Bilateral Breast Lumps Research Articles

Acute lymphoblastic leukemia presenting as a breast lump: A report of two cases

Extra-medullary leukemic infiltration of the breast by acute lymphoblastic leukemia (ALL) is very rare. We report two cases of ALL presenting as breast masses and diagnosed on fine-needle aspiration (FNA). Our first patient, a post-partum 30-year-old female, developed bilateral breast lumps in her last trimester of pregnancy and complained of easy fatigability. Our second patient, a 14-year-old girl, presented with a right-breast lump of 1-week duration. She had received treatment for ALL 1 year back and had been in complete remission for the last 1 year. FNA of the breast nodules done in both the cases revealed diffuse infiltration by lymphoblasts. Subsequent hematological investigations confirmed bone marrow involvement by ALL in the first case and extra-medullary relapse in the second case. Fine-needle aspiration cytology (FNAC) is an easy and cost effective method for the early diagnosis of metastatic leukemic infiltration, avoiding unnecessary excisional biopsies in such cases.

Diabetic mastopathy: a case report

Diabetic mastopathy (DMP) is an uncommon collection of clinical, radiological, and histological features, classically described in premenopausal women with long-term insulin-dependent diabetes mellitus. This entity can mimic breast carcinoma, but, in the appropriate clinical and imaging setting, the diagnosis can be made by core biopsy, avoiding unnecessary surgeries. We report the case of a 34-year-old female, with a 12-year history of type 1 diabetes, who presented with bilateral breast lumps. Mammography, ultrasonography, and magnetic resonance imaging could not exclude the suspicion of malignancy, and a core biopsy was performed showing the typical histologic features of DMP. The literature is briefly reviewed.

Bilateral giant juvenile fibroadenoma of breasts

An 11-year-old girl with rapidly enlarging bilateral breast lumps is reported. It was diagnosed as a case of juvenile fibroadenoma following fine needle aspiration cytology and confirmed on histopathological examination of the excised specimens.

Alveolar Rhabdomyosarcoma of the Left Hand with Bilateral Breast Metastases in an Adolescent Female

Rhabdomyosarcoma is a common extramammary malignancy in pediatric age groups, but it rarely metastasizes to the breast. Breast rhabdomyosarcomas are commonly metastatic, with possible primary locations at the head and neck, trunk, extremities, retroperitoneum and perianal region. We report a case of primary alveolar rhabdomyosarcoma of the upper extremities in a 17-year-old adolescent female who presented with bilateral lower limb weakness and bilateral breast lumps.

Fine needle aspiration cytology of bilateral Non -- Hodgkin′s lymphoma of the breast with leukemic phase in a pre-pubertal girl

Non-Hodgkin's lymphoma (NHL) of the breast is very rare and is mostly seen in young puerperal women bilaterally or unilaterally and in older women with distinctly different clinicopathologic presentation. Bilateral NHL is rarely seen in very young non-puerperal patients and such an entity with bone marrow involvement along with a leukaemic phase in young patients has not been reported in literature. We report this case of a 13 year old girl who presented with bilateral breast lumps and malaise with blasts in peripheral blood smear. Fine needle aspiration cytology of breast helped in the diagnosis of NHL with leukaemic phase thereby preventing further unnecessary work-up. Examination of the bone marrow was adopted to stage the patient and initiate prompt treatment without delay.

Florid Papillomatosis: A Rare Cause of Bilateral Giant Breast Lumps in the Elderly

Florid Papillomatosis: A Rare Cause of Bilateral Giant Breast Lumps in the Elderly

Diabetic Mastopathy of Bilateral Breasts in an Elderly Japanese Woman with Type 2 Diabetes: A Case Report and a Review of the Literature in Japan

We report a case of diabetic mastopathy in an elderly woman with type 2 diabetes. The patient was a 69-year-old woman diagnosed with type 2 diabetes at the age of 33 years. She had been treated with insulin for 25 years, however, her blood glucose had been poorly controlled. She noticed bilateral breast lumps in September 2002. Mammography of the breast showed increased density in the glandular pattern and architectural distortion without focal mass and microcalcification. Ultrasonography of the breast showed an irregular-shaped hypoechoic mass with an acoustic shadow. As malignancy needed to be excluded, core needle biopsy was performed in the left breast and diabetic mastopathy was confirmed pathologically. Diabetic mastopathy is usually a complication of pre-menopausal type 1 diabetes and develops in a unilateral breast. This case developed in bilateral breasts in an elderly type 2 diabetic patient.

A Case Presentation on Bilateral Breast Cancer

We present a case of a 56 year old female who presented with a short history of synchronous, bilateral breast lumps. Core biopsies of both lesions revealed different morphological adenocarcinomas in both breasts. The recognised aggressive course and rapid progression of bilateral synchronous tumours was apparent in our patient who subsequently died 6 weeks after initial presentation with multi organ metastasis. This case illustrates the importance of screening for metastatic disease in patients presenting with bilateral breast lumps. INTRODUCTION A 56 year old female patient presented to the breast unit with a short history of bilateral breast lumps. On examination a 1 cm discrete lump was palpated in the upper outer quadrant of her right breast and a 2cm lump in the axillary tail was felt in the left breast. Her past medical history included hysterectomy at the age of 26 for cervical carcinoma-in-situ; chronic back pain managed by the GP and an abnormal mammogram 5 years prior showing microcalcification. She had a significant family history with a sister being diagnosed with breast cancer at the age of 55, and both her mother and maternal aunt being diagnosed with ovarian cancer in their forties. Mammograms of both breasts were carried out urgently due to the high index of suspicion. Figure 1 Mammogram 1: Right breast. Medio-lateral view. Figure 2 Mammogram 2 : Right breast, cranio-caudal view. Figure 3 Mammogram 3: Left breast, medio-lateral view. A Case Presentation on Bilateral Breast Cancer 2 of 3 Figure 4 Mammogram 4: Left breast, cranio-caudal view. Mammogram of the right breast had shown 3 masses, all in the upper outer quadrant. The largest was 2cm. Mammogram of the left breast revealed an irregularly shaped mass in the axillary tail (1.9cm). Core biopsies of the larger lesion in the right breast confirmed it to be a well differentiated adenocarcinoma whereas the smaller one was a moderately differentiated adenocarcinoma with a different morphology to the larger mass. Core biopsy of the left breast lump showed it to be a moderately differentiated carcinoma identical to the morphology of the smaller lesion in the right breast. The patient was reviewed in breast clinic 2 weeks later with a view to perform a bilateral mastectomy. However clinically she had deteriorated rapidly; she was in severe pain and was short of breath with intermittent euphoria. A whole body bone scan confirmed metastatic activity in multiple ribs, throughout the spine, pelvis and the proximal end of the long bones and in the scalp. Metastatic lesions were also noted in the liver and also possibly in the brain. The patient rapidly deteriorated and died within a week of final review.

Bilateral breast lumps in a young female – cytological approach to diagnosis

Bilateral breast lumps in a young female – cytological approach to diagnosis

Fine Needle Aspiration Cytology Diagnosis of Lymphoproliferative Disease of the Breast

To evaluate the role of fine needle aspiration cytology (FNAC) in the diagnosis of lymphoproliferative disease (LPD) of the breast. Over a period of 20 years (January 1982-December 2001), 13 diagnosed and/or suspected cases of LPD of the breast on FNAC were retrieved and reviewed from the files of the Cytology Laboratory, Department of Pathology, All India Institute of Medical Sciences. For each case, both May-Grünwald-Giemsa- and Papanicolaou-stained smears were reviewed along with hematoxylin and eosin-stained tissue sections and immunohistochemistry, when available. Of the 13 cases, 1 aspirate was from a male breast and the rest were from female. Only 12 cases with documented histology were included in the study. Five of the 12 cases were diagnosed on FNAC as high grade lymphoma, 2 as low grade lymphoma, 2 as poorly differentiated malignant tumor/lymphoma, and 1 each as Hodgkin's lymphoma, acute myeloid leukemia (AML) deposit and immature lymphoid cells, ?leukemia/lymphoma deposit. The tumors manifested mostly as an unilateral mass (10 cases), with 2 cases presenting with bilateral breast lumps. The lymph nodes were involved in 8 cases. Histologically, 2 of the 12 cases were poorly differentiated malignant tumors. Of the remaining 10 cases, 8 were documented as non-Hodgkin's lymphoma and 1 each as Hodgkin's lymphoma, mixed cellularity and AML. FNAC is an inexpensive but highly useful diagnostic tool to distinguish between primary lymphoma and carcinoma of the breast. This helps with clinical management in avoiding unnecessary surgical procedures.

Accuracy of the “Triple Test” in the Diagnosis of Palpable Breast Masses in Saudi Females

For patients who present to clinicians with palpable breast lesions, the triple test: (physical examination, mammography and fine-needle aspiration cytology) can be employed to provide accurate diagnosis. In this study, the sensitivity, specificity and predictive values of triple test components were studied separately and in combination. During the study period (from January 1998 to December 1999), 140 patients with palpable breast masses were subjected to all components of the triple test followed by confirmatory open biopsy. Physical examination showed 82.6% sensitivity, 97.3% specificity and 86.4% positive predictive value. Mammography showed 87.5% sensitivity, 97.3% specificity and 87.5% positive predictive value and fine-needle aspiration cytology (FNAC) showed 91.7% sensitivity, 100% specificity and 100% positive predictive value in concordant cases (elements had either all malignant or all benign results). The triple test was 100% accurate in the diagnosis of palpable breast lesions when all three elements were concordant. Based on these results, we recommend elimination of the confirmatory open biopsy, which will result in reduced expenses and morbidity compared with open biopsy.

Subcutaneous sarcoidosis mimicking carcinoma of the breast

A 65 year old woman presented with bilateral breast lumps. Clinical examination suggested a diagnosis of mammary carcinoma, but a histological diagnosis of sarcoidosis was made. Subsequent investigations revealed evidence of pulmonary sarcoidosis.

Bilateral Breast Cancer-A Case Report

We present a case of a 40 year old female who presented with a short history of synchronous, bilateral breast lumps. Core biopsies of both lesions revealed duct cell carcinoma in both breasts. The recognized aggressive course and rapid progression of bilateral synchronous tumors was apparent in our patient. This case illustrates the importance of screening for metastatic disease in patients presenting with bilateral breast lumps. DOI: 10.3329/medtoday.v22i1.5607 Medicine Today Vol.22(1) 2010. 48-49