field effect of early genetic events preceding morphologic changes in the mammary glands of BRCA mutation carriers.

Classification of signal-time curves from dynamic MR mammography by neural networks

The aim of this study was to test the performance of artificial neural networks for the classification of signal-time curves obtained from breast masses by dynamic MRI. Signal-time courses from 105 parenchyma, 162 malignant, and 102 benign tissue regions were examined. The latter two groups were histopathologically verified. Four neural networks corresponding to different temporal resolutions of the signal-time curves were tested. The resolution ranges from 28 measurements with a temporal spacing of 23s to just 3 measurements taken 1.8, 3, and 10 minutes after contrast medium administration. Discrimination between malignant and benign lesions is best if 28 measurement points are used (sensitivity: 84%, specificity: 81%). The use of three measurement points results in 78% sensitivity and 76% specificity. These results correspond to values obtained by human experts who visually evaluated signal-time curves without considering additional morphologic information. All examined networks yielded poor results for the subclassification of the benign lesions into fibroadenomas and benign proliferative changes. Neural networks can computationally fast distinguish between malignant and benign lesions even when only a few post-contrast measurements are made. More precise specification of the type of the benign lesion will require incorporation of additional morphological or pharmacokinetic information.

BREAST DISEASE IN ADOLESCENTS AND YOUNG WOMEN

Breast lesions, including mastalgia; benign proliferative changes; and benign masses, including fibroadenomas, are common in adolescents and young adult women. Breast cancer is rare in women less than 20 years old and uncommon in women less than 30 years old. Discrete masses in women less than 30 years old that do not feel suspicious on examination can be observed for 1 or 2 months. If they persist, than an FNA can differentiate those that are benign and can be observed versus those that need either an excisional biopsy or definitive surgery. Mammography has little role in the diagnosis of women less than 30 years old except in those individuals with highly suspicious lesions on examination.

Prognostic significance of benign proliferative breast disease.

Recent studies concerning an association between benign breast diseases and risk of subsequent breast cancer have focused on benign proliferative lesions recognized in biopsy specimens. Some have implicated atypical hyperplasia as being associated with the greatest risk. The histologic sections of specified benign breast lesions from 1799 women were reviewed and reclassified, using published criteria for proliferative disease. Prognostic significance was assessed by relating the pathologic findings to the development of breast cancer observed during an average 21 years of follow-up, in which time 157 women developed the disease. Benign proliferative changes were recognized in 85% of the patients, with a corresponding relative risk of subsequent carcinoma equal to 2.2 times population rates (95% confidence limits, 1.9 and 2.6). Increasing levels of hyperplasia and atypia in lobules or ducts were associated with modest increases in risk, ranging from 2.1 to 2.3 to 3.0 for proliferative changes with no atypia, mild atypia, and moderate to severe atypia, respectively. This trend was not statistically significant. The most significant risk indicators in this study were the presence of adenosis (relative risk, 3.7), and moderate or severe atypia in ducts (relative risk, 3.9). Benign proliferative breast disease recognized in biopsy specimens is associated with an increased risk of future breast cancer, but fine distinctions among levels of hyperplasia and atypia did not significantly distinguish risk among patients in this study.

Syringomatous squamous tumors of the breast

Four cases are reported of syringomatous squamous tumors of the breast occurring in women aged 37 to 70 years. The lesions were characterized histologically by relatively well-circumscribed tumor-like nodules composed of a proliferation of teardrop or comma-shaped islands of squamous epithelium. The squamous epithelial islands contained central lumens lined by eosinophilic cuticles and were surrounded by a densely cellular fibrous matrix, thus closely resembling the growth pattern of dermal eccrine syringomas. The lesions appeared to arise de novo from breast parenchyma without evidence of transitions with the surrounding normal or hyperplastic mammary epithelium and were not associated with the overlying skin or nipple epidermis. In all cases, the surrounding breast tissue showed fibrocystic and benign proliferative changes, and in one case, the lesion was found in the vicinity of a large cyst surrounded by microcalcifications. All patients were treated by local surgical excision and have shown no evidence of recurrence over a follow-up period of 1 to 6 years. The histologic differential diagnosis and the possible pathogenesis of these lesions are discussed.

Malignant and benign papillary lesions of the breast

This presentation describes criteria that we found most helpful in classifying the various proliferative changes of the breast and in separating papillary carcinoma from other benign papillary lesions. The criteria we used are easily understood and extremely reproducible. The true incidence of benign proliferative changes in fibrocystic disease and the significance of these lesions in later development of cancer were determined by studying 200 randomly selected cases of fibrocystic disease seen at least 10 years earlier. Of the 200 cases of fibrocystic disease, 40 showed intraductal papillomatosis or terminal duct hyperplasia. None of the patients with benign proliferative lesions for whom we have complete follow-up data (up to 14 years) developed cancer. In order to determine the type of proliferating cells in papillary carcinoma and benign proliferative lesions, some of the recently encountered cases were studied by transmission and scanning electron microscopy and histochemistry. Our ultrastructural and histochemical study suggests that both epithelial and myoepithelial cells participate in papillary lesions of the breast.