Discrete Breast Masses Research Articles

Tumour forming Pseudoangiomatous stromal hyperplasia: a case report

Tumor-forming Pseudoangiomatous stromal hyperplasia (PASH) is a rather uncommon breast lesion and only very few cases of tumor-forming PASH were reported from 1986, since the lesion was originally described. In contrast, focal, non-tumor forming PASH may be an incidental microscopic finding in up to 23% of breast biopsies. PASH is a benign proliferative lesion of the breast stroma that is characterized by slit-like pseudovascular spaces lined by endothelial-like spindle cells. It is indeed rare for a discrete breast mass to have PASH as the main pathological feature on histopathology. The breast mass, typically unilateral, was usually diagnosed clinically as a fibroadenoma.When found in tumour form, PASH most commonly manifests as a single, circumscribed, palpable mass in a premenopausal female. The main differential diagnosis histologically are fibroadenoma, phyllodes tumor and angiosarcoma. However, PASH is a benign condition with very good prognosis. Hence possibility of PASH in nodular or tumour form has to be considered when approaching a case of breast lump whose management is different. We report here a case of PASH in tumour form from our Institute.

Discrete Breast Masses in Female Children and Adolescents: Is there a Place for Non-operative Management by Pediatric Surgeons?

Background: The treatment of breast masses in female children and adolescents is controversial. While some advocate for early surgical removal others prefer the conservative non operative approach. The aim of this study is ascertain the evidence for the current protocol of early surgical removal in our centre. Materials and Methods: Retrospective observational study to highlight the epidemiology of discrete breast masses in female children and adolescents 0.05). Conclusion: This series show that breast masses in children and adolescents are almost always benign. It is advocated that conservative non-operative management (with close follow up with imaging such as breast ultrasound and/or MRI) should be adopted by paediatric surgeons in cases of breast masses in children except when surgery is specifically indicated. These indications which should be individualized include: cosmesis, bloody nipple discharge, persistent history of pain in the mass, rapid growth of the mass and malignancies with predilection for the breasts.

Idiopathic Granulomatous Mastitis, a Clinicopathological Review of 22 Cases

Background: Idiopathic granulomatous mastitis is a rare chronic inflammatory disease and typically occurs in women at the reproductive life. The etiology, clinical course, and optimal treatment of this disorder remain obscure. The most common clinical presentation is a unilateral, firm, discrete breast mass, often associated with inflammation of the overlying skin. Because clinically the lesion can simulate carcinoma, definitive diagnosis is made using histopathology. The main purpose of this study was to present the clinicopathological features of patients with idiopathic granulomatous mastitis, as well as the authors’ experience with surgical treatment of these patients. Methodology: The unit’s pathology database and clinic letters for the time period from January 2005 to May 2010 were used to identify patients who had presented with idiopathic granulomatous mastitis. Results: 22 female patients with a mean age of 35.14 ± 6.07 were included. The patients ranged in age from 24 to 44 years. All patients were parous, the median number of their pregnancies was 2 (ranging from 2 to 6) and the median duration of the last delivery was 4 years (ranging from 1.4 to 14 years).19 patients had a history of breast feeding. 8 patients (36.4%) had used hormonal contraception. The right breast was involved in 8 (36.4%) cases and in 12 (54.5%) patients; the left breast was affected. Erythema was the most common presenting symptom. Surgery was the definitive procedure in all patients. 13 patients (61.9%) presented with recurrence. Conclusion: Increased recognition of this disease will improve its understanding and management of it. Longterm follow-up is necessary.

Aetiology of idiopathic granulomatous mastitis.

Idiopathic granulomatous mastitis is a rare chronic inflammatory lesion of the breast that can clinically and radiographically mimic breast carcinoma. The most common clinical presentation is an unilateral, discrete breast mass, nipple retraction and even a sinus formation often associated with an inflammation of the overlying skin. The etiology of idiopathic granulomatous mastitis is still obscure. Its treatment remains controversial. The cause may be the autoimmune process, infection, a chemical reaction associated with oral contraceptive pills, or even lactation. Various factors, including hormonal imbalance, autoimmunity, unknown microbiological agents, smoking and α 1-antitrypsin deficiency have been suggested to play a role in disease aetiology. In this review, causing factors in the aetiology of idiopathic granulomatous mastitis are reviewed in detail.

Palpable discrete breast masses in young women: Two of the components of the modified triple test may be adequate

Palpable breast masses in young women, though usually benign, are a common source of anxiety. Current practice is assessment using the modified triple test (MTT). This entails clinical breast examination (CBE), ultrasound scans and cytological examination of a fine-needle aspiration biopsy specimen (FNAC). It is unclear whether it is necessary to utilise all three components in most patients. We aimed to determine the diagnostic value of the MTT for the evaluation of palpable discrete breast masses in women under 35 years of age, and to assess the performance of its components when used individually or in combinations of two. This was a cross-sectional study carried out between August 2010 and October 2010 in the breast and general surgical outpatient clinics at Kenyatta National Hospital, Nairobi, Kenya. Fifty-eight patients presenting during the study period with palpable discrete breast masses satisfying the inclusion criteria were recruited. All patients had a CBE, ultrasound scans and FNAC. A core biopsy was performed as a reference standard. Main outcome measures. The test results of the MTT and its elements (CBE, ultrasonography and FNAC) were compared with the histological findings (the reference standard). The age range of the 58 patients was 18 - 34 years (mean 25.5 years, standard deviation 5.1 years). Forty-five patients (77.6%) had concordant MTT results (agreement in all the three components). Concordant MTTs had a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 100%. Sensitivity, specificity, PPV and NPV were 100%, 92.3%, 60% and 100%, respectively, for CBE; 100%, 94.2%, 66.7% and 100%, respectively, for ultrasonography; and 100%, 98.1%, 83.3% and 100%, respectively, for FNAC. The combinations CBE plus ultrasound and CBE plus FNAC had sensitivities, specificities, PPVs and NPVs of 100%. Use of the MTT for diagnosis of palpable breast masses in young women (

An audit of excised breast lumps in Ghanaian women

In our environment, all patients presenting with breast masses insist on complete surgical removal as the preferred treatment option acceptable to them. We report on a 6-year prospective study of the clinical and pathological features of these breasts masses excised for histopathological examination. Details of all consecutive women referred to the surgical out-patients' clinic of the Komfo Anokye Teaching Hospital from January 1998 to December 2003 inclusive, for clinical assessment and excision of breast masses were prospectively recorded. Open surgical biopsies were performed on these masses and the pathological features recorded. A total of 443 patients were reported. Approximately 80% of the women were 40 years old or younger There were 355 (80.9%) benign breast lesions and 88 (19.1%) carcinomas. The principal histopathological types were fibroadenoma, fibrocystic breast changes and carcinoma occurring in 47.7%, 23.9% and 19.1% of the patients respectively. The cumulative frequency at >30 years for fibroadenoma and carcinoma was 0.81 and 0.11 respectively. No carcinomas were found below 26 years. There was a significant association between the ages of the patients and the type of breast disease (X2 = 20.9 P <0.05). Discrete breast masses in Ghanaian women are mostly due to benign breast disease. The risk of cancer increases with the age of the patient especially after 30 years.

Colour Doppler ultrasonography studies of benign and malignant breast lesions.

Colour Doppler scanning was carried out on 53 patients with solid, discrete breast masses. Twenty-five of 32 breast cancers and none of 21 benign lesions gave a positive scan, giving a sensitivity of 78 per cent for association with malignancy, a specificity of 100 per cent and a positive predictive value of 100 per cent. Tumours less than 1 cm in diameter and invasive lobular cancers were least likely to give a positive scan. Axillary node scans were performed in 31 of 32 patients with breast cancer with 29 undergoing an axillary staging procedure. Nine patients had a positive axillary scan and all nine had involved axillary nodes. Three patients had involved axillary nodes, but a negative axillary scan. The sensitivity of colour Doppler scanning for axillary node involvement was 75 per cent, with a specificity of 100 per cent and a positive predictive value of 100 per cent.

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.

Prevalence and longitudinal study of breast masses in adolescents

This study examined the prevalence and outcome of breast masses in adolescent females and compared these teens to those without breast masses. A longitudinal study of adolescents with breast masses was conducted from October 1984 through January 1990. The prevalence of discrete breast masses in the 13-month study period was 13/400 (3.25%) among new female patients. The mean length and width of the masses were 2.8 and 1.9 cm; 86% had a solitary mass. Of 61 diagnosed with breast masses, 39 were followed for up to 40 months (mean, 7 months). Teens with a mass were older (16.8 versus 15.1 years, p < 0.001) and had a greater chance of a family history of breast disease (26% versus 10.5%, p < 0.05) than those without a breast mass. Of 39 teens returning for at least one follow-up visit, 10 had a clinical diagnosis of “fibrocystic changes”. Of these, the lesions resolved in six. Of the 29 teens with a discrete mass on examination, 7 underwent surgery and were found to have fibroadenomas. Nine of the 29 teens had masses which resolved over 1–12 months, six teens had masses which remained unchanged over 3–40 months, while four had masses which became smaller, and two had masses which became larger. One teen with mastitis improved. Eighteen underwent ultrasonographic examination at the breast. Of the 12 teens found to have a solid mass on ultrasound, none had a mass that resolved on follow-up examination. Of the six teens that had either a normal ultrasound or fibrocystic changes on ultrasound, 3/6 (50%) had lesions that resolved on follow-up examination. The correlations between ultrasound and clinical findings were length, r = 0.9 ( p > 0.0001) and width, r = 0.93 ( p < 0.0001).

Cytology and mammography in the diagnosis of breast cancer

The results of an analysis of the accuracy of two diagnostic tests in a series of 714 patients with breast masses are presented. Fine needle aspiration cytology and mammography each had a false negative rate of 5,3%. Use of a combination of both techniques reduced the number of carcinomas missed to 2,3%. The need for histological examination of dominant discrete breast masses is emphasised.