Lump In Left Breast Research Articles

Adenomyoepithelioma of breast

Adenomyoepithelioma of breast is a rare, benign proliferative tumor formed of proliferationof myoepithelial cells surrounding small epithelium lined spaces. We present two cases ofadenomyoepithelioma of the breast. The irst case was of a 23-years-old female with right breast lump and the second of a 41-year-old female with left breast lump. No patient had prior, coexistent carcinoma of either breast. None had any family history of breast cancer either. Excisional biopsy, Hematoxylin and Eosin staining and immunohistochemistry with S100 were performed. The pathological diagnosis was adenomyoepithelioma.

Idiopathic granulomatous mastitis

37 year old, mother of two, presented with clinically and radiologically suspicious (malignant) left breast lump of 3 months duration. Even though FNAC revealed predominant inflammatory cells as the lump was highly suspicious it was decided to go for Wide Local Excision and the histopathology report revealed Idiopathic Granulomatous Mastitis. She is being followed up in surgical clinic without a relapse yet.

Invasive ductal carcinoma within borderline phyllodes tumor with lymph node metastases: A case report and review of the literature.

Phyllodes tumor (PT) is a rare type of biphasic fibroepithelial neoplasm that may coexist with a breast tumor in rare cases. In the current study, a 52-year-old female presented with a left breast lump. Mammography and sonographic examination results suggested a diagnosis of malignant tumor. Histological analysis revealed a borderline PT with invasive ductal carcinoma (IDC) within the tumor. Due to the presence of a single micrometastasis in three of the sentinel lymph nodes, the patient underwent modified radical mastectomy. The excised tumor contained triple negative breast cancer; therefore, postoperative treatment included six cycles of chemotherapy and 25 cycles of radiotherapy. The patient exhibited no recurrence and no metastatic disease at the 23-month follow-up examination. Thus, the present study discussed the case of a female patient that presented with IDC within borderline PT and reviewed the literature on this rare type of neoplasm. Various types of breast carcinoma have been identified to coexist with PT in different masses; however, no standard therapeutic regimen has been established for the coexistence of PT and breast cancer in the same mass. The present study indicates that determination of an appropriate treatment strategy predominantly depends on the characteristics of the individual breast tumor.

Intracystic papillary carcinoma in the male breast: A diagnostic challenge

Breast carcinoma in men is rare, and “intracystic papillary carcinoma (IPC)” of a male breast is an extremely rare entity accounting for <1% of all breast malignancies. It represents a small distinctive subgroup of noninvasive breast cancer. We discuss a case of a 70-year-old male presented with left breast lump of 6 months duration which rapidly increasing in size over 10-day period showed cystic mass with a mural nodule on ultrasonography. A diagnosis of papillary neoplasm was awarded (suspicious for malignancy-C4) on cytology. The patient underwent simple mastectomy, and a final diagnosis of “IPC” was confirmed on histopathology. IPC of the male breast is an extremely rare entity with favorable prognosis. Triple assessment (clinical examination and radiological and histological assessment) is necessary to diagnose IPC. Pathologic diagnosis can be difficult at classical histological examination; thus, the absence of myoepithelial cells layer by immunohistochemical study can be useful.

Case Report of Patient with Relapse of B-cell Lymphoma in the Breast Parenchyma.

We present a patient with relapse of B-cell non-Hodgkin's lymphoma in the breast that was clinically presented as a primary breast cancer. A 72-year old female was treated with chemotherapy and monoclonal antibodies (anti-CD20) due to diffuse large B-cell non-Hodgkin's lymphoma. Complete remission was achieved. Three years later, she was presented with a palpable left breast lump in the perimammillar area of the left breast, dimensions up to 3 cm. Laboratory results were within normal range. Mammography re-vealed a solitary, bilobulated, non-calcified mass of the left breast. On ultrasound, the lesion was hypo-echoic with blurred edges, with posterior acoustic enhancement, measuring 2 × 3 × 7 × 2 cm. Histological findings of ultrasound-guided fine needle aspiration and core needle biopsy were corre-spondent to diffuse large B-cell lymphoma. Pathohistological report showed cells with CD20+/Bcl- 2+/Bcl-6-/MUM-1+/CD3- imunophenotype. The breast parenchyma was infiltrated with B-cell lym-phoma. After diagnosis was confirmed, radiotherapy was initiated. Repeat ultrasound studies showed complete regression of the left breast lesion as did positron emission tomography- computed tomography (PET/CT) scan three months after therapy. In conclusion, the relapse of lymphoma in the breast is very rare. In patients previously treated for lymphoma, differential diagnosis should always include relapse, although it clinically presents itself as a primary breast cancer.

Bilateral synchronous carcinoma breast- a rare case presentation.

IntroductionBilateral Breast Carcinoma (BBC) is a rare entity with incidence of synchronous carcinoma being 2-5% of all breast malignancies, which is much less than metachronous carcinoma. Synchronicity/ metachronicity are usually associated with local and lymphatic spread and with blood–borne spread to lungs, bones and liver. Moreover BBC are mostly lobular carcinomas but we report a rare case of Infiltrating Ductal Carcinoma (IDC) as the primary carcinoma and Lobular Carcinoma as the secondary.Case description56 year old female who presented with a Stage IIIB fungating growth around 10x8cm in the lower inner, lower outer and upper outer quadrant of right breast since 6 months and a StageIIA 4x4cm tumour felt in the left breast in the upper inner and lower outer quadrant. Wedge biopsy of the right breast fungating mass showed Ductal Carcinoma and FNAC of the left breast lump suggested Lobular carcinoma which was confirmed on Histopathology after surgery.Patient was subjected to Hormonal therapy (Tab Tamoxifen), chemotherapy (Cyclophosphamide, 5 FU, and Doxorubicin) followed by Radiotherapy.Patient recovered well and shows no recurrence or signs of metastasis in the 8 months of follow up.Discussion and evaluationDifferent histological subtypes with different grades of tumour in both breasts suggested two different synchronous primary tumours. Early detection of the contralateral tumour is of utmost importance emphasising the significance of breast self-examination. Screening tools like MRI have a greater sensitivity compared to Mammography. There are no clear treatment guidelines for bilateral breast cancer. Patients are often treated with bilateral mastectomy, with breast conservative surgery having unclear importance.ConclusionMeticulous diagnosis and appropriate management help to improve the longitivity with an improved quality of life.

Secretory carcinoma of breast mimicking an abscess: A diagnostic dilemma

Secretory carcinoma is a rare type of breast carcinoma usually seen in the young females, and it is also called as Juvenile carcinoma. We report here a case of secretory carcinoma in an elderly female with an unusual clinical presentation. She had a painful swelling in left breast of 6 cm × 5 cm size for the past 6 months. Skin over the swelling was inflamed and ulcerated. Mammogram findings favored a chronic infected hematoma/abscess. Fine needle aspirate (FNA) is a murky fluid admixed with blood and was reported as acute inflammatory lesion. 2 weeks later she developed nipple retraction and an increase in size of the swelling. Fine needle aspiration cytology (FNAC) was repeated again from firm areas and in multiple points of swelling. To our surprise, FNA smears revealed dysplastic ductal epithelial cells with minimal atypia. Modified radical mastectomy was planned. Histopathological examination confirmed the mass as secretory carcinoma, a rare variant of ductal carcinoma of the breast. Postoperative chemotherapy and radiotherapy was started. We report this case to emphasize that FNAC can be repeated in suspicious cases and should be correlated clinico-radiologically to give a preoperative diagnosis.

Drug interaction resulting in massive chest wall hematoma in a patient on therapeutic anticoagulation.

Sir, The incidence of spontaneous large hematomas is rare compared to several case reports of major intracranial bleed in patients on therapeutic anticoagulation. The most commonly involved anticoagulant is warfarin, used in the prevention of thrombo-embolism in deep vein thrombosis, prosthetic valves, atrial fibrillation, etc.[1] The incidence of hematomas requiring invasive intervention is rarely encountered. There is a case of pectoral hematoma reported by Cinar, et al., in a case series, which was managed conservatively.[2] We report a case of an elderly woman, on therapeutic anticoagulation for deep-vein thrombosis, who presented with a large left chest wall hematoma requiring embolization of the bleeding vessel. An 82-year-old female patient was admitted to Intensive Care Unit (ICU) with a history of disorientation for 2 days. She was on therapeutic anticoagulation with warfarin 2 mg OD since 1-year after presenting with chronic deep vein thrombosis due to hyperhomocysteinemia and protein S deficiency and required inferior vena cava filter insertion earlier. Her platelet count and serum creatinine levels were within normal range. At present, she was found to have urinary tract infection for which ertapenem was started. International normalized ratio (INR) at time of admission was 1.8 and was monitored daily and antibiotic was de-escalated to levofloxacin 500 mg intravenous (IV) OD as per the urine culture report and she was shifted to wards. She was back in ICU 3 days later, with a painful swelling in left breast. Ultrasonogram [Figure 1a], chest X-ray [Figure 1b], and CT chest [Figure 1c-​-e]e] showed a large left anterior chest wall hematoma, inseparable from pectoralis major, measuring 15 cm × 8.2 cm axially and 16 cm craniocaudally. Figure 1 (a) Gross appearance. (b) Chest X-ray. (c) Computed tomography (CT) image coronal section. (d) CT image transverse section. (e) CT image, sagittal section Her hemoglobin had dropped to 4.5, and INR had shot up to 6.22 over 3 days. She was resuscitated with IV fluids and packed red blood cells. Fresh frozen plasma and injection Vitamin K 10 mg were given to prevent further bleed. But the hematoma continued to increase in size requiring an emergency angio-embolization of a large branch of left internal mammary artery. INR came down to 0.8 next day. Hemoglobin remained stable, and she went home in 3 days. A significant resorption of the hematoma was observed on review, and anti-coagulant therapy was re-started after 10 days. Hematoma in pectoral muscle has been rarely reported in the literature. Kocer et al. described cases of spontaneous intra-pectoral bleeding.[3] It was considered that in our patient, interaction between levofloxacin and warfarin could have possibly potentiated the action of warfarin, and even mild physiotherapy could have triggered a bleed.[4,5] This case is rare as it occurred over a very short duration and involved an arterial bleed requiring interventional management. The drop in hemoglobin was a very significant 8%. The interaction of warfarin with various medications and food substances is well-known. Its life-threatening complication is something that should be kept in mind considering the fact that levofloxacin is a very common antibiotic prescribed by community physicians for common cold, urinary tract, and upper respiratory tract infections. As noted here, the trigger for a torrential bleed could be very trivial as mild physiotherapy.[4,5] To conclude, a careful screening for interactions is required before prescribing medicines for patients on anticoagulation therapy.

A Case of Liponecrotic Pseudocyst after Breast Augmentation by Autologous Fat Injection

A 21-year-old woman underwent bilateral augmentation mammoplasty by injection of an unknown volume of fat obtained via trochanteric and abdominal liposuction. The procedure was performed by a surgeon untrained in plastic surgery, at a clinic not affili- ated with a hospital. Six months later, she presented to our clinic with a palpable left breast lump. Physical examination revealed a large firm mass occupying the entire up- per outer quadrant of the left breast and a normal right breast. Breast ultrasound show- ed a large, well-defined isoechoic mass in the left upper outer breast. Considering her age, the patient underwent core needle biopsy, since the mass mimicked a phyllodes tumor on ultrasonography. The 14-gauge core needle biopsy demonstrated multiple lipid droplets with some white-yellowish tissue, caused by liquefaction of the injected fat. Histopathologic examination demonstrated the presence of a pseudocyst with fat necrosis, granulomatous reaction to lipid material, and cystic formations containing oily fluid. No signs of malignancy were detected. Surgical excision was performed, and histopathology revealed findings consistent with fat necrosis.

Primary tuberculosis of the breast: A rare case

Introduction: Tuberculosis (TB) is a very common entity that is predominant in the developing countries. However, coming across TB of the breast is a rare, exceptional and an exciting experience. Primary breast TB incidence is reported to range between 0.025 and 0.1% in the developed countries compared to the incidence of breast TB in the developing countries which is approximated at 3–4.5% of TB cases. The breast is generally labeled as the body organ which is structured in such a manner that its environment is not conducive for the multiplication of the bacilli. Case Report: A case of a 32-year-old female presented with an occasionally painful left breast and left axillary lumps over a period of two months duration. She had been well with no remarkable past medical history. There is no history of previous trauma and she was not exposed to people with TB at home and at work. There are no respiratory system signs of TB. Biopsies of the left breast lump as well as that of the left axillary lump were performed and the diagnosis of TB breast and the left axillary was clinched. The patient was then put on anti-TB treatment. Conclusion: There are no specific clinical or radiological features of TB of breast. The final diagnosis of breast TB is made though histopathological findings. The radiological investigations help with the characterization of the extent of the lesions.

Tuberculous mastitis simulating carcinoma of the breast in a young Nigerian woman: a case report

Tuberculous mastitis is an uncommon disease even in countries where tuberculosis is highly endemic. It typically presents a diagnostic challenge masquerading as carcinoma or other primary disease of the breast. We report the case of a young multiparous Nigerian woman who presented with a tender left breast lump and enlargement of the left axillary lymph nodes for which a provisional diagnosis of carcinoma of the breast was made after clinical and radiological evaluation. The mass was pathologically diagnosed as tuberculous mastitis and anti-tuberculous therapy was instituted although she later absconded. This case shows that TM may present a diagnostic challenge on clinical, radiologic and microbiological investigation. Therefore, a high index of suspicion as well as FNAC and/or histological evaluation of tissue samples remain very important its diagnosis.

Filariasis of the breast

Filariasis is a common occurrence in India.1 However, filariasis of the breast lump diagnosed on FNAC is rare.2 Conventional mode of diagnosis is by demonstration of microfilaria in the peripheral blood smear.1–3 It is infrequent to find microfilaria in Fine needle aspiration cytology smears and body fluids. In the present case report, the patient had a rare presentation of induration of skin over left breast with a subcutaneous lump left breast and nipple secretion right breast. FNAC of left breast lump and right nipple secretion cytology showed evidence of filariasis.

Invasive lobular carcinoma co-existing with benign phylloides tumor

Phylloides tumor constitutes less than 1% of all breast tumors and 2 - 3% of fibroepithelial breast tumors. Several histological parameters should be evaluated, including stromal cellularity, atypia, mitoses, stromal overgrowth, infiltrative borders, and presence or absence of necrosis. Here we report a case of a 60 years- old female who presented with left breast lump. Fine needle aspiration cytology was done which suggested epithelial hyperplasia with fibrocystic changes. Biopsy was performed which showed predominance of stromal hypercellularity with proliferation of spindle cells (no atypia, mitosis and stromal overgrowth were noticed). However, a focus showed proliferation of discohesive tumor cells arranged singly and in single file. A diagnosis of benign phylloides tumor with foci of invasive lobular carcinoma was made. The diagnosis was confirmed with IHC which showed intense 80%positivity for estrogen and progesterone receptor and spindle cells showing positivity for bcl-2. In situ lobular carcinoma component was not observed. DOI: http://dx.doi.org/10.3126/jpn.v4i7.10321 Journal of Pathology of Nepal (2014) Vol. 4, 597-599

Carcinoma or sarcoma of the breast

Carcinosarcomas comprise less than 1% of invasive carcinomas of the breast. They are a heterogeneous group of malignant tumors in which part or all of the carcinomatous epithelium is transformed into a nonglandular component by metaplastic growth process. We report a case of carcinosarcoma of breast. She was a 62-year-old female who presented with complaint of pain and lump in left breast of 6 months duration. There was a discharging ulcer measuring 4 ×6 cm over the nipple of 1-month duration. Computed tomography of chest and positron emission tomography report was suggestive of carcinoma of left breast with left axillary lymphadenopathy and lung metastasis. Histopathology of the tumor was reported as infiltrating duct cell carcinoma (IDC) with angiosarcoma. The IDC was estrogen and progesterone receptor negative and Human Epidermal Growth Factor -2 receptor positive. The angiosarcoma was positive for vimentin, vascular endothelial growth factor, CD34, and CD31. The Ki-67 labeling index was 60% and the epidermal growth factor receptor was positive. This is a case of carcinosarcoma of breast adding to the existing literature.

Primary Tuberculosis of Breast in 22 Year Old Female – A Rare Case Report

Mammary (breast) tuberculosis is a rare extra-pulmonary manifestation of tuberculosis which accounts for less than 0.1% of breast conditions in developed countries, but reaches 3–4% in regions where the disease presents with high incidence (India, Africa). It appears mostly in women of reproductive age group with high incidence in multiparous and lactating women. The clinical presentation is usually of a solitary, ill defined, unilateral hard lump situated in the upper outer quadrant of the breast. The significance of breast tuberculosis is due to rare occurrence and close differentials of breast cancer and pyogenic breast abscess. Breast tuberculosis has no defined clinical features. So clinical suspicion of breast tuberculosis is difficult. Radiological imaging is not diagnostic. Diagnosis is based on identification of typical histological features or the tuberculer bacilli under microscopy or on culture. Revised National Tuberculosis Control Program (RNTCP) recommends category I antitubercular therapy for 6 months for breast tuberculosis. We report a case of breast tuberculosis in a 22 year old female presenting with chief complaints of progressive slow growing lump in left breast. Histopathological examination and Ziehl– Neelsen staining of resected lump confirmed the diagnosis of tuberculosis. Conclusion – In developing countries like India, where tuberculosis is endemic, it should be kept in mind as a differential diagnosis of breast lump.

Cytodiagnosis of papillary carcinoma of the breast: Report of a case with histological correlation

Papillary lesions of the breast pose diagnostic challenges on aspiration cytology due to overlapping features of benign and malignant entities. Accurate cytologic diagnosis of papillary breast carcinoma cannot usually be made pre-operatively. We present the case of an adult female who underwent fine-needle aspiration (FNA) of a left breast lump. FNA smears were highly cellular showing cohesive clusters, complex papillary fragments and few singly dispersed intact cells. The tumor cells had hyperchromatic nuclei, prominent nucleoli and mild nuclear pleomorphism. A cytologic impression of papillary lesion, possibly malignant (in view of high cellularity, complex papillae and single intact cells) was rendered. The lesion proved to be a papillary carcinoma with microscopic foci of stromal invasion on histologic examination. Papillary carcinoma, an uncommon subtype of breast carcinoma, should be considered while evaluating a papillary lesion with complex branching papillae containing delicate fibrovascular cores and singly lying intact atypical cells.

Metastasis of Rare Tumor at an Usual Site-A Case Report

Metastasis to the breast from extra mammary sites is very rare, constituting only 1 to 2 percent of metastasis. Lymphoma, malignant melanoma and bronchial carcinoma are the malignancies which metastasize to the breast. Metastasis to the breast in a case of primary anorectal melanoma is rare with only few cases reported in literature. We present a case of a 40 year old female who presented with a lump in the left breast. She had history of malignant melanoma of anorectal region for which she underwent anterior resection 6 months back. We did FNAC of left breast lump and found metastasis. Unfortunately patient died within few days.

English

Primary breast lymphoma (PBL) is a very uncommon condition having a poor prognosis, that accounts for 0.05-0.53% of all malignant disease of breast and 2.2% of extranodal malignant lymphoma. A 60yrs female presented with shortness of breath and on examination bilateral breast lumps and left axillary lymphadenopathy were found. Further evaluation done and by cytological, histopathological and immunohistochemical (IHC) correlation a final diagnosis of Non Hodgkins Lymphoma (B cell type) was made. INTRODUCTION: PBL is a very uncommon condition constituting 0.05-0.53% of all malignant disease of breast but it is most frequent hematopoietic tumor of breast.10 MATERIALS AND METHODS: Fine needle aspiration cytology (FNAC) done under aseptic precautions using 22 gauge needle. Excision biopsy done under general anaesthesia of both right and left breast lumps and left axillary lymph node. H & E stain done. Immunohistochemistry (IHC markers -CD 3, CD 20, CD 30). Consent –Patient died 4 months back , Consent taken from kin[son] RESULTS: On examination-bilateral breast lumps and left axillary lymphadenopathy were found. Left breast lump measuring 5x5cm, hard in consistency, in upper central quadrant having restricted mobility. Right breast lump measuring 2x2cm, hard in consistency, in central quadrant, freely mobile. Left axillary lymphadenopathy measuring 2.5x2 cm, solitary, firm, mobile. No generalized lymphadenopathy[cervical, right axilla, inguinal region examined] Investigations: Routine investigations done: CBP Hb-9.7gm%,RBC-3.4 million,WBC-7,300/cumm,N-66% L-30% M2%,E-2%,Platelet-2,76,000/cumm CUE albumin ++,sugar nil,EC-2-4/hpf, pus cell plenty/hpf X-RAY CHEST -NAD ESR first hour-120mm,second hour-140mm LDH -512 U/l BLOOD UREA 60mg% BONE MARROW ASPIRATION-within normal limits

Cytodiagnosis of the primary breast lymphoma in a young woman

Primary breast lymphoma (PBL) is a rare entity. It represents 0.4% of malignant breast lesions and 2% of extranodal lymphomas. A 23-year-old woman presented with a left breast lump followed by palpable left axillary lymphadenopathy. Fine-needle aspiration cytology (FNAC) and histopathology were diagnostic of non-Hodgkin lymphoma-large cell type. Immunohistochemistry was positive against leukocyte common antigen and CD20. Because PBLs are uncommon malignant lesions and they usually do not have characteristic clinical and imaging findings, FNAC may prove to be a simple, rapid, reliable, and cost-effective procedure for successful diagnosis of the PBL.

Ewing′s sarcoma humerus presenting along with metastatic breast nodule: An unusual case report

Ewing's sarcoma is a highly malignant primary bone tumor and most frequently observed in children and adolescents but rare in adults. Usual sites of metastasis are lung, pleura, other bones and occasionally to lymph node, central nervous system, and liver. Metastasis into breast is extremely rare and only one case has been reported. Most common tumors metastasizing into breast are lymphoma, malignant melanoma, and rhabdomyosarcoma. A 25-year-old female presented simultaneously with both left arm swelling and breast lump. Fine needle aspiration done from both swellings revealed similar morphology and comprised monomorphic population of round cells dispersed singly with scant cytoplasm and reticulogranular chromatin. IHC done on cell block material was positive for CD99. Hence diagnosis of Ewing's sarcoma metastasizing to breast was made. Hereby, we present a rare case of Ewing's sarcoma humerus with simultaneous metastatic deposit in breast as the initial presentation.