Lump In Left Breast Research Articles

Male breast cancer presenting with bilateral pleural effusion

Male breast cancer presenting with bilateral pleural effusion

Bilateral Angiosarcoma of the Breast: Case Report and Review of the Literature

INTRODUCTION: The Angiosarcoma of the breast is a malignant mesenchymal neoplasia that has its origin at endothelial cells of blood vessels of the breast. It is a rare pathology, which represents 0. 04% of the primary tumors of the breast and about 8% of the sarcomas presented at the mammary gland. It occurs mainly in women under 40 years old. The incidence of synchronic contralateral breast Angiosarcoma is about 20%. The dissemination of the tumor is mainly hematogenic. It is usually presented as tumor, with a diameter of about 5 centimeters with soft consistence and badly bounded borders. The diagnosis is histopathological. The prognosis is unfavorable due to the high aggressiveness of the tumor, with recurrence taxes around 50% and a survival index of about 41% in 3 years. The usually recommended treatment is the surgical approach through mastectomy. CASE REPORT: SNPM, female, 44 years old. She was sent to Hospital Federal da Lagoa for having a touchable nodule in the left breast two months before the first interview. The physical examination showed medium-volume breasts, with a palpable tumor at the union of internal quadrants of the left breast with four centimeters in diameter, badly defined bounds, mobile, with a slightly hard consistence and negative papillary discharge bilaterally. Mammography presented with no suspicious lesions. Ultrasonography of the breasts showed at the union of the internal quadrants of the left breast a hypoechogenic, heterogeneous and irregular nodule with. This nodule measured 3. 2 x 1. 3 x 2. 8 centimeters category BI-RADS 4. We made then a core biopsy of this nodule, with a hystopathological report compatible with breast Angiosarcoma of a low degree. An MRI was performed after this diagnosis. The MRI revealed an irregular and heterogeneous nodule, with intense precocious impregnation by the contrast medium and signals of limited distribution at the union of medium quadrants of the left breast. The nodule measured 4. 7 x 3. 8 x 3.5 centimeters corresponding to what was found at the USG performed previously. The MRI showed also a small irregular nodule with intense heterogeneous impregnation of the contrast medium and ascending curve placed in the third medium of the union of the superior quadrants of the right breast classified as BI-RADS 4. At this point, we performed core biopsy of the nodule of the right breast, which made the same diagnosis of the left breast lump. Skin bilateral sparing mastectomy with expander placement bilaterally was performed as the surgical treatment. Histopathological examination of the surgical right breast revealed a low-grade breast angiosarcoma with free surgical margins. The result of the left breast surgical specimen was breast angiosarcoma of intermediate histological grade with foci of high grade, focal necrosis, angiolymphatic invasion was not observed, surgical margins were also free. CONCLUSION: This is a rare and very agressive disease. In the case reported, the patient is at the age when the most cases of this kind of sarcoma appear. The patient had a bilateral tumor. Although the prognosis is dark and there is a high recurrence of the disease, we have decided for the bilateral adenectomy that spare the skin and areolopapilar complexes with expander placement bilaterally, respecting the desire of a young and depressive patient.

A RARE CASE ON METAPLASTIC SQUAMOUS CELL CARCINOMA OF BREAST

Metaplastic breast carcinomas represent a morphologically heterogeneous group of invasive breast cancers in which a variable portion of the glandular epithelial cells comprising the tumor have undergone transformation in an alternate cell type either a nonglandular epithelial cell type or a mesenchymal cell type. Metaplastic carcinomas are uncommon lesions, representing less than 5% of all invasive breast cancer. This is a case of 51 year old female with left breast swelling since 3 months. She underwent Modified Radical Mastectomy. The histopathological findings were in favour of diagnosis invasive metaplastic carcinoma of breast squamous cell variant well differentiated.

Chondrolipoma of breast: A case report with the review of the literature

Chondrolipoma of the breast is a rare benign mesenchymal tumor composed of mature cartilage and adipose tissue. We present one such case in a 55-year-old woman presenting with left breast lump detected by self-examination. The tumor was diagnosed as fibroadenoma clinically. The diagnosis of chondrolipoma was possible only by histopathological examination. This case is reported because of its rarity in breast.

Desmoid tumour of the breast as a manifestation of Gardner's syndrome

INTRODUCTIONDesmoid tumours of the breast are rare. Although benign, they can mimic breast cancer on physical examination, mammography and breast ultrasound and can also be locally invasive. Even though they occur sporadically, they can also be seen as a part of Gardner's syndrome. We describe a case of desmoid tumour in a woman with Gardner's syndrome where the lesion was mammographically occult. PRESENTATION OF CASEA 63-year old woman presented with four months history of a painful left breast lump. She had a screening mammogram seven months ago which was normal. She is known to have Gardner's syndrome and had a total colectomy, she has also had multiple abdominal desmoids excised in the past. On examination there was a 4cm×5cm firm, mobile lump in the left breast. Her mammograms in the clinic were also normal. Ultrasound suggested a benign lesion of the breast and a core biopsy showed it to be a benign spindle cell lesion. She underwent wide local excision of the lump, the intraoperative mammograms of the excised specimen also failed to detect the lesion. Histopathology of the excised specimen confirmed the tumour to be a benign desmoid tumour. She has now been offered radiotherapy and nonsteriodal anti-inflammatory drugs (NSAIDs) to reduce her chances of a local recurrence. CONCLUSIONA high index of suspicion and a thorough triple examination protocol is necessary to detect rare lesions like a desmoid tumour which can masquerade as breast carcinoma.

Chronic breast abscess due to Mycobacterium fortuitum: a case report

IntroductionMycobacterium fortuitum is a rapidly growing group of nontuberculous mycobacteria more common in patients with genetic or acquired causes of immune deficiency. There have been few published reports of Mycobacterium fortuitum associated with breast infections mainly associated with breast implant and reconstructive surgery.Case presentationWe report a case of a 51-year-old Caucasian woman who presented to our one-stop breast clinic with a two-week history of left breast swelling and tenderness. Following triple assessment and subsequent incision and drainage of a breast abscess, the patient was diagnosed with Mycobacterium fortuitum and treated with antibiotic therapy and surgical debridement.ConclusionThis is a rare case of a spontaneous breast abscess secondary to Mycobacterium fortuitum infection. Recommended treatment is long-term antibacterial therapy and surgical debridement for extensive infection or when implants are involved.

Nodular hidradenoma of male breast: Cytohistological correlation

Nodular hidradenoma is an established entity as a skin adnexal tumor arising from eccrine sweat glands. A skin adnexal tumor located in the breast is unusual and is one of the differential diagnoses for subareolar breast nodules. With the exception of gynecomastia, other lesions of the male breast are not very common. The review of literature showed only 25 reported cases till date. The rarity of this neoplasm and failure to identify its morphologic features may lead to misdiagnosis. Being itself rare, cytological features of this lesion are hardly encountered in case reports. We report a case of an 18-year-old male who presented with a left breast lump and underwent fine needle aspiration and was diagnosed as having a benign skin adnexal tumor. Later it was confirmed by histopathology to be a nodular hidradenoma.

Spontaneous Hematoma of the Breast 30 Years after Augmentation

Sir: Delayed hematoma formation following augmentation mammaplasty is a rare complication.1–5 We encountered the largest hematoma ever reported, and the furthest from initial surgery, when a 56-year-old African American woman presented with a 3-month history of left breast swelling. The patient had subglandular silicone breast implants placed in the late 1970s and denied any recent trauma. On examination, the patient had extensive asymmetry, with a very large, firm left breast distended to approximately the size of a basketball (Fig. 1). Mammography and ultrasound showed evidence of implant rupture and a large fluid collection surrounding the implant. Computed tomography identified a well-defined fat plane between the fluid and the pectoralis major muscle (Fig. 2).Fig. 1.: The patient presented with a 3-month history of a slowly enlarging left breast.Fig. 2.: Computed tomographic scan of the chest reveals a large heterogeneous fluid collection within the left breast, a well-demarcated plane between this collection and the pectoralis major muscle, and bilateral implant rupture.During surgical exploration, the implant was found to be ruptured with silicone mixed within the hematoma fluid. In total, 4.5 liters of material was removed from the breast. Open periprosthetic capsulectomy was performed, and biopsy specimens were obtained from thickened areas of the capsule. Results of cultures were negative and pathologic evaluation revealed a ruptured silicone implant, with benign fibroadipose tissue and chronic inflammation. Within the specimen, silicone granulomas with multinucleated giant cell reaction and hemosiderin-laden macrophages were identified. The postoperative course was uneventful, and staged reconstruction is planned. In 1979, Georgiade et al. first reported a hematoma developing in a 25-year-old patient 2.5 years after breast augmentation using saline prostheses containing triamcinolone acetonide.1 During exploration, an eroded capsular artery was found to be actively bleeding, and this was ascribed to the steroid infusion. Follow-up reports attribute late hematoma formation to the erosion of vessels arising from the breast capsule, and various inciting factors have been described, including inflammation, microfracture of the capsule, friction of the implant against the capsule, and trauma.2–5 Our pathologic findings are consistent with inflammation contributing to the development of the hematoma, likely as a reaction to the ruptured silicone implant. Previous case reports describe chronic expanding hematomas developing around various types of implants after a period ranging from 5 months to 22 years; thus, this hematoma is the furthest from time of onset, developing 30 years after augmentation.4 Before this study, the largest hematoma evacuated was 500 ml, whereas in this case, 4.5 liters of fluid was removed, making this the largest collection to date.5 Described treatment of hematomas ranges from close observation to surgical management.2–5 In the setting of hematoma development many years after augmentation without an inciting event, other pathologic findings such as infection, inflammation, and malignancy should be considered. The hematoma requires drainage, and the capsule must be examined for any evidence of persistent bleeding. In addition, the breast and capsule must be inspected for any evidence of malignancy, especially in the setting of reconstruction and prior malignancy. In summary, hematoma formation is a rare complication of breast implantation. Patients presenting with sudden swelling of the breast should be evaluated for infection, malignancy, and late hematoma formation. Imaging studies are useful adjuncts to better characterize breast abnormality, but ultimately surgical exploration is the standard treatment. DISCLOSURE The authors have no financial interest to disclose in relation to the content of this article. Yvonne Rasko, M.D. Department of Surgery Division of Surgical Oncology Michel Saint-Cyr, M.D. Department of Plastic and Reconstructive Surgery Yan Peng, M.D. Department of Pathology Roshni Rao, M.D. Department of Surgery Division of Surgical Oncology University of Texas Southwestern Medical Center Dallas, Texas

Adenoid cystic carcinoma of breast and the importance of differentiation from collagenous spherulosis by FNAC

We are presenting a case of adenoid cystic carcinoma (ACC) of breast in a 66-year-old woman having lump in left breast, admitted to surgical ward of our institute. A diagnosis of ACC of breast was made and subsequently confirmed histopathologically and on immunohistochemistry.

A breast fibroadenoma mimicking an extranodal deposit of Hodgkin's lymphoma in67Ga imaging

We present the case of a young woman with classical nodular sclerosing Hodgkin's lymphoma (clinical stage IIB). During staging work-up, intense gallium-67 ((67)Ga) accumulation in a left breast lump raised the suspicion of an extranodal deposit, but biopsy favoured a benign histology. A post-treatment (67)Ga scan showed complete remission of the disease with normal tracer uptake in the left breast. However, a few months after treatment, a faint left mammary concentration of (67)Ga was observed. The breast mass was excised and histopathology was consistent with fibroadenoma. This unusual presentation is a new addition to the literature on false-positive (67)Ga findings and chemotherapy-associated tracer changes.

Histogenesis of metaplastic breast carcinoma and axillary nodal metastases

A 40-year-old breast-feeding woman presented with left breast swelling. On physical examination a 7 cm mass was found in the breast. Because biopsy demonstrated malignant tissue, mastectomy with axillary nodal dissection was performed. Pathological findings were consistent with metaplastic breast carcinoma with nodal metastases. The primary tumor consisted of three types of invasion: ductal, squamous, and sarcomatous. Furthermore, three morphological transitions were observed: ductal-squamous, ductal-sarcomatous, and squamous-sarcomatous. Ductal-squamous (12/18 microscopy slides) and squamous-sarcomatous transitions (10/18) were more commonly observed than ductal-sarcomatous transition (3/18). Furthermore, immunohistochemistry showed loss of epithelial marker (cytokeratin) and acquisition of mesenchymal markers (vimentin and alpha-smooth muscle actin) in the sarcomatous component. These findings suggested that epithelial-mesenchymal transition had occurred in the tumor and that two pathways, ductal-squamous-sarcomatous and ductal-sarcomatous transition, were involved in progression of metaplastic breast carcinoma. The main pathway appeared to be ductal-squamous-sarcomatous transition. Regarding the nodal metastases, of 13 positive nodes, ductal, squamous, and sarcomatous components were observed in 13, seven, and two nodes, respectively. Moreover, as in the primary tumor, ductal-squamous and squamous-sarcomatous transitions were observed. This suggested that the ductal component metastasized to the nodes and that epithelial-mesenchymal transition subsequently occurred within the nodes.

DISCORDANCE ANATOMO-RADIOLOGIQUE DANS LES TUMEURS DU SEIN

Introduction : Phyllode sarcoma is a rare lesion .Its epithelial component is usually benign and the mesenchymal component can differentiate into liposarcoma. These tumor has clinical and radiological characters of the benign lesions. But only the histological examination can diagnose and evaluate its prognosis.Carcinosarcoma of the breast results from a dedifferentiation of the invasive epithelial component found in the liposarcoma.The aim of our observation is to emphasize the clinical, radiological and the anatomo pathological discordances of these tumours and to underline the importance of the anatomopathological finding in its diagnosis and its impact on treatement. Observation : She is a 17-years-old girl, who has since one year a left breast lump and, after excision, a fast recurrence occurred. Echographic picture was in favour of a fibroadenoma. The tumour was diagnosed as a possible phyllode tumour .The histopathological and the immunochemistry findings proposed three diagnosis: a phyllod sarcoma with a heterogonous liposarcomatous stroma, a liposarcoma associated with an itracananicular carcinomas, carcinosarcoma with invasive differentiated carcinomatous components in a liposarcoma. Discussion : Although physical and radiological examinations were in favour of a benign tumour, the anatomo pathological analysis proved the malignant nature of the tumour, and invited the surgeons to deal with the case as a carcinosarcoma due to its bad prognosis. Conclusion : pathological analysis is therefore mandatory for diagnosis and the choice of treatment since, in our case, an aggressive treatment is necessary instead of a conservative one if the diagnosis of fibroadenoma was retained.

Primary mammary small-cell carcinoma: A case report and review of the literature

Only a few cases of primary small-cell carcinoma of the breast have been documented in the current medical literature. A confident diagnosis can only be made if a nonmammary site is excluded or if an in-situ component can be demonstrated histologically. These criteria have been met only in a very few of the published cases, including this case report. We describe a case of a 68-year-old lady with left breast lump, which was diagnosed as breast cancer on fine-needle aspiration and core biopsy. Metastatic workup was negative for disease elsewhere, and she received 3 cycles of neoadjuvant chemotherapy followed by surgery (modified radical mastectomy). However, the disease behaved very aggressively in the postoperative period. There is a lack of consensus regarding the management of the primary tumor. Present surgical treatment options are similar to those in cases of invasive ductal breast cancer, as appropriate for the size and stage of the lesion. A review of current literature on his rare entity is also presented.

Metastatic Hurthle Cell Carcinoma of the thyroid presenting as a Breast Lump: A Case Report

BackgroundHurthle cell carcinoma of the thyroid is a rare form of thyroid cancer. It may present as a low grade tumour or can present as a more aggressive metastatic carcinoma. Hurthle cell carcinoma has the highest incidence of metastasis among all differentiated thyroid cancers. Most commonly haematogenous spread to lungs, bones and brain, however spread to regional lymph nodes is not uncommon. The breast is a rare site for metastasis from extramammary sources. We present the first case of breast metastasis from Hurthle cell carcinoma of the thyroid.Case presentationWe report a 77 year old lady who had total thyroidectomy and bilateral neck dissection followed by radiotherapy for a high grade metastatic Hurthle cell carcinoma of the thyroid. Ten months later she presented to the breast clinic with left breast lump and a lump at the left axilla. Fine needle aspiration cytology of the lumps and histology after wide local excision of the breast lump confirmed metastatic Hurthle cell carcinoma.ConclusionThe presence of breast lumps in patients with history of extramammary cancer should raise the possibility of metastasis.

Disseminated Tuberculosis Masquerading as Metastatic Breast Carcinoma on PET-CT

PET has an established role in the management of breast cancer. However, F-18 FDG uptake sometimes has been associated with benign disease leading to false positive results. We present a case of a 37-year-old woman who presented with a 3-month history of a left breast lump and palpable left axillary lymph nodes. Whole-body PET-CT scan demonstrated multiple focal areas of intense FDG uptake in the left breast and multiple axillary, cervical, and mediastinal lymph nodes. PET-CT findings mimicked metastatic breast cancer, which was subsequently confirmed as disseminated tuberculosis by mammotome-guided biopsy of the breast lesion and fine needle aspiration biopsy of lymph nodes.

Adenomyoepithelioma of the Breast

Adenomyoepithelioma of the breast is an uncommon tumor characterized by the presence of both epithelial and myoepithelial cells; its first full description was published in 1970 by Hamperl. A 45-year-old woman presented a left breast lump that had been palpable for 4 weeks. There was no family history of breast cancer. Neither axillary nor supraclavicular lymph nodes were palpable. Craniocaudal mammography showed a 1.6 cm, well-defined nodule with several punctate intranodular calcifications in the subareolar region of the left breast. Color Doppler sonogram showed an ovoid, well-defined, homogeneous hypoechoic subareolar nodule with prominent peripheral vessels in the 6 o'clock position of the left breast. Operation was arranged and intraoperative frozen section examination revealed proliferation of round, oval or tubular glandular elements with intervening islands and bands of polygonal myoepithelial cells. Adenomyoepithelioma of the breast was the impression. Wide excision with adequate removal of the tumor and preservation of the left breast contour was successfully achieved. The diagnosis of adenomyoepithelioma of the breast was confirmed by immunohistochemical studies.

Lupus mastitis in male mimicking a breast lump

A 43-year-old male, with a 3-month history of a left breast lump underwent clinical evaluation in our Institute. This solid and irregular mass measured 2 2 cm and was located at the upper lateral quadrant with no skin changes. There were no inflammatory signs. However, a lymphadenopathy was presented with a mobile ipsilateral axillary node 1.5 cm in diameter. Computerized tomography demonstrated a hyperplastic lateral cervical lymph nodes reaction

Granulocytic sarcoma of breast: An aleukemic presentation

Granulocytic sarcoma is a rare extramedullary tumor composed of immature myeloid cells. It is usually associated with leukemia or other myeloproliferative disorders but can also occur without overt hematologic diseases. The breast is an uncommon site of presentation and requires a high index of suspicion for diagnosis. We report such a case in a 45-year-old female, who presented with nontender left breast lump of 6 months' duration. A peripheral smear and bone marrow examination at that time was normal. A lumpectomy was done. An H and E diagnosis of lobular carcinoma vs. non-Hodgkin's lymphoma was entertained. Immunostains, however, revealed myeloperoxidase, naphthol AS-D chloroacetate esterase and CD43 positivity, indicating a diagnosis of granulocytic sarcoma. It appears that early initiation of systemic AML-type chemotherapy is beneficial and may delay or avert the development of AML in bone marrow and blood. Eight months later, the patient presented with an orbital mass; bone marrow and peripheral smear involvement by AML.

Metastatic Malignant Pleural Mesothelioma to the Breast

A 51-year-old woman suffered from dyspnea for several days before she came to an outside clinic for help. Pleura biopsy was performed and the histologic diagnosis was malignant mesothelioma. Sixteen months later, a palpable left breast lump was noted. Physical examination revealed a firm mass in the breast, measuring about 4 x 3.5 cm in size. Breast sonography showed a hypoechoic mass about 3 x 2 x 1.5 cm in size with irregular border in the middle part of the left breast. A mammogram revealed a speculated mass. Chest computed tomography was also performed, which revealed a large pleural mesothelioma and an irregular breast lesion. Incisional biopsy of the left breast lump was performed and histologic examination revealed an infiltrative growth of neoplastic polygonal cells bearing hyperchromatic and pleomorphic nuclei and a small amount of pale, pinkish cytoplasm. Further immunohistochemical study was performed and the tumor cells were positive for low and high molecular weight cytokeratin, thrombomodulin and focally positive for CEA. The final histologic diagnosis was metastatic malignant mesothelioma.

Two cases of ductal adenoma of the Breast

We encountered two cases of ductal adenoma of the breast. In the first case, a 32-year-old woman presented with a two-year history of a left breast lump. Previous ultrasonography had demonstrated three tumors which were thought to be most likely fibroadenoma. On excisional biopsy of the largest , intraoperative pathological examination of frozen sections was suspicious for ductal carcinoma with a differential diagnosis of intraductal papilloma or intraductal papillary carcinoma. Ductal adenoma was diagnosed after pathological examination of the permanent sections. The second case was a 64-year-old woman who presented with a hard lump in her left breast. Mammography and ultrasonography demonstrated images typical of carcinoma. Aspiration biopsy cytology (ABC) repeated twice was reported as " indeterminate". Excisional biopsy was later done. Ductal adenoma (sclerosing papilloma) with hemorrhagic infarction was diagnosed. It is noteworthy that ductal adenoma have clinical and histopathological features that should be differentiated from carcinoma, especially when the tumor is accompanied by secondary changes such as hemorrhage or infarction.