Incidental Microscopic Finding Research Articles

Incidental Pathologic Findings in Young Adult Reduction Mammaplasty.

This study aims to characterize incidental microscopic findings in this population to determine whether there is a benefit to routine histopathologic examination of breast tissue in young women. A retrospective review of young women who underwent reduction mammaplasty between June of 2010 and May of 2018 was performed at a single institution to identify demographics, age at the time of surgery, breast cancer risk factors, and pathologic data. Histologic reevaluation was performed when diagnostic clarification was needed. Descriptive, univariate, and multivariable statistical analyses were performed. A total of 798 young women were included. At the time of surgery, the mean patient age was 17.5 ± 2.0 years, the mean body mass index was 28.7 ± 5.7 kg/m2, and the mean resection weight was 685 ± 339 g/breast. The majority of patients were reported to have pathologically normal tissue [n = 704 (88.2 percent)]. Of the 94 patients (11.8 percent) with abnormal findings, 21 (2.6 percent) had benign nonproliferative changes, 64 (8.0 percent) had proliferative lesions without atypia, nine (1.1 percent) had proliferative lesions with atypia, and a single patient (0.1 percent) had a borderline phyllodes tumor. Univariate and multivariate analyses revealed that age at menarche younger than 12 years was significantly associated with increased incidence of proliferative lesions. Over 10 percent of young women with reduction mammaplasty have histopathologic findings. Although this study demonstrated an overall low incidence of atypical lesions, because early identification offers potential for improved surveillance, the authors continue to advocate for routine pathologic evaluation, particularly for women with early menarche. Risk, III.

Bilateral diffuse pseudoangiomatous stromal hyperplasia in a pregnant woman: case report

Pseudoangiomatous stromal hyperplasia (PASH) is a benign proliferation of breast stroma, usually described as an incidental microscopic finding. Clinically, it can manifest as a palpable and well-circumscribed mass or, in rare cases, as a diffuse bilateral process, causing massive and rapid breast growth. The most widely accepted theory about PASH is the hormonal stimulation of breast myofibroblasts, mainly caused by progesterone. A definitive PASH diagnosis is based on typical findings, such as stromal hyperplasia and slit-like channels. The main clinical differential diagnosis is fibroadenoma or phyllodes tumor and, histologically, low-grade angiosarcoma. This work aims at evaluating the maternal and fetal prognosis of a diffuse PASH case in a pregnant woman. This is the case report of a 27-year-old woman with no comorbidities, previously diagnosed with PASH in January 2018, without clinical repercussion or treatment at the time. In 2019, in the 16th week of her second pregnancy, she noticed a rapid and significant breast growth. In the first trimester, she had a weight gain of 12 kg, and her breasts had a four-fold volume increase, preventing her from performing routine activities, such as standing and walking. Over the days, still with progressive breast tissue growth, she showed a considerable reduction in peripheral breast vascularity, intense pain, hyperemia, skin necrosis, overall worsening, and hemodynamic repercussion. Since this is a case little reported in the literature and given the clinical and hemodynamic conditions of the patient, the treatment chosen was bilateral mastectomy, performed with her consent in October 2019. In the immediate postoperative period, she progressed to fetal death and hemodynamic stabilization in the intensive care unit. After a few days of hospitalization, stable, and with good progress, she was discharged for outpatient follow-up. Anatomopathological results corroborated the PASH diagnosis made in 2018. Data on the final pregnancy outcome and the consequences for mother and fetus will be reported. Data analysis was based on a review of the patient's medical records. We concluded that each case should be assessed individually, taking into account the clinical, surgical, and obstetric aspects to determine the best workup and therapeutic approach.

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.

Fibrin-associated EBV-positive Large B-Cell Lymphoma: An Indolent Neoplasm With Features Distinct From Diffuse Large B-Cell Lymphoma Associated With Chronic Inflammation.

Incidental cases of localized fibrin-associated Epstein-Barr virus (EBV)+ large B-cell proliferations have been described at unusual anatomic sites and have been included in the category of diffuse large B-cell lymphoma associated with chronic inflammation (DLBCL-CI) in the WHO Classification. We describe 12 cases and review the literature to define their clinicopathologic spectrum and compare features with typical cases of DLBCL-CI. Median age was 55.5 years with a M:F ratio of 3. In all 12 cases, the lymphoma was an incidental microscopic finding involving atrial myxomas (n=3), thrombi associated with endovascular grafts (n=3), chronic hematomas (n=2), and pseudocysts (n=4). All cases tested were nongerminal center B-cell origin, type III EBV latency, and were negative for MYC rearrangements and alternative lengthening of telomeres by FISH. Most showed high CD30, Ki67, and PD-L1, and low to moderate MYC and p53 expression. Among 11 patients with detailed follow-up, 6 were treated surgically, 3 with cardiac or vascular lesions had persistent/recurrent disease at intravascular sites, and 4 died of causes not directly attributable to lymphoma. Reports of previously published fibrin-associated cases showed similar features, whereas traditional DLBCL-CI cases with a mass lesion had significantly higher lymphoma-associated mortality. Fibrin-associated EBV+ large B-cell lymphoma is clinicopathologically distinct from DLBCL-CI, warranting separate classification. Most cases, particularly those associated with pseudocysts, behave indolently with the potential for cure by surgery alone and may represent a form of EBV+ lymphoproliferative disease rather than lymphoma. However, primary cardiac or vascular disease may have a higher risk of recurrence despite systemic chemotherapy.

Sinusoidal hemangioma of the breast: diagnostic evaluation management and literature review

Vascular tumors of the breast are rare and may pose a diagnostic challenge. Breast hemangioma is a very rare benign vascular neoplasm accounting for 0.4% of all breast tumors. It is most commonly detected as an incidental microscopic finding in biopsy specimens obtained for unrelated reasons. We describe here a very rare case of a sinusoidal breast hemangioma in a postmenopausal patient who presented with a palpable breast mass. A complete surgical resection was performed because the tumor exhibited atypical imaging features. We conclude that although in carefully selected cases of breast hemangioma a conservative management with follow up imaging is a reasonable option, in cases with atypical imaging or pathological characteristics a complete surgical resection of the vascular tumor is mandatory in order to exclude the possibility of an underlying angiosarcoma.

Pseudoangiomatous Stromal Hyperplasia Presenting as Rapidly Growing Bilateral Breast Enlargement Refractory to Surgical Excision.

Pseudoangiomatous stromal hyperplasia (PASH) is a benign proliferative mesenchymal lesion of the breast. PASH presents as a palpable or mammographically detectable mass or is an incidental microscopic finding in up to 23% of breast biopsies. Its pathogenesis is unclear but may involve hormonal factors, as recently postulated. Its clinical, cytological, and radiological characteristics resemble those of other benign tumors, including low-grade angiosarcomas and phyllodes tumors. Because of its uncertain pathogenesis, PASH is usually treated via surgical excision, with post-excision recurrence rates ranging from 7% to 22% [1]. Although several cases of PASH have been recently reported, cases of PASH involving large, rapidly growing lesions refractory to surgical incision are rare [2]. In this study, we report our experience with a case of PASH that presented as rapidly growing bilateral breast enlargement refractory to surgical excision. We also review the pertinent literature, including the clinical and histopathological features, pathogenesis, imaging findings, treatment, and prognosis of PASH.

Bilateral diffuse pseudoangiomatous stromal hyperplasia (PASH) causing gigantomastia in a 33-year-old pregnant woman: case report

Pseudoangiomatous stromal hyperplasia (PASH) is a benign proliferation of mammary stroma mostly described as incidental microscopic finding. It can clinically manifest as a palpable, well circumscribed breast mass or in rare cases as a diffuse bilateral process causing massive breast enlargement. The most postulated theory for aetiology of this condition is hormonal stimulation of mammary miofibroblast, particularly by progesterone. The definite diagnosis of PASH is based on typical pathological findings like stromal hyperplasia and empty slitlike channels positive for myofibroblastic and negative for endothelial markers. The main clinical differential diagnosis is a fibroadedoma or phylloid tumour and histologically a low grade angiosarcoma. There are less than 200 cases of tumorous PASH and less than 20 of diffuse PASH reported so far. Here we present a case report of huge diffuse PASH, that is, to our knowledge, first one in a pregnant woman.

Is isolated aortitis mild form of takayasu aortitis? comparison of clinical and histopathological features

Background Takaytasu aortitis (TA) is an inflammatory large-vessel vasculitis of unknown origin. In rare cases, isolated aortitis (IA) is usually diagnosed by its incidental microscopic findings after ascending aortic surgery. Some of isolated aortitis are thought to be IgG-4 related disease. Methods We compared 52 TA patients and 7 IA patients who underwent aortic surgery to investigate clinical and histopathological features. Results Patients with TA were older than IA patients (M/F; 3/4) (median 56 vs 78 years; p Conclusions In comparison to IA, TA tends to show poor clinical outcome because of its multiple vascular damage. Clinically, isolated aortitis may be a distinct disease of TA. IA was also considered in case of ascending aortic aneurysm.

Bilateral diffuse tumorous pseudoangiomatous stromal hyperplasia: a case of bilateral mastectomy in a 29-year-old woman.

Pseudoangiomatous stromal hyperplasia (PASH) is a benign breast lesion commonly encountered as an incidental microscopic finding. However, it can also manifest as a mass-forming lesion (tumorous PASH) capable of recurrence after surgical excision. Most of the previously reported cases of tumorous PASH present as a single dominant mass. Here we reported a rare case of diffuse tumorous PASH involving bilateral breasts clinically mimicking malignancy. A 29-year-old African-American female presented with a one-year history of bilateral breast enlargement and asymmetry. Physical examination revealed multiple palpable nodules in bilateral breasts. Imaging studies demonstrated innumerable homogeneously enhancing masses throughout both breasts, greater on the left, with multiple cysts and edema. Biopsy of the breast nodules demonstrated histopathological changes consistent with PASH. Due to the extent of the lesions and progressive clinical symptoms, decision was made to perform bilateral mastectomy. Macroscopic examination of the bilateral mastectomy specimens revealed markedly enlarged breasts with marked edema and numerous well-defined firm nodules. Microscopic evaluation of the nodules confirmed the diagnosis of PASH. No evidence of malignancy was identified. Recognition of this rare form of PASH is essential for the proper clinical management.

Microscopic Kaposiform Hemangioendothelioma With Extensive Lymphangiomatosis

Kaposiform hemangioendothelioma (KHE) is presently classified as a vascular neoplasm of intermediate malignant potential. The clinical course of large, deep-seated tumors is frequently complicated by consumptive coagulopathy and life-threatening hemorrhage, while superficial tumors tend to behave in an indolent manner, with no known reports of distant metastasis. We describe an unusual example of KHE occurring as an incidental microscopic finding, within a background of extensive lymphangioma-like changes. The patient underwent 4 intralesional excisions over a period of 6 years, and the Kaposiform component accounts for less than 5% of the overall tissue excised. The patient remains clinically well with residual disease 5 years after conservative surgery, and there has been no evidence of regional or distant metastasis. Based on existing literature, it appears doubtful that KHE has any metastatic potential at all, which calls into question the appropriateness of its place in the spectrum of malignant vascular neoplasms.

Pseudoangiomatous Stromal Hyperplasia (PASH) of the Breast With Foci of Morphologic Malignancy: A Case of PASH With Malignant Transformation?

Pseudoangiomatous stromal hyperplasia (PASH) is a benign proliferation of the hormonally responsive, specialized mammary stroma characterized by slit-like pseudovascular spaces lined by bland spindle cells. It is usually an incidental microscopic finding but in some cases it may present as a slowly growing mass. A malignant counterpart for this lesion has not been reported. We describe a case of PASH with foci of malignant histologic features presenting as a slowly growing mass in a 30-year-old woman. The previously reported variants of PASH and the other mammary stromal lesions related to PASH are also discussed. This is perhaps the first case of PASH with foci of malignant histologic features reported in the literature and represents a rare sarcoma derived from specialized hormonally responsive mammary stroma.

Myocardial disease in human immunodeficiency virus (HIV) infection: a review

Heart muscle disease is the most important cardiovascular manifestation of HIV infection and is likely to become even more prevalent as HIV infected patients live longer. This may present as myocarditis, dilated cardiomyopathy or isolated left or right ventricular dysfunction. Myocardial involvement in HIV infection is multifactorial and may arise as a result of myocardial invasion with HIV itself, opportunistic infections, viral infections, autoimmune response to viral infection, drug-related cardiac toxicity, nutritional deficiencies, and prolonged immunosuppression. Both adults and children are affected with severity ranging from incidental microscopic inflammatory findings at autopsy to clinically significant cardiac disease with chronic cardiac dysfunction. It is associated with a poor prognosis, and results in symptomatic heart failure in up to 5% of HIV patients. Clinical pathological studies from the pre-HAART era show a 30% prevalence of cardiomyopathy in patients with AIDS. The introduction of highly active antiretroviral therapy (HAART) regimens has substantially modified the course of HIV disease by lengthening survival and improving quality of life of HIV-infected patients. There is also good evidence that HAART significantly reduces the incidence of cardiovascular manifestations of HIV infection. By preventing opportunistic infections and reducing the incidence of myocarditis, HAART regimens have reduced the prevalence of HIV-associated cardiomyopathy by almost 7-fold from the pre-HAART era. HAART is however only available to a minority of HIV infected individuals in most areas of the world and studies from the pre-HAART period still apply. In this review, the aetiopathogenesis and presentation of HIV related myocardial disease were reviewed and measures taken to improve survival discussed.

Incidental Microscopic Finding Of Acellular Mucin In An Inguinal Hernia Sac As A Warning Sign Of Pseudomyxoma Peritonei

Here we describe, an incidental microscopic finding of acellular mucin embedded within the wall of a grossly unremarkable hernia sac specimen in a male patient presenting clinically with an inguinal hernia. Due to its acellular nature and routine associated clinical history, the presence of microscopic mucin within the hernia sac may be easily dismissed. As the following case illustrates, the finding of acellular mucinous material in a hernia sac specimen can be associated with mucin-producing abdominal malignancy and may be an initial presentation of pseudomyxoma peritonei.

Pseudoangiomatous Stromal Hyperplasia. A Case for Bilateral Mastectomy in a 12-Year-Old Girl

Pseudoangiomatous stromal hyperplasia (PASH) is a benign proliferation of breast stromal cells with a complex pattern of interanastomosing spaces lined by myofibroblasts and is most commonly seen in women of child-bearing age. PASH is a frequent incidental microscopic finding in breast biopsies. Nodular PASH, however, resulting in a clinically appreciable mass and rapid growth is a rare entity, with only four such patients cited in the literature. Surgical excision results in a cure in the majority of cases, with a recurrence rate of approximately 7-22%. We report a case of a 12-year-old girl with nodular PASH who presented with bilateral breast enlargement refractory to surgical excisions, eventually requiring bilateral mastectomies. To our knowledge, our patient is the youngest patient to have nodular PASH and to undergo bilateral mastectomies.

Minute pulmonary meningothelial‐like nodules and myxedema

Minute meningothelial-like nodules (MMN)formerly known as minute chemodectomas are incidental microscopic findings in lungs. Often multiple, they seem to be reactive proliferations rather than neoplasms. Their ultrastructure and immunohistochemical reactions are consistent with a meningothelial nature. The function of the presumed normal pulmonary cell underlying them is unknown. MMN occur somewhat more frequently in relationship to thromboembolism, heart failure, and high altitude. It has been postulated that a tendency to pulmonary edema may be a common factor in their initiation, and that, like arachnoid granulations, they may be involved in the absorption and transfer of fluid. We have observed large numbers of MMN in the lungs of a human cretin in whom myxedema was a prominent feature. We have also observed them consistently in the lungs of lambs with a similar condition made hypothyroid in utero by means of maternal thyroidectomy. Thyroid hormone normally plays a role in interstitial fluid homeostasis. MMN formation may be secondary to an alteration in interstitial fluid in the lung caused by a lack of thyroid hormone. Alternatively, it may be secondary to matrix protein or other metabolic effects of hypothyroidism, or might even be a direct response to pituitary secretion. The observation of an unexpected link between cretinism and MMN provides a potential tool for the study of MMN, and more importantly, for investigation of the underlying cell and its possible role in an arachnoid-like function in the periphery of the pulmonary acinus.

Bilateral Risk for Subsequent Breast Cancer After Lobular Carcinoma-In-Situ: Analysis of Surveillance, Epidemiology, and End Results Data

Noninvasive lesions involving the lobules of the breast are increasingly diagnosed as incidental microscopic findings at the time of lumpectomy or core-needle biopsy. We investigated the incidence rates of invasive breast cancer (IBC) after a diagnosis of lobular carcinoma-in-situ (LCIS) by using Surveillance, Epidemiology, and End Results (SEER) data. Patients (N = 4,853) having a diagnosis of primary LCIS in the time period of 1973 to 1998 were identified using the SEER Public Use CD-ROM data. The database was then searched for patients with subsequent primary IBC occurrences (n = 350). The clinical and pathologic characteristics of patients with subsequent primary IBCs were compared with the characteristics of patients with primary IBCs attained during the same time period (N = 255,114). The incidence of IBC increased over time from diagnosis of LCIS, with 7.1% +/- 0.5% incidence of IBC at 10 years. IBCs detected after partial mastectomy occurred in either breast (46% ipsilateral and 54% contralateral); however, after mastectomy, most IBCs were contralateral (94.7%). IBCs occurring after LCIS more often represented invasive lobular histology (23.1%) compared with primary IBCs (6.5%). The standardized incidence ratio (the ratio of observed to expected cases) for developing IBC was 2.4 (95% CI, 2.1 to 2.6) adjusted for age and year of diagnosis. LCIS is associated with increased risk of subsequent invasive disease, with equal predisposition in either breast. The minimum risk of developing IBC after LCIS is 7.1% at 10 years.

In situ and invasive adenocarcinomas of the gallbladder extending into or arising from Rokitansky-Aschoff sinuses: a clinicopathologic study of 49 cases.

We report 49 cases of gallbladder carcinomas that extended into or originated from Rokitansky-Aschoff sinuses (RAS), all of which were resected by laparoscopic cholecystectomy. Twenty-one tumors were in situ carcinomas that extended along RAS; six in situ carcinomas arose in adenomyomatous hyperplasia and 22 were invasive adenocarcinomas with extension into RAS. Thirty-seven patients were women and 12 men. Forty patients had cholelithiasis. The age of the patients ranged from 55 to 84 years (mean 67 years). All in situ carcinomas were incidental microscopic findings in gallbladders removed for cholelithiasis and/or cholecystitis. No patient with in situ carcinoma died as a result of the tumor, including two with in situ carcinoma that originated in adenomyomatous hyperplasia and showed microinvasion. In contrast, of 15 patients with invasive well to moderately differentiated adenocarcinoma extending into RAS and invading the muscle layer or subserosal connective tissue, 8 died 2 to 4 years after surgery. Seven patients survived 1 to 8 years after cholecystectomy. Useful clues to separate RAS with in situ carcinoma from tubular neoplastic invasive glands were the following: connection of the epithelial invaginations to the surface epithelium, recognition of normal biliary epithelium admixed with neoplastic epithelium, presence of inspissated bile in long dilated spaces, and lack of invasion to the smooth muscle bundles. In situ carcinoma spreading along RAS consisted of long tubular often dilated structures extending through the intermuscular connective tissue, whereas neoplastic glands were usually small or of medium size that invaded smooth muscle bundles or intermuscular connective tissue. Perineural invasion was seen only in invasive glands located in the subserosal connective tissue. Two cases of in situ carcinoma that arose in adenomyomatous hyperplasia and three invasive adenocarcinomas that were composed predominantly of tall columnar mucin containing cells similar to gastric foveolar cells with varying degrees of atypia and cells with biliary phenotype bear some resemblance to intraductal papillary mucinous carcinoma of the pancreas or to mucinous cystic pancreatic neoplasm. Metaplastic pyloric glands often seen in the muscle layer and subserosal connective tissue maintain their lobular pattern and should not be confused with invasive glands. Our findings indicate that distinction of in situ carcinoma spreading into RAS from tubular neoplastic glands of invasive adenocarcinomas is crucial to determine prognosis in this group of patients with gallbladder carcinoma.

Lobular carcinoma in situ presenting as architectural distortion on mammograms: a case report and review of the literature

Lobular carcinoma in situ (LCIS) is an uncommon high-risk lesion of the breast, often diagnosed as an incidental microscopic finding in tissue removed for other mammographic finding, and is usually adjacent to, but not within the mammographically depicted lesions. Thus, there are no distinctive mammographic features of LCIS, according to most reports in the literature. We present a woman with multifocal LCIS involving an area of mammographically detected architectural distortion. The mammographic findings and the pathologic correlation are discussed.

Endometrial Polyps in a Cat

Endometrial polyps from an 11-year-old female nulliparous mongrel cat are described. Pedunclated polypoid masses consisting mainly of endometrial glands and stroma protruded into the lumen of the uterus. The endometrial glands were distributed in a haphazard low density pattern, while the stromal cells were distributed with various consistency. Throughout the polyps, mild to moderate proliferation of the connective tissue with admixed small blood vessels was observed, with some of these blood vessels exhibiting thickened walls. The perivascular stromal element was also observed in polyps, as an incidental microscopic finding. It was characterized by multiple perivascular whorl-like arrangements of spindle shaped cells. They were immunohistochemically positive for alpha-smooth muscle actin, desmin, and S-100. These elements appear to originate from the endometrial stromal cells through smooth muscle metaplasia.

Granulosa Cell Tumor of the Ovary

BACKGROUND Late recurrence can be extensive with initial, clinically undetectable, microscopic granulosa cell tumor of the ovary. CASE We describe an 83-year-old patient who presented with extensive recurrent granulosa cell tumor of the ovary 6 years after undergoing abdominal hysterectomy and bilateral salpingo-oophorectomy for atypical endometrial hyperplasia with an incidental microscopic finding of ovarian granulosa cell tumor. CONCLUSION Patients must be monitored closely after a diagnosis of ovarian granulosa cell tumor, even if the tumor is occult.