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Xu K, Chung M, Hayward JH, Kelil T, Lee AY, Ray KM. MRI of the Lactating Breast. Radiographics 2024; 44:e230129. [PMID: 38300813 DOI: 10.1148/rg.230129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
The breasts undergo marked physiologic changes during lactation that can make conventional imaging evaluation with mammography and US challenging. MRI can be a valuable diagnostic aid to differentiate physiologic and benign processes from malignancy in patients who are lactating. In addition, MRI may allow more accurate delineation of disease involvement than does conventional imaging and assists in locoregional staging, screening of the contralateral breast, assessment of response to neoadjuvant chemotherapy, and surgical planning. Although the American College of Radiology recommends against patients undergoing contrast-enhanced MRI during pregnancy because of fetal safety concerns, contrast-enhanced MRI is safe during lactation. As more women delay childbearing, the incidence of pregnancy-associated breast cancer (PABC) and breast cancer in lactating women beyond the 1st year after pregnancy is increasing. Thus, MRI is increasingly being performed in lactating women for diagnostic evaluation and screening of patients at high risk. PABC is associated with a worse prognosis than that of non-PABCs, with delays in diagnosis contributing to an increased likelihood of advanced-stage disease at diagnosis. Familiarity with the MRI features of the lactating breast and the appearance of various pathologic conditions is essential to avoid diagnostic pitfalls and prevent delays in cancer diagnosis and treatment. The authors review clinical indications for breast MRI during lactation, describe characteristic features of the lactating breast at MRI, and compare MRI features of a spectrum of benign and malignant breast abnormalities. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material. See the invited commentary by Chikarmane in this issue.
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Affiliation(s)
- Kali Xu
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S-261, San Francisco, CA 94143
| | - Maggie Chung
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S-261, San Francisco, CA 94143
| | - Jessica H Hayward
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S-261, San Francisco, CA 94143
| | - Tatiana Kelil
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S-261, San Francisco, CA 94143
| | - Amie Y Lee
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S-261, San Francisco, CA 94143
| | - Kimberly M Ray
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S-261, San Francisco, CA 94143
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Sharma R, Rattan A, Kumari K, Sharad S. Infiltrating duct cell carcinoma in lactating adenoma: A rare case in pair. J Cancer Res Ther 2023; 19:1462-1464. [PMID: 37787331 DOI: 10.4103/jcrt.jcrt_1183_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Lactating adenomas, though considered being benign, sometimes turn out to be malignant. We are hereby presenting two cases of lactating adenomas which turned out to be harboring infiltrating duct cell carcinoma (DCC). Two lactating women with mass in the breast were referred from surgery for fine-needle aspiration cytology and biopsy. On histopathology, it was found that both had infiltrating DCC (either as collision tumor or as a malignant transformation of lactating adenoma). These cases point toward some association between lactating adenoma and DCC, however, small it may be. Therefore, any mass lesion in the breast should be followed up under strict vigilance for an early diagnosis and management of this deadly disease. A large sample size and elaborate study are required to frame its prognostic relevance. Like estrogen receptor and progesterone receptor, prolactin and prolactin receptor expression can be exploited for developing newer receptor-targeted therapy.
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Affiliation(s)
- Renu Sharma
- Department of Pathology, Shri Lal Bahadur Shastri Government Medical College, Himachal Pradesh, Mandi, India
| | - Amit Rattan
- Department of Surgery, Shri Lal Bahadur Shastri Government Medical College, Mandi, Himachal Pradesh, India
| | - Kavita Kumari
- Department of Pathology, Dr R.K.G.M.C, Hamirpur, Himachal Pradesh, India
| | - Satyendra Sharad
- Department of Pharmacology, Dr R.K.G.M.C, Hamirpur, Himachal Pradesh, India
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Chung M, Ruiz-Cordero R, Lee AY, Joe BN, Kelil T. MRI Evaluation of the Lactating Breast. CURRENT RADIOLOGY REPORTS 2022. [DOI: 10.1007/s40134-022-00395-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Abstract
Purpose of Review
To review the MRI appearance of physiologic lactational changes, common benign pathologies, and malignancies in the lactating breast.
Recent Findings
The prevalence of pregnancy-associated breast cancer has increased as more women delay childbirth and lactation. There is a transient increase in breast cancer risk after delivery when women may be lactating. MRI is more sensitive than mammography and ultrasound for the evaluation of the extent of disease in lactating women.
Summary
Understanding the key MRI findings of benign and malignant pathologies in the lactating breast is critical for accurate diagnosis and prompt evaluation of pregnancy-associated breast cancer.
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Dafaalla H, Khougali HS, Malassi Y. Bilateral complex lactating adenosis: Clinical presentation and management in Sudan. Clin Case Rep 2021; 9:e05213. [PMID: 34938564 PMCID: PMC8667293 DOI: 10.1002/ccr3.5213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 10/26/2021] [Accepted: 11/09/2021] [Indexed: 11/25/2022] Open
Abstract
Lactating adenosis is a benign breast neoplasm usually seen during pregnancy and lactation. We present a rare case of bilateral complex benign lactating adenosis in 19-year-old female patient presented with lactating adenosis that mimics cancer growth after giving birth. Histopathology confirmed diagnosis. Simple mastectomy was the treatment of choice.
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Affiliation(s)
- Hatoun Dafaalla
- Department of General SurgeryWad‐Medani Teaching HospitalWad‐MedaniSudan
| | | | - Yussra Malassi
- Department of Research and MethodologyIbn‐Seina HospitalKhartoumSudan
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Phung HT, Nguyen LT, Nguyen HV, Nguyen CV, Nguyen HT. Aggressive lactating adenoma mimicking breast carcinoma: A case report. Int J Surg Case Rep 2020; 70:17-19. [PMID: 32348915 PMCID: PMC7191075 DOI: 10.1016/j.ijscr.2020.03.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 03/17/2020] [Accepted: 03/30/2020] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Lactating adenoma is a rare breast tumor which is commonly found in late pregnancy or lactation period. Despite its benign nature, lactating adenoma might develop aggressively and can be misdiagnosed as breast cancer. CASE PRESENTATION We report a case of a 25-year-old female presenting with two large, ulcerative and bleeding breast masses. An open biopsy demonstrating lactating adenoma was considered discordant and surgery was performed to confirm the diagnosis. CONCLUSION Careful clinical and histological evaluations are necessary to diagnose and manage lactating adenoma.
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Affiliation(s)
- Huyen Thi Phung
- Department of Medical Oncology 6, Vietnam National Cancer Hospital, Hanoi, Viet Nam; Department of Oncology, Vietnam University of Traditional Medicine, Hanoi, Viet Nam
| | | | - Hung Van Nguyen
- Department of Oncology, Hanoi Medical University, Hanoi, Viet Nam; Department of Oncology and Palliative Care, Hanoi Medical University Hospital, Hanoi, Viet Nam
| | - Chu Van Nguyen
- Quan Su Pathology Department, Vietnam National Cancer Hospital, Hanoi, Viet Nam
| | - Hoa Thi Nguyen
- Department of Medical Oncology 6, Vietnam National Cancer Hospital, Hanoi, Viet Nam
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Gochhait D, Dehuri P, Devi D. Role of fine-needle aspiration cytology in peripartum/pregnancy.associated breast malignancy . Six cases with review of literature. MULLER JOURNAL OF MEDICAL SCIENCES AND RESEARCH 2020. [DOI: 10.4103/mjmsr.mjmsr_9_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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7
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Lactating adenoma arising from a tubular adenoma in a pediatric patient. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2019.101278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Mendez MA, Jones KM, Reiman TR, Kremer HL, Ahmadiyeh N. Large painful lactating adenomas effectively treated during pregnancy with bromocriptine. Breast J 2019; 25:974-976. [PMID: 31165510 DOI: 10.1111/tbj.13380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 02/07/2019] [Indexed: 11/29/2022]
Abstract
Lactating adenomas are painful, benign breast lesions, typically presenting during pregnancy and treated with surgery. Here we present a case of a 25-year-old pregnant woman who developed multiple, bilateral lactating adenomas and was successfully treated during her third trimester with bromocriptine alone. Bromocriptine, a dopamine agonist, may be used in pregnancy to effectively treat lactating adenomas in lieu of surgery.
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Affiliation(s)
- Marissa A Mendez
- University of Missouri Kansas City School of Medicine, Kansas City, Missouri
| | - Kimberly M Jones
- University of Missouri Kansas City School of Medicine, Kansas City, Missouri
| | - Taylor R Reiman
- University of Missouri Kansas City School of Medicine, Kansas City, Missouri
| | - Howard L Kremer
- University of Missouri Kansas City School of Medicine, Kansas City, Missouri.,Truman Medical Centers, Kansas City, Missouri
| | - Nasim Ahmadiyeh
- University of Missouri Kansas City School of Medicine, Kansas City, Missouri.,Truman Medical Centers, Kansas City, Missouri
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Elzahaby IA, Saleh S, Metwally IH, Fathi A, Atallah K. Huge lactating adenoma of the breast: Case report. Breast Dis 2018; 37:37-42. [PMID: 28269736 DOI: 10.3233/bd-160263] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Lactating adenoma is the commonest benign breast lesion seen during pregnancy and puerperium. It is commonly seen in young primigravideous women in the second or third decade during the third trimester of their pregnancy. Occasionally, lactating adenoma is large and rapidly growing and must be differentiated from malignant breast masses that could be seen during pregnancy and lactation. The diagnosis is usually established by cytological and histopathological examination. CASE PRESENTATION Here we have presented a rare case with huge lactating adenoma arising in the left breast of 38 years old Egyptian multiparous lady during lactation. Enucleation of the mass was done with good aesthetic outcome. CONCLUSION The case we have presented was unique in its huge size and in being diagnosed in a multiparous lady and furthermore it was successfully treated by enucleation without any need for reconstruction.
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Affiliation(s)
- Islam A Elzahaby
- IMRCS, Lecturer of surgical oncology, Oncology center Mansoura University Masoura, Egypt
| | - Saleh Saleh
- Assistant lecturer of surgical oncology, Oncology center Mansoura University, Mansoura, Egypt
| | - Islam H Metwally
- Assistant lecturer of surgical oncology, Oncology center Mansoura University, Mansoura, Egypt
| | - Adel Fathi
- Lecturer of surgical oncology, Oncology center Mansoura University, Mansoura, Egypt
| | - Khaled Atallah
- Assistant lecturer of surgical oncology, Oncology center Mansoura University, Mansoura, Egypt
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de Holanda AAR, Gonçalves AKDS, de Medeiros RD, de Oliveira AMG, Maranhão TMDO. Ultrasound findings of the physiological changes and most common breast diseases during pregnancy and lactation. Radiol Bras 2016; 49:389-396. [PMID: 28057965 PMCID: PMC5210035 DOI: 10.1590/0100-3984.2015.0076] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Because of the physiological changes that occur during pregnancy and lactation,
diagnostic ultrasound of the breast during these periods is a challenge for
physicians. Therefore, a comprehensive understanding of imaging, anatomy, and
physiology of the breast is important to effectively diagnosing diseases that
can arise in women who are pregnancy or lactating. The aim of this article was
to review the physiological changes that occur in the breasts during pregnancy
and lactation, as well as to describe the main features of the breast diseases
that occur most frequently during these periods.
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Affiliation(s)
- Antônio Arildo Reginaldo de Holanda
- MSc, Doctoral Student in the Graduate Program in Health Sciences at the Universidade Federal do Rio Grande do Norte (UFRN), Physician at the Maternidade Escola Januário Cicco, Natal, RN, Brazil
| | - Ana Katherine da Silveira Gonçalves
- PhD, Associate Professor in the Department of Obstetrics and Gynecology at the Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil
| | - Robinson Dias de Medeiros
- PhD, Adjunct Professor in the Department of Obstetrics and Gynecology at the Universidade Federal do Rio Grande do Norte (UFRN), Physician at the Maternidade Escola Januário Cicco, Natal, RN, Brazil
| | | | - Técia Maria de Oliveira Maranhão
- PhD, Full Professor in the Department of Obstetrics and Gynecology at the Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil
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Volckmar AL, Leichsenring J, Flechtenmacher C, Pfarr N, Siebolts U, Kirchner M, Budczies J, Bockmayr M, Ridinger K, Lorenz K, Herpel E, Noske A, Weichert W, Klauschen F, Schirmacher P, Penzel R, Endris V, Stenzinger A. Tubular, lactating, and ductal adenomas are devoid of MED12 Exon2 mutations, and ductal adenomas show recurrent mutations in GNAS and the PI3K-AKT pathway. Genes Chromosomes Cancer 2016; 56:11-17. [DOI: 10.1002/gcc.22396] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 07/13/2016] [Accepted: 07/18/2016] [Indexed: 12/12/2022] Open
Affiliation(s)
- Anna-Lena Volckmar
- Institute of Pathology, University Hospital Heidelberg; Heidelberg Germany
| | - Jonas Leichsenring
- Institute of Pathology, University Hospital Heidelberg; Heidelberg Germany
| | | | - Nicole Pfarr
- Institute of Pathology, Technical University Munich (TUM); Munich Germany
| | - Udo Siebolts
- Institute of Pathology University Hospital Halle; Halle Germany
| | - Martina Kirchner
- Institute of Pathology, University Hospital Heidelberg; Heidelberg Germany
| | - Jan Budczies
- Institute of Pathology, Charité University Hospital; Berlin Germany
| | - Michael Bockmayr
- Institute of Pathology, Charité University Hospital; Berlin Germany
| | - Kathrin Ridinger
- Institute of Pathology, University Hospital Heidelberg; Heidelberg Germany
| | - Katja Lorenz
- Institute of Pathology, University Hospital Heidelberg; Heidelberg Germany
| | - Esther Herpel
- Institute of Pathology, University Hospital Heidelberg; Heidelberg Germany
- Tissue Bank of the National Center for Tumor Diseases (NCT); Heidelberg Germany
| | - Aurelia Noske
- Institute of Pathology, Technical University Munich (TUM); Munich Germany
| | - Wilko Weichert
- Institute of Pathology, Technical University Munich (TUM); Munich Germany
- German Cancer Consortium (DKTK); Heidelberg Germany
| | | | - Peter Schirmacher
- Institute of Pathology, University Hospital Heidelberg; Heidelberg Germany
- German Cancer Consortium (DKTK); Heidelberg Germany
| | - Roland Penzel
- Institute of Pathology, University Hospital Heidelberg; Heidelberg Germany
| | - Volker Endris
- Institute of Pathology, University Hospital Heidelberg; Heidelberg Germany
| | - Albrecht Stenzinger
- Institute of Pathology, University Hospital Heidelberg; Heidelberg Germany
- German Cancer Consortium (DKTK); Heidelberg Germany
- National Center of Tumor Diseases; Heidelberg Germany
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Barco Nebreda I, Vidal MC, Fraile M, Canales L, González C, Giménez N, García-Fernández A. Lactating Adenoma of the Breast. J Hum Lact 2016; 32:559-62. [PMID: 27197575 DOI: 10.1177/0890334416646564] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 04/04/2016] [Indexed: 11/17/2022]
Abstract
Lactating adenoma is an uncommon breast palpable lesion occurring in pregnancy or lactation. Although it is a benign condition, it often requires core biopsy or even surgery to exclude malignancy. As with other solid lesions in pregnancy and lactation, lactating adenoma needs an accurate evaluation in order to ensure its benign nature. Work-up must include both imaging and histologic findings. Ultrasound evaluation remains the first step in assessing the features of the lesion. Some authors consider magnetic resonance imaging as a useful tool in cases of inconclusive evaluation after ultrasound and histologic exam in an attempt to avoid surgery. Most lactating adenomas resolve spontaneously, whereas others persist or even increase in size and must be removed. The authors present a case of a 35-year-old woman at 6 months postpartum with a lactating adenoma in her right breast. After surgical removal, breastfeeding was perfectly continued within the next 24 hours, which highlights the fact that breast surgery is most often compatible with breastfeeding.
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Affiliation(s)
- Israel Barco Nebreda
- Breast Unit, Department of Gynaecology, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain
| | - M Carmen Vidal
- Department of Nursing, Breastfeeding Consultant, Promotion and Supporting Program, Institut Català de la Salut, ASSIR Mollet, Barcelona, Spain
| | - Manel Fraile
- Nuclear Medicine Department, CTD, Hospital Universitari Mútua Terrassa, Research Foundation Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain
| | - Lydia Canales
- Breast Unit, Department of Radiology, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain
| | - Clarisa González
- Breast Unit, Department of Pathology, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain
| | - Nuria Giménez
- Research Unit, Research Foundation Mútua Terrassa, University of Barcelona, Barcelona, Spain Laboratory of Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antonio García-Fernández
- Breast Unit, Department of Gynaecology, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain
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Cruz BLG, da Silva PC, Tomasin R, Oliveira AG, Viana LR, Salomao EM, Gomes-Marcondes MCC. Dietary leucine supplementation minimises tumour-induced damage in placental tissues of pregnant, tumour-bearing rats. BMC Cancer 2016; 16:58. [PMID: 26847205 PMCID: PMC4743202 DOI: 10.1186/s12885-016-2103-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 01/29/2016] [Indexed: 01/22/2023] Open
Abstract
Background The occurrence of cancer during pregnancy merges two complex, poorly understood metabolic and hormonal conditions. This association can exacerbate the conditions of both the mother and the foetus. The branched-chain amino acid leucine enhances cellular activity, particularly by increasing protein synthesis. This study aimed to analyse the modulatory effect of a leucine-rich diet on direct and indirect tumour-induced placental damage. This was accomplished by evaluating the expression of genes involved in protein synthesis and degradation and assessing anti-oxidant enzyme activity in placental tissues collected from pregnant, tumour-bearing rats. Results Pregnant rats were either implanted with Walker 256 tumour cells or injected with ascitic fluid (to study the indirect effects of tumour growth) and then fed a leucine-rich diet. Animals in a control group underwent the same procedures but were fed a normal diet. On the 20th day of pregnancy, tumour growth was observed. Dams fed a normoprotein diet showed the greatest tumour growth. Injection with ascitic fluid mimicked the effects of tumour growth. Decreased placental protein synthesis and increased protein degradation were observed in both the tumour-bearing and the ascitic fluid-injected groups that were fed a normoprotein diet. These effects resulted in low placental DNA and protein content and high lipid peroxidation (measured by malondialdehyde content). Decreased placental protein synthesis-related gene expression was observed in the tumour group concomitant with increased expression of genes encoding protein degradation-associated proteins and proteolytic subunits. Conclusions Consumption of a leucine-rich diet counteracted the effects produced by tumour growth and injection with ascitic fluid. The diet enhanced cell signalling, ameliorated deficiencies in DNA and protein content, and balanced protein synthesis and degradation processes in the placenta. The improvements in cell signalling included changes in the mTOR/eIF pathway. In conclusion, consumption of a leucine-rich diet improved placental metabolism and cell signalling in tumour-bearing rats, and these changes reduced the deleterious effects caused by tumour growth.
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Affiliation(s)
- Bread Leandro Gomes Cruz
- Department of Structural and Functional Biology, Biology Institute, State University of Campinas, UNICAMP, CP 6109, Campinas, São Paulo, 13083862, Brazil.
| | - Priscila Cristina da Silva
- Department of Structural and Functional Biology, Biology Institute, State University of Campinas, UNICAMP, CP 6109, Campinas, São Paulo, 13083862, Brazil.
| | - Rebeka Tomasin
- Department of Structural and Functional Biology, Biology Institute, State University of Campinas, UNICAMP, CP 6109, Campinas, São Paulo, 13083862, Brazil.
| | - Andre Gustavo Oliveira
- Department of Structural and Functional Biology, Biology Institute, State University of Campinas, UNICAMP, CP 6109, Campinas, São Paulo, 13083862, Brazil.
| | - Lais Rosa Viana
- Department of Structural and Functional Biology, Biology Institute, State University of Campinas, UNICAMP, CP 6109, Campinas, São Paulo, 13083862, Brazil.
| | - Emilianne Miguel Salomao
- Department of Structural and Functional Biology, Biology Institute, State University of Campinas, UNICAMP, CP 6109, Campinas, São Paulo, 13083862, Brazil.
| | - Maria Cristina Cintra Gomes-Marcondes
- Department of Structural and Functional Biology, Biology Institute, State University of Campinas, UNICAMP, CP 6109, Campinas, São Paulo, 13083862, Brazil. .,, Rua Monteiro Lobato, 255, Campinas, Zip code 13083862, Brazil.
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Kumar H, Narasimha A, Bhaskaran, M N DR. Concurrent Lactating Adenoma and Infiltrating Ductal Carcinoma: A Case Report. J Clin Diagn Res 2015; 9:ED14-5. [PMID: 26435957 DOI: 10.7860/jcdr/2015/12786.6326] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 06/12/2015] [Indexed: 11/24/2022]
Abstract
A lactating adenoma is a benign tumour which usually occurs in younger women who are either pregnant or breast feeding. In some instances these lactating adenomas can occur simultaneously with breast carcinoma, so they have to be carefully evaluated. We report an unusual case of simultaneous occurrence of a lactating adenoma and infiltrating ductal carcinoma occurring in a 25-year-old lactating mother.
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Affiliation(s)
- Harendra Kumar
- Professor and HOD, Department of Pathology, Sri Devaraj Urs Academy of Higher Education and Research , Bangalore, India
| | - Aparna Narasimha
- Professor, Department of Pathology, Sapthagiri Institute of Medical Sciences and Research Centre , Bangalore, India
| | - Bhaskaran
- Professor and HOD, Department of Surgery, Sri Devaraj Urs Academy of Higher Education and Research , Kolar, India
| | - Divya Rani M N
- Professor and HOD, Department of Surgery, Sri Devaraj Urs Academy of Higher Education and Research , Kolar, India
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15
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Heymann JJ, Halligan AM, Hoda SA, Facey KE, Hoda RS. Fine needle aspiration of breast masses in pregnant and lactating women: experience with 28 cases emphasizing Thinprep findings. Diagn Cytopathol 2014; 43:188-94. [PMID: 24976078 DOI: 10.1002/dc.23197] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 06/11/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND Fine needle aspiration (FNA) of breast masses in pregnant or lactating women is an uncommon procedure, and cytological interpretation is considered problematic due to atypia inherent to secretory change in glandular epithelia. Previous descriptions of "lactating adenoma" (LAd), the most common tumor in this population, have been on direct smears (DS), while ThinPrep (TP, Hologic, Boxborough, MA) findings therein remain largely uncharacterized. METHODS FNA cases from breast masses in pregnant or lactating women (2005-2012), processed as TP and/or DS were retrospectively reviewed. RESULTS 28 cases from as many patients (mean age 36 years), at 23 weeks of pregnancy to 10 months postpartum, were reviewed. Size of mass ranged from 1.0 to 4.5 cm. Corresponding histopathology was available in 21/28 cases. TP was available in 24/28 cases. Relative to DS, in TP, LAd showed "lacy" fragments, tissue paper-like texture, and globular clumps of "milky" background material, with embedded singly dispersed "bare" epithelial cell nuclei containing cherry-red macronucleoli. Architecture appeared disrupted in TP with isolated cells, smaller cell clusters, and lobules in LAd. Cellular morphology was better preserved in TP. Cytological features of carcinoma on TP were similar to DS. There were no false-positive cases. In this series, LAd was the most common diagnosis for breast masses in pregnant and lactating women (78.5%) and demonstrated background, architectural, and cellular alterations on TP. CONCLUSION In this setting, malignancy is an important consideration (encountered in 3/28, 11% of cases, including one false-negative angiosarcoma case).
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Affiliation(s)
- Jonas J Heymann
- Department of Pathology and Cell Biology, New York Presbyterian Hospital, College of Physicians & Surgeons, Columbia University, New York, New York
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16
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Heymann JJ, Bulman WA, Maxfield RA, Powell CA, Halmos B, Sonett J, Beaubier NT, Crapanzano JP, Mansukhani MM, Saqi A. Molecular testing guidelines for lung adenocarcinoma: Utility of cell blocks and concordance between fine-needle aspiration cytology and histology samples. Cytojournal 2014; 11:12. [PMID: 24987443 PMCID: PMC4058904 DOI: 10.4103/1742-6413.132989] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 02/20/2014] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Lung cancer is a leading cause of mortality, and patients often present at a late stage. More recently, advances in screening, diagnosing, and treating lung cancer have been made. For instance, greater numbers of minimally invasive procedures are being performed, and identification of lung adenocarcinoma driver mutations has led to the implementation of targeted therapies. Advances in molecular techniques enable use of scant tissue, including cytology specimens. In addition, per recently published consensus guidelines, cytology-derived cell blocks (CBs) are preferred over direct smears. Yet, limited comparison of molecular testing of fine-needle aspiration (FNA) CBs and corresponding histology specimens has been performed. This study aimed to establish concordance of epidermal growth factor receptor (EGFR) and Kirsten rat sarcoma (KRAS) virus homolog testing between FNA CBs and histology samples from the same patients. MATERIALS AND METHODS Patients for whom molecular testing for EGFR or KRAS was performed on both FNA CBs and histology samples containing lung adenocarcinoma were identified retrospectively. Following microdissection, when necessary, concordance of EGFR and KRAS molecular testing results between FNA CBs and histology samples was evaluated. RESULTS EGFR and/or KRAS testing was performed on samples obtained from 26 patients. Concordant results were obtained for all EGFR (22/22) and KRAS (17/17) mutation analyses performed. CONCLUSIONS Identification of mutations in lung adenocarcinomas affects clinical decision-making, and it is important that results from small samples be accurate. This study demonstrates that molecular testing on cytology CBs is as sensitive and specific as that on histology.
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Affiliation(s)
- Jonas J Heymann
- Address: Department of Pathology and Cell Biology, Departments of Medicine, Columbia University Medical Center, New York-Presbyterian Hospital, New York, NY 10032, USA
| | - William A Bulman
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York-Presbyterian Hospital, New York, NY 10032, USA
| | - Roger A Maxfield
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York-Presbyterian Hospital, New York, NY 10032, USA
| | - Charles A Powell
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, The Mount Sinai Medical Center, New York, NY 10029, USA
| | - Balazs Halmos
- Division of Hematology/Oncology, Columbia University Medical Center, New York-Presbyterian Hospital, New York, NY 10032, USA
| | - Joshua Sonett
- Department of Surgery, Division of General Thoracic Surgery, Columbia University Medical Center, New York-Presbyterian Hospital, New York, NY 10032, USA
| | - Nike T Beaubier
- Department of Pathology, Northwestern Memorial Hospital, Chicago IL 60611, USA
| | - John P Crapanzano
- Address: Department of Pathology and Cell Biology, Departments of Medicine, Columbia University Medical Center, New York-Presbyterian Hospital, New York, NY 10032, USA
| | - Mahesh M Mansukhani
- Address: Department of Pathology and Cell Biology, Departments of Medicine, Columbia University Medical Center, New York-Presbyterian Hospital, New York, NY 10032, USA
| | - Anjali Saqi
- Address: Department of Pathology and Cell Biology, Departments of Medicine, Columbia University Medical Center, New York-Presbyterian Hospital, New York, NY 10032, USA
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17
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Prasaad PR. Fine Needle Aspiration Cytologic Diagnosis of Lactating Adenoma: Report of two Cases. J Clin Diagn Res 2013; 7:2417-8. [PMID: 24298549 DOI: 10.7860/jcdr/2013/5260.3544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 08/28/2013] [Indexed: 11/24/2022]
Affiliation(s)
- Priavadhana Rajan Prasaad
- Assistant Professor, Department of Pathology, Sree Balaji Medical College and Hospital , Chennai, India
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18
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Joshi S, Dialani V, Marotti J, Mehta TS, Slanetz PJ. Breast disease in the pregnant and lactating patient: radiological-pathological correlation. Insights Imaging 2013; 4:527-38. [PMID: 23881348 PMCID: PMC3781252 DOI: 10.1007/s13244-012-0211-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 11/30/2012] [Accepted: 12/07/2012] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE Substantial physiological changes occur during pregnancy and lactation, making breast evaluation challenging in these patients. This article reviews the imaging challenges of the breast during pregnancy and lactation. The normal imaging appearance, imaging protocols and the imaging features of each commonly encountered benign and malignant entity with pathological correlation and supporting examples is described. An awareness of the imaging features of the breast during these physiological states and of various benign and malignant diseases that occur permits optimal management. CONCLUSIONS Evaluation of the pregnant and lactating patients who present with a breast problem is challenging. Although ultrasound may characterise the finding in many cases, mammography and even MRI may have a role in the management of these patients. TEACHING POINTS • To review physiological changes of the breast during pregnancy and lactation • To review imaging protocols of the breast during pregnancy and lactation • Discuss imaging findings with pathological correlation of benign and malignant diseases in pregnancy and lactation • Discuss pathological correlation of imaging findings in pregnancy and lactation.
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Affiliation(s)
| | - Vandana Dialani
- Division of Breast Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215 USA
| | - Jonathan Marotti
- Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH USA
| | - Tejas S. Mehta
- Division of Breast Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215 USA
| | - Priscilla J. Slanetz
- Division of Breast Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215 USA
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19
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Breast diseases during pregnancy and lactation. Obstet Gynecol Sci 2013; 56:143-59. [PMID: 24327995 PMCID: PMC3784111 DOI: 10.5468/ogs.2013.56.3.143] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 04/15/2013] [Accepted: 04/17/2013] [Indexed: 11/26/2022] Open
Abstract
Breast is a typical female sexual physiologic organ that is influenced by steroid hormone from menarche until menopause. Therefore various diseases can be developed by continuous action of estrogen and progesterone. Breast diseases are mainly categorized as benign and malignant. It is very important to distinguish the malignancy from breast diseases. However, it is very difficult to diagnose malignancy in pregnant and lactating women even though the same breast diseases took place. Therefore, we will review breast diseases such as breast carcinoma during pregnancy and lactation.
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20
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Ulery M, Carter L, McFarlin BL, Giurgescu C. Pregnancy-associated breast cancer: significance of early detection. J Midwifery Womens Health 2009; 54:357-363. [PMID: 19720336 DOI: 10.1016/j.jmwh.2008.12.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2008] [Revised: 12/17/2008] [Accepted: 12/17/2008] [Indexed: 11/27/2022]
Abstract
Pregnancy-associated breast cancer (PABC) is defined as cancer of the breast diagnosed during pregnancy and up to 1 year postpartum. Delays in diagnosis are frequently associated with increased morbidity and mortality. The aim of this article is to determine the significance of early detection of PABC and to alert health care providers to include PABC in the differential diagnosis when evaluating a breast mass in the perinatal period. This integrative literature review evaluated 15 research studies by using the hypothetical deductive model of clinical reasoning to determine factors related to diagnosis of PABC. As women delay childbearing, the incidence of PABC increases with age. In the reviewed studies, breast cancer was diagnosed with greater frequency in the postpartum period than during any trimester in pregnancy. Delay in diagnosis is complicated by axillary lymph node metastasis, high-grade tumors at diagnosis, and poor outcomes. Early detection is a significant predictor of improved outcomes. Diagnostic modalities such as ultrasound, mammography, and biopsy can be safely used for diagnostic purposes in the evaluation of potential cases of PABC during pregnancy.
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Affiliation(s)
- MaryAnn Ulery
- MaryAnn Ulery, APN, WHNP-BC, MS, is a women's health nurse practitioner, employed at Woman To Woman Obstetrics and Gynecology, P.C. in Crystal Lake, Illinois.Linnette Carter, APN, CNS, MS, is a perinatal clinical nurse specialist at Rockford Memorial Hospital, Northwestern Illinois Perinatal Network.Barbara L. McFarlin, CNM, RDMS, PhD, is a research assistant professor at the University of Illinois at Chicago College of Nursing.Carmen Giurgescu, RN, WHNP, PhD, is an assistant professor at the University of Illinois at Chicago College of Nursing
| | - Linnette Carter
- MaryAnn Ulery, APN, WHNP-BC, MS, is a women's health nurse practitioner, employed at Woman To Woman Obstetrics and Gynecology, P.C. in Crystal Lake, Illinois.Linnette Carter, APN, CNS, MS, is a perinatal clinical nurse specialist at Rockford Memorial Hospital, Northwestern Illinois Perinatal Network.Barbara L. McFarlin, CNM, RDMS, PhD, is a research assistant professor at the University of Illinois at Chicago College of Nursing.Carmen Giurgescu, RN, WHNP, PhD, is an assistant professor at the University of Illinois at Chicago College of Nursing
| | - Barbara L McFarlin
- MaryAnn Ulery, APN, WHNP-BC, MS, is a women's health nurse practitioner, employed at Woman To Woman Obstetrics and Gynecology, P.C. in Crystal Lake, Illinois.Linnette Carter, APN, CNS, MS, is a perinatal clinical nurse specialist at Rockford Memorial Hospital, Northwestern Illinois Perinatal Network.Barbara L. McFarlin, CNM, RDMS, PhD, is a research assistant professor at the University of Illinois at Chicago College of Nursing.Carmen Giurgescu, RN, WHNP, PhD, is an assistant professor at the University of Illinois at Chicago College of Nursing
| | - Carmen Giurgescu
- MaryAnn Ulery, APN, WHNP-BC, MS, is a women's health nurse practitioner, employed at Woman To Woman Obstetrics and Gynecology, P.C. in Crystal Lake, Illinois.Linnette Carter, APN, CNS, MS, is a perinatal clinical nurse specialist at Rockford Memorial Hospital, Northwestern Illinois Perinatal Network.Barbara L. McFarlin, CNM, RDMS, PhD, is a research assistant professor at the University of Illinois at Chicago College of Nursing.Carmen Giurgescu, RN, WHNP, PhD, is an assistant professor at the University of Illinois at Chicago College of Nursing
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21
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Magno S, Terribile D, Franceschini G, Fabbri C, Chiesa F, Di Leone A, Costantini M, Belli P, Masetti R. Early onset lactating adenoma and the role of breast MRI: a case report. J Med Case Rep 2009; 3:43. [PMID: 19183446 PMCID: PMC2647934 DOI: 10.1186/1752-1947-3-43] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2008] [Accepted: 01/30/2009] [Indexed: 11/15/2022] Open
Abstract
Introduction Lactating adenoma is a benign condition, representing the most prevalent breast lesion in pregnant women and during puerperium; in this paper, a case of a woman with lactating adenoma occurring during the first trimester of pregnancy is reported. There have been no reports in the literature, according to our search, focusing on magnetic resonance imaging findings in cases of lactating adenomas. Also the early onset of the lesion during the first trimester of pregnancy is quite unusual and possibly unique. Case presentation We report the case of a primiparous 30-year-old Caucasian woman, who noted an asymptomatic lump within her left breast during the 9th week of gestation, slightly increasing in size over the next few weeks. Ultrasound demonstrated a hypoecoic solid mass, hypervascularized and measuring 4 cm. On magnetic resonance imaging, performed in the first month after delivery, the lesion appeared as an ovoidal homogeneous mass, with regular margins and a significant contrast enhancement indicative of a giant adenoma. Conclusion Magnetic resonance imaging could play an important role in the differential diagnosis of pregnancy-related breast lumps, particularly during puerperium, thus avoiding unnecessary surgical biopsies.
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Affiliation(s)
- Stefano Magno
- Department of Surgery, Breast Unit, Catholic University, Policlinico "A, Gemelli", Largo Agostino Gemelli, Rome, Italy.
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22
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Sabate JM, Clotet M, Torrubia S, Gomez A, Guerrero R, de Las Heras P, Lerma E. Radiologic Evaluation of Breast Disorders Related to Pregnancy and Lactation. Radiographics 2007; 27 Suppl 1:S101-24. [DOI: 10.1148/rg.27si075505] [Citation(s) in RCA: 161] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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