Fibroadenoma Research Articles

The Utility of Texture Analysis Based on Breast Magnetic Resonance Imaging in Differentiating Phyllodes Tumors From Fibroadenomas.

Background: The preoperative diagnosis of phyllodes tumors (PTs) of the breast is critical to appropriate surgical treatment. However, reliable differentiation between PT and fibroadenoma (FA) remains difficult in daily clinical practice. The purpose of this study was to investigate the utility of breast MRI texture analysis for differentiating PTs from FAs.Materials and Methods: Forty-two PTs and 42 FAs were enrolled in this retrospective study. Clinical and conventional MRI features (CCMF) and MRI texture analysis were used to distinguish between PT and FA. Texture features were extracted from the axial short TI inversion recovery T2-weighted (T2W-STIR), T1-weighted pre-contrast, and two contrast-enhanced series (first contrast and third contrast). The Mann–Whitney U test was used to select statistically significant features of texture analysis and CCMF. Using a linear discriminant analysis, the most discriminative features were determined from statistically significant features. The K-nearest neighbor classifier and ROC curve were applied to evaluate the diagnostic performance.Results: With a higher classification accuracy (89.3%) and an AUC of 0.89, the texture features on T2W-STIR outperformed the texture features on other MRI sequences and CCMF. The AUC of the combination of CCMF with texture features on T2W-STIR was significantly higher than that of CCMF or texture features on T2W-STIR alone (p < 0.05). Based on the result of the classification accuracy (95.2%) and AUC (0.95), the diagnostic performance of the combination strategy performed better than texture features on T2W-STIR or CCMF separately.Conclusions: Texture features on T2W-STIR showed better diagnostic performance compared to CCMF for the distinction between PTs and FAs. After further validation of multi-institutional large datasets, MRI-based texture features may become a potential biomarker and be a useful medical decision tool in clinical trials having patients with breast fibroepithelial neoplasms.

Genomic characterisation of breast fibroepithelial lesions in an international cohort

Fibroepithelial lesions (FELs) are a heterogeneous group of tumours comprising fibroadenomas (FAs) and phyllodes tumours (PTs). Here we used a 16-gene panel that was previously discovered to be implicated in pathogenesis and progression, to characterise a large international cohort of FELs via targeted sequencing. The study comprised 303 (38%) FAs and 493 (62%) PTs which were contributed by the International Fibroepithelial Consortium. There were 659 (83%) Asian and 109 (14%) non-Asian FELs, while the ethnicity of the rest was unknown. Genetic aberrations were significantly associated with increasing grade of PTs, and were detected more in PTs than FAs for MED12, TERT promoter, RARA, FLNA, SETD2, TP53, RB1, EGFR, and IGF1R. Most borderline and malignant PTs possessed ≥ 2 mutations, while there were more cases of FAs with ≤ 1 mutation compared to PTs. FELs with MED12 mutations had significantly higher rates of TERT promoter, RARA, SETD2, EGFR, ERBB4, MAP3K1, and IGF1R aberrations. However, FELs with wild-type MED12 were more likely to express TP53 and PIK3CA mutations. There were no significant differences observed between the mutational profiles of recurrent FAs, FAs with a history of subsequent ipsilateral recurrence or contralateral occurrence, and FAs without a history of subsequent events. We identified recurrent mutations which were more frequent in PTs than FAs, with borderline and malignant PTs harbouring cancer driver gene and multiple mutations. This study affirms the role of a set of genes in FELs, including its potential utility in classification based on mutational profiles. © 2019 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

Treatment of Breast Fibroadenoma with Ultrasound-Guided High-Intensity Focused Ultrasound Ablation: A Feasibility Study.

Breast fibroadenomas (FAs) are common, benign, and often bothersome. Current management includes observation or surgical excision. This study evaluated the safety and feasibility of ultrasound-guided high-intensity focused ultrasound ablation for the treatment of FAs. Twenty women with a palpable, biopsy-confirmed FA were enrolled in a prospective trial, and they underwent treatment utilizing an ultrasound-guided high-intensity focused ultrasound ablation device. Tumors were greater than 1 cm in diameter, with volumes of 0.3-10 cc. Safety, treatment experience, toxicity, cosmesis, and change in tumor size on palpation and ultrasound measurement were obtained before and after treatment at 3, 6, and 12 months. All of the 20 patients completed therapy. Pretreatment mean tumor volume was 1.8 cc (standard deviation = 1.23, range 0.57-5.7). Half of the patients reported a painful mass before treatment. All adverse events were well tolerated and transient, with the most common being mild pain, reported by 15 of 20 patients during treatment, and 14 of 20 at the day-7 postprocedure follow-up. Mean pain score during treatment was 16, and at day 7, it was 12.2, on a scale from 0 to 100 (100 = worst pain). Mean patient satisfaction was 4.4 on a scale of 1-5 (5 = most satisfied). Mean likelihood of recommending treatment was 4.7 (5 = most likely). At the 12-month postprocedure follow-up, the mean reduction in volume of the FA was 65.5% on ultrasound; the mass was no longer palpable in 80% of the patients; no patients reported pain; and cosmesis was rated as excellent in all patients. Ultrasound-guided high-intensity focused ultrasound ablation appears to be effective, safe, and well tolerated for the treatment of FAs. A larger multicenter clinical trial is currently under way.

A CASE OF EMPYEMA SECONDARY TO ACTINOMYCES NEUII

SESSION TITLE: Monday Fellow Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Actinomyces neuii is a gram-positive organism infrequently recognized and can cause a myriad of infections. To date, no infections have been described in the pleural space. We present a case of empyema secondary to A. neuii. CASE PRESENTATION: 74 year old woman presented with 2 months of dyspnea on exertion, 5 days of acute pleuritic chest pain, fever, and oxygen desaturation to 88% on room air as outpatient prompting hospitalization. She denied weight loss, had a history of hypothyroidism, remote history of removed left breast fibro-adenoma and quit smoking 40 years prior. She received antibiotics for an upper respiratory infection a month prior. She had a neutrophil predominant leukocytosis to 19.4 and elevated liver enzymes. Computed tomography of chest showed right hilar lymphadenopathy and loculated pleural effusion. She was admitted and started on broad spectrum antibiotics. A chest tube was placed yielding purulent drainage and fluid analysis revealed 85% neutrophils with lactate dehydrogenase of 1843 U/L indicating an exudate. She was treated according to the MIST II protocol for empyema. Further workup revealed negative respiratory viral, HIV, immunoglobulin and hepatitis panels. Blood culture grew gram positive rods 84 hours after admission in anaerobic media which speciated 2 weeks after as A. neuii. Pleural fluid cytopathology was negative for malignancy and culture, including acid fast bacilli. CT of her abdomen and pelvis was negative for intra-abdominal source of infection, but revealed fibroid uterus and an intrauterine device (IUD) without evidence of infection. She completed 4 weeks of Ceftriaxone followed by 4.5 months of Amoxicillin with resolution of leukocytosis, lymphadenopathy and complete resolution of pleural space on outpatient interval imaging. DISCUSSION: A. neuii is an aerobic and facultative anaerobic organism that does not produce sulfur granules or branching filaments. It can cause soft tissue abscesses especially surrounding foreign bodies, post intravitreal injection endopthalmitis, and 2 cases of neonatal sepsis that resulted in premature delivery. One mother had emergent placement of cervical cerclage while the other had prolonged use of IUD. A. neuii is susceptible to beta-lactam antibiotics, clindamycin and erythromycin. Fluoroquinolones and trimethoprim-sulfamethoxazole have less in-vitro activity against isolates. Surgical resection is usually indicated for soft tissue infections. Though inconclusive, the preceding respiratory infection or the prolonged use of IUD may have been sources for infection. We suspect A. neuii was the causative organism for the empyema despite the fact that it was only cultured from blood and not from the pleural space. CONCLUSIONS: To date, no cases of empyema due to A. neuii have been reported in literature. We describe a case with successful non-surgical management. Reference #1: 1. Zelyas N, Gee S, Nilsson B, Bennett T, Rennie R. Infections Caused by Actinomyces neuii: A Case Series and Review of an Unusual Bacterim. Can J Infect Dis Med Mircobiol. 2016;2016:6017605 Reference #2: 2. Olson JM, Vary JC Jr. Primary Cutaneous Actinomyces neuii Infection of the Breast Successfully Treated with Doxycycline. Cutis 2013;92(16)E3-4 Reference #3: 5. Alsohime F, Assiri RA, Al-Shahrani F, Bakeet H, Elhazmmi M, Somily AM. Premature labor and neonatal sepsis caused by Actinomyces neuii. J Infect Public Health 2018 S1876-0341(18)30037-6 DISCLOSURES: no disclosure on file for Stella Hahn; no disclosure on file for Gita Lisker; No relevant relationships by Etieno Umobong, source=Web Response

A clinicopathological study to determine age specific prevalence rate of benign breast lumps

Background: The pathogenesis involves disturbance in the breast physiology extending from an extreme normality to well defined disease processes. The clinician must provide a degree of diagnostic accuracy while at same time ensuring that an excessive biopsy rate is prevented. The aim of this study was to evaluate the benign breast lumps in different age groups and to determine the prevalence of benign breast lumps among the breast symptomatic.Methods: This clinico-pathological cross sectional study was conducted with a sample size of 100. The study was conducted during the period from July 2018 to June 2019 which included all patients presenting with benign breast lump during the study period.Results: Out of 100 studied cases of benign breast diseases, the most common benign breast tumor found as fibro adenoma and majority of the fibro adenoma found in the 2nd and 3rd decade of life. Right breast and upper outer quadrant were most commonly affected. Majority of benign breast lesions presented with painless lump in the breast and most of them were from rural background. Majority of benign Breast lumps (45%) cases were found in the age group of 21-30 years. Majority of the patients (60%) attain menarche between ages 13-15 years. Majority of cases (55%) were belonged to lower socio economic status.Conclusions: Our study indicates that FNAC is diagnostically more accurate, safe, cost effective and OPD procedure, however when FNAC was inconclusive, biopsy is the best choice for breast tumors.

Ultrasound Imaging Characteristics of Breast Lesions Diagnosed During Pregnancy and Lactation.

Background and Objectives: The breast undergoes extensive physiologic changes during pregnancy/lactation. We aimed to review the ultrasound (US) imaging characteristics of breast lesions during pregnancy/lactation and to demonstrate ultrasonography as an excellent imaging modality in this patient population. Materials and Methods: We performed a retrospective study involving 195 patients with 206 pathologically confirmed breast lesions during pregnancy/lactation over the period of January 2010 to December 2018; 51 were diagnosed with breast cancer, including 50 invasive ductal carcinomas and 1 low malignant potential phyllodes tumor, whereas 144 were diagnosed with 155 benign lesions, including 103 mastitis/abscesses, 45 fibroadenomas, 2 intraductal papillomas, 2 sclerosing lesions, and 3 benign phyllodes tumors. The patients' age, lesion diameter, and US characteristics were analyzed. Results: The breast lesions of patients during pregnancy/lactation were compared with those during nonpregnancy/lactation. Patients with breast cancer or fibroadenomas during pregnancy/lactation were younger than those during nonpregnancy/lactation. The average lesion diameter was significantly higher among pregnant/lactating patients compared with controls of childbearing age for fibroadenomas, but not for malignant lesions. The fibroadenomas and mastitis/abscesses during pregnancy/lactation usually have higher BI-RADS categories than those during nonpregnancy/lactation. Conclusions: The imaging features of breast cancer during pregnancy/lactation did not differ much from those of nonpregnancy/lactation; however, some benign lesions had suspicious sonographic features, and US-guided core biopsies were necessary for differentiating benign from malignant lesions.

The accuracy of ultrasound in the diagnosis of breast diseases

The study was intended to evaluate the role of ultrasound as diagnostic technique in the diagnosis of breast diseases, comparing it to the conventional and widely used technique i.e mammography,FNAC and histopathology.&#x0D; THE breast diseases were divided according to their clinical and ultrasound criteria into simple cyst(10), galactocele(3), fibro adenoma (64), carcinoma (36), duct ectasia (6), abscess (3), mammary dysplasia (25) , and undetermined cases (3).&#x0D; All those patients were subjected for pathological confirmation by needle aspiration cytology in (80) and/or excisional biopsy in 110 patients.Twelve patients refuse FNAC (18%). The age of the patients ranged from 15-80 years with a mean of 40 years .One hundred and fourteen(76), patients had benign lesions and 36 cases of them (24%) had malignant lesions. For cystic lesions like simple cyst, abscesses , and cystic changes of mammary dysplasia , the study shows 100% sensitivity , specificity and accuracy. For FNAC , the sensitivity , specificity, and accuracy were 91% 92% respectively. For carcinoma of the breast , thee sensitivity , specificity and accuracy were 86.7% , 91%. And 90% respectively ,which is less because of some overlap of the ultrasonic criteria of benign and malignant lesions.The sensitivity ,specificity and accuracy of ultrasound is high, especially in benign lesions . therefore ultrasound is an accurate , safe , and non-invasive technique for diagnosis of breast diseases in addition to be without danger of radiation, especially for young patients less than 35 years of age.

Fiber Bragg Grating Sensor for Temperature Monitoring During HIFU Ablation of Ex Vivo Breast Fibroadenoma

In this work, we report a fiber Bragg grating (FBG) sensing system for a real-time temperature monitoring during a high-intensity focused ultrasound (HIFU) treatment of breast fibroadenoma. Temperature monitoring of the HIFU procedure within the treated area contributes to a successful outcome of a thermal ablation procedure by providing a valid feedback to the clinician. The unique characteristics of the FBG sensors make them a valid alternative to traditional sensing techniques for a variety of biomedical applications, including thermotherapies. The experiments were conducted on ex vivo breast fibroadenoma tissues. Results confirm that proposed setup is able to perform multipoint temperature measurements and to distinguish between consecutive ultrasound pulses.

Human Cytomegalovirus DNA among Women with Breast Cancer.

Section TitleBreast cancer is the most common cause of death among women worldwide. Although there are many known risk factors in breast cancer development, infectious diseases have appeared as one of the important key to contribute to carcinogenesis formation. The effects of Human Cytomegalovirus (HCMV) on women with breast cancer has been recently studied and reported. To contribute to this research trend, this study was conducted to evaluate the association between HCMV and the women with breast cancer.Objective:This experiment aimed to evaluate HCMV DNA in women with breast cancer in Ahvaz city, Iran. Materials and Methods:A total of 37 formalin fixed paraffin embedded tissues of the patients with ductal breast carcinoma and 35 paraffin embedded tissues of the patients with fibro adenoma as control group were collected. The deparaffinization of all the samples were carried out and the DNA was extracted. Initially, the PCR test was carried out to detect beta –globulin DNA as an internal control. For those samples positive for beta –globulin DNA, Polymerase Chain reaction (PCR) was used to detect HCMV for the tests and control samples. Results:Among 37 ductal breast carcinoma, 20 (54.04%) cases were proved positive for HCMV DNA by PCR. While among the 35 control group (fibroadenoma), 10 (28.57%) cases were positive for HCMV DNA (P >0.028). The prevalences of HCMV DNA among the age groups 30-39, 40-49 and >50 years were 7 (72.22%), 9 (69.23%), 4 (57.14%), respectively (P=0.066). A high frequency of HCMV DNA was detected in tumor grade III, 13/18 (58.33%) compared with tumor grade II, 7/19 (36.84%) (p=0.044). A high frequency of 16/24 (66.66%) of HCMV DNA was found in invasive ductal breast cancer compared with 4/13 (30.76%) HCMV DNA in situ (P<0.028). Conclusion:A high prevalence of 54.05% HCMV was found among the patients with ductal carcinoma. The percentages of the high prevalence of HCMV among age group (40-49) years, tumors grades, and invasive stage were (69.23%), (58.33%), (66.66%), respectively. Further study of HCMV in the latency phase in patients with ductal carcinoma would be necessary to extend our knowledge.

Clinical value of peripheral blood CD62P and CA153 in diagnosis of breast cancer

Objective To study the expression of CD62P and carbohydrate antigen 153 (CA153) in peripheral blood of patients with breast cancer, and to explore the value of CD62P and CA153 in the diagnosis of breast cancer. Methods The CD62P ratio in peripheral blood of 60 patients with breast cancer (breast cancer group), 52 patients with breast fibroma (fibroma group) and 25 healthy volunteers (control group) was detected by flow cytometry (FCM). The serum CA153 level was detected by electro chemiluminescence (ECLIA), and the relationship between their expression levels and clinicopathological factors of breast cancer patients was analyzed. The sensitivity and specificity of serum CD62P, CA153 and their combination in the diagnosis of breast cancer were analyzed by receiver operating characteristic (ROC) curve. Results ⑴ The expression levels of CD62P and CA153 in breast cancer group were significantly higher than those in fibroma group and control group (P 0.05). ⑵ The expression levels of CA153 and CD62P in peripheral blood of breast cancer group were correlated with clinical stage and lymphatic metastasis (all P<0.05), and the expression levels of CA153 and CD62P were positively correlated (r=0.514, P<0.05). ⑶ The sensitivity and specificity of combined detection of CD62P and CA153 for breast cancer were higher than those of single detection. Conclusions CD62P is highly expressed in peripheral blood of patients with breast cancer, which may be a new marker for the diagnosis of breast cancer. Key words: Breast neoplasms; Flow cytometry; P-selectin; Antigens, neoplasm

Evaluating the glycophenotype on breast cancer tissues with quantum dots-Cramoll lectin conjugates

During carcinogenesis, changes in the glycosylation can modulate many biological processes. Thus, the interest in exploring and understanding the roles of carbohydrates as cancer biomarkers has been increasing. Lectins have been applied as useful tools in glycobiology, especially when associated with fluorescent reporters. Therefore, to take advantage of the physicochemical properties of quantum dots (QDs), herein, we conjugated Cramoll, a lectin that recognizes glucose/mannose residues, with those nanoparticles. We applied the conjugates to investigate the glycocode of normal, fibroadenoma (FB), and invasive ductal carcinoma (IDC) human breast tissues. Additionally, we proposed a method to quantitatively evaluate the tissue labeling intensity by a fluorescence microplate assay (FMA). Conjugates showed intense fluorescence and specificity. The lectin activity and secondary structure were also preserved after the conjugation with QDs. Moreover, fluorescence images showed that ductal cells of normal and FB tissues were preferentially labeled by conjugates, whereas both cells and stroma were strongly labeled in IDC. FMA showed in a quantitative, practical, and sensitive way that the level of exposed glucose/mannose residues increased accordingly to the sample malignancy degree. In conclusion, QDs-Cramoll conjugates can be considered effective, specific, and versatile probes to evaluate glycan profiles in normal and transformed tissues, by fluorescence microscopy as well as FMA quantification. Furthermore, FMA showed to be a potential method that can be applied with other fluorescent conjugates.

Can Radiologist and Pathologist Reach The Truth Together in The Diagnosis of Benign Fibroepithelial Lesions?

Benign fibroepithelial lesions (BFL) lesions of the breast are various and predominantly benign, although a few can be locally aggressive. Definitive diagnosis of some BFL can be challenging from core needle biopsy (CNB). Radiological findings can help guide the management of the lesions. The aim of this study was to investigate the accuracy rate of CNB results and evaluate the radiological findings of the most common BFL according to the final excision pathology results. The secondary aim was to assess the contribution of the imaging findings to CNB results. A retrospective review was made of 266 patients diagnosed with suspicious BFL, conventional fibroadenoma, complex fibroadenoma, cellular fibroadenoma and benign phyllodes tumor (PT). The study included 132 patients who underwent surgical excision. The radiological and histopathological findings were evaluated. While 66 patients were diagnosed with more descriptive results on CNB, the other 66 patients were diagnosed with suspicious BFL. Agreement between CNB and excisional pathology was good, when CNB provided a definite diagnosis. While conventional and complex fibroadenoma were observed to have hypo or normal vascularity, cellular fibroadenoma and PT showed hypervascularity. Oval shaped and homogeneous internal echo pattern were significantly associated with conventional fibroadenoma. A heterogeneous internal echo pattern was seen in complex fibroadenomas and PT. CNB often reaches the correct diagnosis alone when it gives a definite diagnosis. The radiological findings which help in the differentiation of BFL are hypervascularity, oval shape and internal heterogeneity. More accurate results can be obtained when histopathological and radiological findings are evaluated together.

Выявление BRCA- и CHEK2-ассоциированных форм рака молочной железы и рака яичников у женщин в амбулаторной клинической практике врача-онколога

Introduction. Currently breast cancer is considered a heterogeneous disease and spectrum of several biological subtypes. Ovarian cancer is also characterized by a variety of molecular genetic alterations. Both diseases remain the leading specific causes of death in age group 40-49 and 50-59 for females. Objective: to evaluate the frequency of mutations in the genes BRCA1/2 and CHEK2 in patients with breast cancer and patients with ovarian cancer, as well as in women with benign neoplasms of the mammary glands, and to analyze their clinical and morphological correlations with the disease characteristics in the routine clinical practice of an outpatient oncologist. Patients and Methods: Seventy-six women were included in the present analysis. All of them were observed by the oncologist in Consultative and diagnostic center of Burdenko Main Military Clinical Hospital (Moscow) between January 2016 and May 2019, and were divided in three groups: patients with breast cancer (n=20), patients with ovarian cancer (n=17) and control group of women with benign neoplasms of the mammary glands (fibrocystic mastopathy in 29, breast fibroadenoma in 11), with no history of any oncological disease. One patient has metachronous malignant neoplasms of independent (primary) multiple sites: breast and ovarian cancer. All women were genotyped for pathogenic germline mutations 185delAG, 300T&gt;C (Cyse61Gly), 2080delA, 3819delGTAAA, 3875delGTCT, 4153delA, 5382InsC in the gene BRCA1, mutation 6174delT in the gene BRCA2 and mutations IVS2+1G&gt;A, I157T and IVS2+1G&gt;A in the gene CHEK2 by polymerase chain reaction real-time using a set “OncoGenetics” (LLC «Research and Production Company DNA-Technology», Russia, registration certificate № 2010/08415). Results: Pathogenic germline BRCA1 mutations were identified in 4 (20%) patients with breast cancer, 3 (17,6%) patients with ovarian cancer and 1 (2,5%) women with breast fibroadenoma. Pathogenic germline CHEK2 mutations were identified in 3 (15%) patients with breast cancer, all cases were represented by the I157T mutation. In the control group carriers of BRCA1 or BRCA2 mutations (n=2) were associated with early onset development of breast fibroadenoma in the age before 30 years. The risk of BRCA or CHEK2 mutated genes was significant higher in patients with breast cancer (45%, HR 9.0, 95% CI: 2.14 - 37.8) compared with the control group of women with benign breast tumors (5%, p &lt;0.001). The risk of BRCA or CHEK2 mutations was also higher in patients with ovarian cancer (17.6%, HR 3.53, 95% CI: 0.65 – 19.26) compared with the control group (5%), but the difference did not reach significance (p=0.151). Genotyping BRCA and CHEK2 results were correlated (r = 0.423) with a family history: mutations were more often detected in women with a family history of cancer (42.9% versus 7.3%, p = 0.001). Women with identified mutations showed an increased risk of early onset cancer development before the age of 50 years (69.2%, HR 4.33, 95% CI: 1.64 - 11.36, p = 0.003) compared with wild-type carriers BRCA and CHEK2 genes (16%). The only case of primary multiple metachronous malignant tumors of the breast and ovaries, as well as cases of bilateral breast cancer lesions were detected only among carriers of BRCA1/2 mutations. The prevalence of aggressive high grade cancer was higher in patients with BRCA and CHEK2 mutations (63.6%, HR 2.45, 95% CI: 0.87 - 6.90) than in patients with wild type genes (47.1 %), however, the difference did not reach significance (p = 0.141). Conclusions: Our results have shown the relevance and value of identifying for BRCA- and CHEK2-related breast cancer and ovarian cancer in women in everyday clinical practice. The vast majority of cases of breast and ovarian cancer among carriers of BRCA1/2 and CHEK2 mutations are found in the working and reproductive age of women and are associated with unfavorable disease characteristics - high grade and lower survival.

Cytological criteria of differentiation of phyllodes tumor of the breast and fibroadenoma

The article is devoted to the determination of the cytological criteria of differentiation of fibroadenoma and phyllodes tumor. By means of multivariate analysis the 11 most informative cellular signs of fibroadenoma, juvenile fibroadenoma and benign phyllodes tumors were identified. According to the discriminant analysis, only 37.97 % of patients with benign phyllodes tumors are classified correctly, that indicates the difficulties of differentiation of these tumors. Some cellular signs of fibroadenoma, borderline and malignant phyllodes tumor allow to diagnose these forms of tumors.

Effect of Converting From Calcineurin Inhibitor– to Sirolimus-Based Immunosuppressant Regimen on Breast Fibroadenoma Among Kidney Transplant Patients

The incidence rate of breast fibroadenomas is higher among female kidney transplant (KT) patients treated using cyclosporine (CsA) for immunosuppression than in the general population. As such, there is an effort to convert immunosuppression from CsA or tacrolimus to sirolimus. Our aim was to assess the reversibility of a breast fibroadenoma after conversion in a small cohort of female KT recipients. This was an open-label, single-arm study including 128 female KT recipients, with a positive finding of a breast fibroadenoma in 15. Lesions were classified according to the Breast Imaging Reporting and Data System (BIRADS). Among these 15, a total of 7 converted from tacrolimus to sirolimus and 8 converted from CsA. We measured the change in BIRADS category and hormone and cytokine levels from baseline to 12 months after conversion. The primary outcome was progression or reversal of existing fibroadenomas at 12 months after conversion. Secondary outcomes were differences in hormone and cytokine levels. Conversion from CsA or tacrolimus to sirolimus had no significant effect on the BIRADS classification. However, conversion to sirolimus did produce a significant decrease in the level of transforming growth factor β cytokine, this level being closely associated with fibroadenomas. Conversion from a calcineurin inhibitor to sirolimus can block the progression of fibroadenomas. Further research is needed to confirm our results.

Use of ultrasound combined with magnetic resonance imaging for diagnosis of breast masses and fibroids.

ObjectiveTo investigate the clinical value of ultrasound plus magnetic resonance imaging (MRI) for the diagnosis of breast masses and fibroids.MethodsClinical data for 357 patients with breast masses diagnosed at our hospital were analyzed retrospectively. The diagnostic performances were compared between 243 patients who underwent routine ultrasound examinations (control group) and 114 patients who underwent routine ultrasound plus MRI (test group).ResultsThe overall accordance rates of routine ultrasound and routine ultrasound plus MRI for the diagnosis of breast masses, based on postoperative pathological diagnoses, were 70.78% (172/243) and 90.35% (103/114). The addition of MRI significantly improved the overall diagnostic performance of routine ultrasound for breast masses. The diagnostic accordance rate of routine ultrasound for the diagnosis of breast fibroids (fibroadenomas) was 74.12% (63/85 cases) compared with 93.94% (31/33 cases) for routine ultrasound plus MRI. The diagnostic performance of routine ultrasound plus MRI was therefore also significantly higher than routine ultrasound alone for diagnosing breast fibroids.ConclusionsRoutine ultrasound plus MRI can greatly improve the diagnostic accordance rates for breast masses and fibroadenomas.

A case-control study of Metallothionein-1 expression in breast cancer and breast fibroadenoma

The overexpression of Metallothionein-1 (MT-1) may play an important role in breast cancer; however, few studies have compared MT-1 expression between breast cancer and fibroadenoma. A cross-sectional controlled study was performed in 66 premenopausal women, aged 20–49 years, who had been histologically diagnosed with breast fibroadenoma or breast cancer. The patients were divided into two groups: group A, control (fibroadenoma, n = 36) and group B, study (breast cancer, n = 30). Immunohistochemistry was performed on tissue samples of fibroadenoma and breast cancer patients to evaluate the expression of metallothionein using an anti-MT-1 polyclonal antibody (rabbit polyclonal anti-metallothionein-Catalog Number biorbyt-orb11042) at a dilution of 1:100. The data were analyzed using NOVA (p < 0.05). Microscopic analysis showed a higher concentration of anti-MT-1-stained nuclei in breast cancer tissues than in fibroadenoma tissues. The mean proportion of cells with anti-MT-1-stained nuclei was 26.93% and 9.10%, respectively, in the study and control groups (p < 0.001). Histological grade 3 tumors showed a significantly higher MT-1 expression than hitological grade 1 (p < 0.05), while breast tumors negative for estrogen-, progesterone- and HER2- receptors had a significantly higher MT-1 expression than positive breast tumors positive for these parameters (p < 0.05). MT-1 protein in women of reproductive age was significantly higher in breast cancer than in fibroadenoma in this study. Furthermore, there was higher MT-1 immunoreactivity in more aggressive tumors.

A Unique Four-Point Approach for Removal of Giant Breast Fibroadenoma With Marked Asymmetry: A Modified Round Block Technique

Purpose: The removal of the giant breast fibroadenoma (GFA) with esthetic repair of the severe deformed breast is a surgical challenge. Materials and Methods: This was a retrospective study of data of 10 patients with GFAs who treated with a modified round block technique at the Department of Breast Surgery, Hangzhou First People’s Hospital (Hangzhou, Zhejiang province, China) from March 2014 to June 2017. Preoperatively, according to the degree of excess skin and asymmetry, a four-point approach was designed. The area between the inner and outer circles was de-epidermized. The tumors were entirely stripped off along the capsule through an incision on a part of the outer circle. To avoid the nipple–areola complex widening, purse-string suture technique was used. Results: Patients’ age ranged from 12 to 32 years (mean age, 23 years), and the largest tumor weighed 2 kg, with a diameter of 16.5 cm. After a mean follow-up of 25 months (range, 9–32 months), no local recurrences were found. Cosmetic results were satisfactory with breast symmetry and minimal scarring. Complications were minimal and widening of the periareolar scar was slight as well. Conclusion: The modified round block technique is recommended to resect GFA in order to improve the cosmetic results with minimal scar.

Differential mast cell density in spectrum of benign neoplasms of breast: potential for patient stratification and personalised treatment approach

Background: Mast cells have a clear anti-tumorigenic role in invasive breast carcinoma. However, their role in the stepwise progression of benign fibroepithelial neoplasms of breast and mesenchymal tumours of the breast is less understood. Increased C-KIT (a receptor tyrosine kinase) expression in those tumours have been found to be due to presence of mast cells and a potential for patient stratification and individualized targeted therapy especially in phyllodes tumours. The present analysis was undertaken to assess the differential mast cell density within the spectrum of benign fibroepithelial neoplasms of the breast. Methods: Tissue from fifty three cases of fibroadenoma and it variants including cellular fibroadenoma, fibroadenoma with increased stromal cellularityand benign phyllodes tumour were included in the study. Mast cells were clearly demonstrated in breast tissue using Toluidine Blue stain at pH 2.3. Mast cells were counted using an eyepiece grid and expressed as no. of cells / per sq. mm, i.e., mast cell density (MCD). Differential mast cell density in spectrum of benign breast neoplasms was analysed and statistical analysis was done. Results: Mast cell density was statistically significantly higher in tissue from fibroadenoma compared to normal breast tissue. MCD was increased in cellular fibroadenoma and fibrodenoma with increased stromal cellularity compared to fibroadenoma. MCD was increased in benign phyllodes tumour compared to fibroadenoma with increased stromal cellularity, cellular fibroadenoma and fibroadenoma. Conclusions: Our results indicate a relative and progressive increase in mast cells in fibroadenomas compared to normal breast tissue and comparatively increased with increased cellularity and increased stromal cellularity among the spectrum of fibroepithelial neoplasms. The study could be extended with larger sample size especially of phyllodes tumours and combined with immunohistochemical (IHC) methods (antibodies for CD 117) could be used for patient stratification and selection for personalized treatment including anti-C-KIT therapy.

Matrix Metalloproteinase-13 (MMP-13): A proposed Tumor Marker in Breast Carcinoma

Breast cancer is estimated to account for 31% new onset female cancers. Matrix metalloproteinases (MMPs) are extracellular zinc-dependent endopeptidases involved in the degradation and remodeling of extracellular matrix in physiological and pathological processes. In this study, we aimed to evaluate the use of matrix metalloproteinase-13 (MMP-13) as a potential tumor marker in breast cancer and we also aimed to investigate the role of infection as a cause of carcinogenesis by estimating the incidence of anti-cytomegalovirus IgG antibodies in breast cancer patients. Subjects and Methods: Serum CA15.3, anti-CMV IgG and MMP-13 were measured in 50 breast cancer female patients, 20 female patients with fibroadenoma of breast and 20 healthy age-matched female volunteers. Results: MMP-13 levels showed no significant difference between breast cancer patients and controls; on the other hand MMP-13 levels were significantly higher in fibroadenoma patients compared to controls. CA15.3 levels were significantly higher in breast cancer cases compared to both fibroadenoma and healthy controls. Conclusion: The results of this study show that MMP-13 level is highest among control group, while fibroadenoma group had the lowest MMP-13 level. CA15.3 is still the most useful serum tumor marker in patients with breast cancer.