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Jyotsna M, Doomra R, Yadav SK. Isolated cysticercosis of breast mimicking a mass lesion: A case report. Int J Surg Case Rep 2023; 112:108956. [PMID: 37837663 PMCID: PMC10667779 DOI: 10.1016/j.ijscr.2023.108956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 10/10/2023] [Indexed: 10/16/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Cysticercosis is a zoonotic disease caused by the larval form of Taenia solium. Its occurrence as a breast lump is rarely observed and therefore presents significant diagnostic challenges, especially in non-endemic regions. CASE PRESENTATION A 25-year-old female patient presented with a lump in her left breast. The lesion was initially non-diagnostic on ultrasound and fine needle aspiration cytology. Excision biopsy of the cystic lesion was done, and histopathological examination confirmed it to be cysticercosis. Post surgery patient was given Albendazole, and she was asymptomatic during the 3 month follow up. CLINICAL DISCUSSION This case highlights the disease's ability to present in atypical forms, such as a breast lump, and the importance of considering cysticercosis in differential diagnosis, especially in endemic regions. Ultrasonography remains the preferred initial diagnostic modality, and the role of FNAC and histopathology is crucial for confirmation. The case also emphasizes the need for heightened clinical suspicion, even when traditional risk factors like pork consumption are absent. CONCLUSION This case emphasizes the importance of considering cysticercosis as a differential diagnosis for breast lumps, even with atypical presentation or in a non-endemic region. It highlights the need for greater awareness of this disease, stringent public health measures, and improved personal hygiene to combat its spread.
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Affiliation(s)
- Mili Jyotsna
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhopal, India
| | - Rhythm Doomra
- All India Institute of Medical Sciences, Bhopal, India
| | - Shakti Kumar Yadav
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhopal, India.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Alameer A, Common M, Elwahab SA, Boland M, Allen M, Power C, Hambly N, Kerr J, Ni Mhuircheartaigh N, Staunton M, Hill ADK, Duke D. Clinically guided core biopsy and cutaneous punch biopsy in the evaluation of breast lesions: a necessary test or an obsolete skill? Ir J Med Sci 2023; 192:317-319. [PMID: 35132568 PMCID: PMC9892099 DOI: 10.1007/s11845-022-02937-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The vast majority of breast cancers are diagnosed via image-guided procedures yet despite significant advances, imaging does not identify all breast malignancies. Clinically suspicious breast lesions with normal breast imaging remain a cause for concern. The aim of this study is to determine the diagnostic value of clinical core and cutaneous punch biopsies in the diagnosis of breast malignancy in clinically suspicious lesions with normal breast imaging. METHODS All patients with suspicious clinical breast findings and normal imaging who underwent a clinical core and/or cutaneous punch biopsy from 2012 to 2019 were reviewed retrospectively. Patients with subsequent breast malignant diagnosis were analysed. RESULTS A total of 283 biopsies (166 clinical core, 117 cutaneous punch) performed over the 7-year period were included in the analysis. A total of 263/283 (93%) yielded a benign outcome. A total of 2/283 (0.7%) yielded B3 lesions (probably benign). These lesions were benign on final surgical excision. A total of 18/283 (6.3%) yielded a malignant histopathology. Sixteen out of 18 were cutaneous punch biopsies, and 2/18 were clinical core biopsies. A total of 14/18 patients presented with nipple changes, while 4/18 had a palpable area of concern. Histopathological analysis demonstrated Paget's disease of the nipple in 8/18, invasive carcinoma in 9/18 out of which two represented a recurrence of breast malignancy. Cutaneous squamous cell carcinoma was diagnosed in 1/18. CONCLUSION Clinical core and cutaneous punch biopsies remain a valuable tool in the diagnosis of breast cancer particularly in the management of clinically suspicious radiographically occult malignancies.
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Affiliation(s)
- Aqeel Alameer
- grid.414315.60000 0004 0617 6058Department of Surgery, Beaumont Hospital, Dublin, Ireland ,grid.416266.10000 0000 9009 9462Department of Radiology, Ninewells Hospital and Medical School, Dundee, UK
| | - Matthew Common
- grid.414315.60000 0004 0617 6058Department of Surgery, Beaumont Hospital, Dublin, Ireland
| | - Sami Abd Elwahab
- grid.414315.60000 0004 0617 6058Department of Surgery, Beaumont Hospital, Dublin, Ireland
| | - Michael Boland
- grid.414315.60000 0004 0617 6058Department of Surgery, Beaumont Hospital, Dublin, Ireland
| | - Michael Allen
- grid.414315.60000 0004 0617 6058Department of Surgery, Beaumont Hospital, Dublin, Ireland
| | - Colm Power
- grid.414315.60000 0004 0617 6058Department of Surgery, Beaumont Hospital, Dublin, Ireland
| | - Niamh Hambly
- grid.414315.60000 0004 0617 6058Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - Jennifer Kerr
- grid.414315.60000 0004 0617 6058Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | | | - Marie Staunton
- grid.414315.60000 0004 0617 6058Department of Pathology, Beaumont Hospital, Dublin, Ireland
| | - Arnold D. K. Hill
- grid.414315.60000 0004 0617 6058Department of Surgery, Beaumont Hospital, Dublin, Ireland
| | - Deirdre Duke
- grid.414315.60000 0004 0617 6058Department of Radiology, Beaumont Hospital, Dublin, Ireland
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Elnahas W, Metwally IH, Bonna K, Youssef M, AbdAllah S, Bonna M, Ali Faried M, Atef Tira M, Hamdy O. Fibroadenoma of the breast; incidence of malignancy and indicators for surgical intervention: An analysis of 1392 patients. Breast Dis 2022; 41:421-426. [PMID: 36565097 DOI: 10.3233/bd-210074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Fibroadenomas are common among young females. The size of the lesion used to be an indication for further assessment or excision. With arising of the watch and see proponents, criteria for selecting patients are important to establish. METHODS This is a retrospective study of a prospectively maintained database where all patients having the clinical/radiological provisional diagnosis of fibroadenoma and attending our center - from January 2008 to March 2020 - were enrolled. The primary outcome was the incidence of malignancy and the secondary outcomes were the correlation of malignancy-risk with epidemiologic and radiologic criteria. RESULTS The study enrolled 1392 patients. The mean age of the patients was 35.7 + ∕- 13.1 years. The median of the longest diameter of the detected breast lesions was 25 mm. The incidence of malignancy was 188 (13.5%). The size of the lesion measured by largest diameter was insignificant (p = 0.99), while the patients' age, marital status, and imaging criteria as measured by BIRADS score were significant (<0.001). CONCLUSION Approaching patients with the age above 35 or with BIRADS 4 provisionally diagnosed with fibroadenomas should be cautious with biopsy and short-term follow-ups The size of the tumor alone should not be used as an indication for surgical intervention.
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Affiliation(s)
- Waleed Elnahas
- Surgical Oncology Unit, Oncology Center Mansoura University (OCMU), Mansoura, Egypt
| | - Islam H Metwally
- Surgical Oncology Unit, Oncology Center Mansoura University (OCMU), Mansoura, Egypt
| | - Khaled Bonna
- Surgical Oncology Unit, Oncology Center Mansoura University (OCMU), Mansoura, Egypt
| | - Marco Youssef
- Surgical Oncology Unit, Oncology Center Mansoura University (OCMU), Mansoura, Egypt
| | - Samar AbdAllah
- Surgical Oncology Unit, Oncology Center Mansoura University (OCMU), Mansoura, Egypt
| | - Mohamed Bonna
- Medical Students, Mansoura University Faculty of Medicine, Mansoura, Egypt
| | - Mohamed Ali Faried
- Medical Students, Mansoura University Faculty of Medicine, Mansoura, Egypt
| | - Mohamed Atef Tira
- Medical Students, Mansoura University Faculty of Medicine, Mansoura, Egypt
| | - Omar Hamdy
- Surgical Oncology Unit, Oncology Center Mansoura University (OCMU), Mansoura, Egypt
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Hudson-Phillips S, Graham G, Cox K, Al Sarakbi W. Fibroadenoma: a guide for junior clinicians. Br J Hosp Med (Lond) 2022; 83:1-9. [PMID: 36322437 DOI: 10.12968/hmed.2022.0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Fibroadenoma is the most common cause of benign breast lumps and is typically seen in women under the age of 40 years. Fibroadenomas are classified as simple, complex, giant, myxoid or juvenile. They present as smooth, rubbery, mobile masses on palpation. Ultrasonographic and mammographic features typical of fibroadenomas include solid, round, well-circumscribed masses, with or without lobulated features. They are predominantly treated conservatively although clinical pathways recommend referral for triple assessment. Surgical intervention is indicated by the presence of one or more of the following features: the presence of symptoms, a diameter greater than 2 cm, rapid growth rate, complex features, disease recurrence or patient anxiety.
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Affiliation(s)
| | - Gemma Graham
- Department of General Surgery, Epsom and St Helier Hospital, London, UK
| | - Kofi Cox
- Department of Medicine, St George's University of London, London, UK
| | - Wail Al Sarakbi
- Department of Oncoplastic Breast Surgery, Croydon University Hospital, London, UK
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Dasgupta R, Rajak TK, Kaushal S, Ritolia N. Giant juvenile fibroadenoma of the breast in a 12-year-old girl. Afr J Paediatr Surg 2022; 19:271-273. [PMID: 36018214 PMCID: PMC9615957 DOI: 10.4103/ajps.ajps_75_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2023] Open
Abstract
Giant juvenile fibroadenomas, encountered usually in adolescents, are rapidly growing benign breast masses which lead to discomfort, anxiety and significant psychological stress. The breasts are in their early formative years, and thus, it is important to rule out malignancy as well as plan treatment options to preserve as much breast tissue as is possible. This report highlights a case of giant juvenile fibroadenoma diagnosed in a 12-year-old female child and our endeavour to achieve a good aesthetic result.
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Affiliation(s)
| | | | - Shalini Kaushal
- Department of General Surgery, SNMMCH, Dhanbad, Jharkhand, India
| | - Nikhil Ritolia
- Department of General Surgery, SNMMCH, Dhanbad, Jharkhand, India
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Velidedeoglu M, Umman V, Kilic F, Celik V, Gazioglu E, Hatipoglu E, Ozturk T, Mete B. Idiopathic granulomatous mastitis: introducing a diagnostic algorithm based on 5 years of follow-up of 152 cases from Turkey and a review of the literature. Surg Today 2022; 52:668-680. [PMID: 34549317 DOI: 10.1007/s00595-021-02367-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 07/28/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE The goals of this study were to report our clinical experience in a single center at a high-volume tertiary university hospital in Istanbul and to introduce a diagnostic algorithm based on a 5-year follow-up of 152 women with biopsy-proven idiopathic granulomatous mastitis (IGM). IGM is an uncommon, non-malignant, chronic inflammatory disease of the mammary gland with an unknown etiology. The symptoms, clinical presentation, and radiologic findings of IGM may resemble carcinomas. To our knowledge, this study comprises the largest series of IGM, especially with a 5-year follow-up, yet reported in the English literature. METHODS The present study reported our single-center clinical experience at a tertiary university hospital in Istanbul, Turkey, and introduced a diagnostic algorithm using our treatment protocol based on a 5-year follow-up of 152 women with biopsy-proven IGM. Our database of 10 years' experience containing over 700 patients with IGM was evaluated. However, to assess recurrence and resistance to treatment, only the 152 patients with a long follow-up period of 5 years were included in the study group. The analysis included 152 women with biopsy-proven IGM who were treated between January 2009 and March 2014. The clinical data of the presentation, histopathology, and treatment modalities were analyzed by reviewing the medical records. RESULTS Of the 152 patients diagnosed with granulomatous mastitis, 32 (21%) recovered by expectant management, while 14 (9%) responded to antibiotics, 65 (43%) received corticosteroids, 20 (13%) had antituberculosis medication, 16 (11%) underwent excision, and 5 (3%) responded to non-steroidal anti-inflammatory drugs. Fifty-one patients (33%) had recurrence; of these, 30 achieved a cure with second-line treatment, 16 underwent excision, and 5 achieved a cure with observation. CONCLUSION IGM is a rare benign breast disorder, and clinicians need a high index of suspicion to diagnose it, as IGM can be mistaken for breast cancer. Unlike periductal mastitis, IGM does not evolve secondary to nicotine addiction and is typically seen in women of childbearing age with a recent history of pregnancy and lactation. The diagnosis can be challenging, and an evaluation with a multidisciplinary team is necessary. There is no consensus concerning the definitive treatment approach. We suggested a diagnostic algorithm in the present study, using our treatment protocol based on the 5 years' follow-up of 152 women.
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Affiliation(s)
- Mehmet Velidedeoglu
- Department of General Surgery, Cerrahpasa School of Medicine, Istanbul University, 34098, Fatih, İstanbul, Turkey
| | - Veysel Umman
- Department of General Surgery, Cerrahpasa School of Medicine, Istanbul University, 34098, Fatih, İstanbul, Turkey.
| | - Fahrettin Kilic
- Department of Radiology, Cerrahpasa School of Medicine, Istanbul University, İstanbul, Turkey
| | - Varol Celik
- Department of General Surgery, Cerrahpasa School of Medicine, Istanbul University, 34098, Fatih, İstanbul, Turkey
| | - Ertugrul Gazioglu
- Department of General Surgery, Cerrahpasa School of Medicine, Istanbul University, 34098, Fatih, İstanbul, Turkey
| | - Engin Hatipoglu
- Department of General Surgery, Cerrahpasa School of Medicine, Istanbul University, 34098, Fatih, İstanbul, Turkey
| | - Tulin Ozturk
- Department of Pathology, Cerrahpasa School of Medicine, Istanbul University, İstanbul, Turkey
| | - Birgul Mete
- Department of Infectious Diseases, Cerrahpasa School of Medicine, Istanbul University, İstanbul, Turkey
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Brahmachari S, Bhagat V, Patil P, Vasuniya V. Evaluating the Effect of Ormeloxifene on Multiple Fibroadenomas and Mastalgia. J Pharm Bioallied Sci 2021; 13:S1386-S1389. [PMID: 35017994 PMCID: PMC8686955 DOI: 10.4103/jpbs.jpbs_222_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/20/2021] [Accepted: 05/09/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Most common benign breast conditions presenting in the breast clinics include fibroadenomas and mastalgia, both these conditions cause considerable anxiety in the patients. Among other treatment modalities, the hormonal drug treatments are gaining popularity. Ormeloxifene (centchroman) is an antiestrogenic drug which is shown to have effect in reducing the pain in mastalgia patients and the size of fibroadenoma. OBJECTIVES Ormeloxifene is selective antiestrogen and a nonsteroidal drug. It has a discerning antiestrogen action and hence is useful for the treatment of mastalgia and multiple small fibroadenomas. Hence, the objective of our study was to assess the effect of Ormeloxifene (centchroman) on multiple fibroadenoma and mastalgia. MATERIALS AND METHODS Patients with benign breast disease attending our surgery outpatient department from June 2016 to July 2017. Patients were started on Ormeloxifene 30 mg on alternate days for a period of 3 months. Patients were followed up to 6 months after the inception of the study. Parameters recorded include the Visual Analog Scale (VAS) for pain and ultrasonography for breast lump size. RESULTS Thirty patients were included in the study. We found very good response in the mastalgia; the VAS scores in these patients dropped from 10 to 3 in 90% in the 1st week of introduction of the drug, and at the end of 1 month, almost all of the patients were painless. Overall final response was noted in terms of complete dissolution and change in the size was noted in 34% partial response in 46 %, no changes in 17 % and increase in size of fibroadenoma was noted in only one case. CONCLUSION Novex is proved to be safe drug for the treatment of mastalgia and fibroadenoma. Its results were great in mastalgia group. At the end of 6 months, the number of surgeries (if needed) decrease and there is considerable improvement in the patient satisfaction rate.
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Affiliation(s)
| | - Vaishali Bhagat
- Department of General Surgery, Shri Shankaracharya Institute of Medical Sciences, Bhilai, Chhattisgarh, India
| | - Pooja Patil
- Department of Obstetrics and Gynaecology, LN Medical College, Bhopal, Madhya Pradesh, India
| | - Vikram Vasuniya
- Department of General Surgery, AIIMS, Bhopal, Madhya Pradesh, India,Address for correspondence: Dr. Vikram Vasuniya, Flat No E1/203, Fortune Kasturi, Jatkhedi Road, Bhopal - 462 026, Madhya Pradesh, India. E-mail:
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Ogbuanya AU, C Anyanwu SN, Nwigwe GC, Iyare FE. Diagnostic accuracy of fine needle aspiration cytology for palpable breast lumps in a Nigerian teaching hospital. Niger J Clin Pract 2021; 24:69-74. [PMID: 33473028 DOI: 10.4103/njcp.njcp_540_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Breast lump is a very common problem in the surgical units of many hospitals. Considering our unique socio-cultural and economic peculiarities, the ideal initial preoperative diagnostic tool for breast diseases should be cost-effective, simple with minimal physical and psychological trauma. Aims This study aimed to evaluate the diagnostic accuracy of Fine Needle Aspiration Cytology (FNAC) in the management of palpable breast lesions in our center. Methodsology This is a prospective study that lasted for one year. Fine needle aspiration cytology was done after clinical examination of all patients who gave consent. Open surgical biopsy was used as a reference standard. Results One hundred and fifteen patients were enrolled. We found that unsatisfactory smears (C1) were seven (6.1%), benign smears (C2), 57 (49.6%), atypical smears (C3), five (4.3%), suspicious of malignancy smears (C4), six (5.2%) and unequivocally malignant smears (C5), 40 (34.8%). Fine needle aspiration cytology achieved high sensitivity (90.4%), specificity (93.7%), positive predictive value (92.2%), negative predictive value (92.2%) and overall diagnostic accuracy (92.2%) for breast lumps in this study. The false positive and negative rates of 7.8% each are both higher than values recommended by National Health Services Breast Screening Program (NHSBSP) of United Kingdom. Conclusion In view of the high sensitivity, specificity and overall diagnostic accuracy combined with early retrieval of pathologic results on first clinic visit reported in this study, FNAC should become a useful tool in the management of breast lumps in our center.
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Affiliation(s)
- A U Ogbuanya
- Department of Surgery, Alex Ekwueme Federal University Teaching Hospital; Faculty of Health Sciences, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria
| | - S N C Anyanwu
- Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi; Department of Surgery, Faculty of Medicine, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | - G C Nwigwe
- Department of Surgery, Alex Ekwueme Federal University Teaching Hospital; Faculty of Health Sciences, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria
| | - F E Iyare
- Faculty of Health Sciences, Ebonyi State University; Department of Pathology, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
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Herle P, Boyages S, Hui R, Nahar N, Ngui NK. Occult metastatic thyroid cancer diagnosed during breast cancer axillary sentinel node biopsy. Endocrinol Diabetes Metab Case Rep 2020; 2020:EDM200048. [PMID: 32820129 PMCID: PMC7487195 DOI: 10.1530/edm-20-0048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 07/29/2020] [Indexed: 12/27/2022] Open
Abstract
SUMMARY In most developed countries, breast carcinoma is the most common malignancy in women and while thyroid cancer is less common, its incidence is almost three to five times greater in women than in men. Since 1966, studies have demonstrated an association between thyroid and breast cancer and despite these studies, the mechanism/s by which they are related, remains unclear. We present a case of a 56-year-old lady who initially presented in 2014 with a screen detected left breast carcinoma but was subsequently found to have occult metastatic thyroid cancer to the axilla, diagnosed from a sentinel node biopsy from the primary breast procedure. The patient underwent a left mastectomy, left axillary dissection and total thyroidectomy followed by three courses of radioactive iodine ablation. Despite this, her thyroglobulin level continued to increase, which was secondary to a metastatic thyroid cancer parasternal metastasis. Breast and thyroid cancer presents metachronously or synchronously more often than by chance. With improving mortality in primary cancers, such as breast and differentiated thyroid cancer, it is likely that as clinicians, we will continue to encounter this association in practice. LEARNING POINTS There has been a long-standing observation of an association between breast and thyroid cancer although the exact mechanism of this association remains unclear. Our patient presented with thyroid cancer with an incidental diagnosis from a sentinel node biopsy during her primary breast operation for breast cancer and was also found to have a parasternal distant bony metastasis. Thyroid axillary metastases are generally rare. The interesting nature in which this patient's metastatic thyroid carcinoma behaved more like a breast carcinoma highlights a correlation between these two cancers. With improving mortality in these primary cancers, clinicians are likely to encounter this association in clinical practice. Systemic therapy for metastatic breast and thyroid cancers differ and therefore a clear diagnosis of metastasis is crucial.
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Affiliation(s)
- Pratima Herle
- Department of Surgery, Westmead Hospital, Westmead, New South Wales, Australia
- General Surgery, Mount Druitt Hospital, Mount Druitt, New South Wales, Australia
| | - Steven Boyages
- Department of Endocrinology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Rina Hui
- Department of Radiation Oncology, Sydney West Cancer Network, Sydney, New South Wales, Australia
| | - Najmun Nahar
- Department of Medical Oncology, Sydney West Cancer Network, Sydney, New South Wales, Australia
| | - Nicholas K Ngui
- General Surgery, Mount Druitt Hospital, Mount Druitt, New South Wales, Australia
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Abstract
Background The breast is a common site for pathologies which predominantly involves the female breast. While benign diseases are more common, malignancies are of utmost concern for the patient, clinician, and the pathologist. Aim The aim of this study is to audit the clinical and pathological features of patients with breast lumps in a tertiary center in Nigeria. Materials and Methods This is a retrospective observational study of histologically diagnosed breast lumps over a period of 8 years. Results Lumps were common in the 20-39 years age group (>50%), with a mean age of 34.95 years. Females accounted for 759 (98.1%) of cases. In 467 (60.4%) cases, the lumps measured >5 cm and only 175 (22.6%) cases presented to the surgeon within 12 weeks of noticing a breast lump. Ninety-one (11.8%) cases also presented with axillary lymph nodes, breast pain 79 (10.2%), peau d' orange 56 (7.2%), and ulceration 47 (6.1%). Benign breast disease (BBD) occurred in 401 (51.8%) cases and malignant breast diseases (MBD) occurred in 344 (44.3%) of cases. Conclusion BBD and MBD are common among the young in Uyo. Lumps are the primary complaint and late presentation is the norm.
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Affiliation(s)
| | - Isaac Assam Udo
- Department of Surgery, University of Uyo, Uyo, Akwa Ibom State, Nigeria
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Manjiri S, Padmalatha SK, Jeevak S. A Prospective Observational Study of Breast Lumps in Adolescent Girls: Tertiary Care South Indian Teaching Hospital Experience. Indian J Surg Oncol 2018; 9:402-406. [PMID: 30288007 PMCID: PMC6154352 DOI: 10.1007/s13193-018-0773-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 05/08/2018] [Indexed: 11/28/2022] Open
Abstract
The aim of the current study was to assess the incidence and varying clinical presentations of benign breast lumps in adolescent age group in a Tertiary care Medical College Hospital. This was a prospective, observational study of 6-year duration (2011 to 2017) conducted in a Medical College, South India. All adolescent age group patients visiting the outpatient department (OPD) with complaints of breast lump were enrolled into the study. Triple assessment comprising of clinical examination, imaging, and core biopsy was used for diagnosis and identification of type of tumor. Management of tumors was based on pathology of core biopsy. During the study duration (2011 to 2017), a total of 15 pediatric patients of age between 11 to 14 years, presented with complaints of breast lumps. The most common symptom included painless lump in breast in 11 patients (73.34%). The histopathological examination (HPE) reported 12 cases (80%) as fibroadenomas and only 3 cases (20%) were phyllodes tumors. Based on the results of HPE, majority of the patients (53.34%) underwent circumareolar cosmetic incision. The most common lesions in pediatric age group are benign fibroadenomas; however, phyllodes are also not rare, and to manage them appropriately, they should be diagnosed preoperatively with core biopsy. Cases of malignancy, including phyllodes tumors, ductal adenocarcinomas, and metastatic lesions, have been documented in children and adolescents. Therefore, malignancy should be considered in the diagnosis of a pediatric and adolescent breast mass until formally ruled out.
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Affiliation(s)
- S. Manjiri
- M.S.Ramaiah Medical College, MSR Nagar, Gokula post, Bangalore, 560054 India
| | - S. K. Padmalatha
- M.S.Ramaiah Medical College, MSR Nagar, Gokula post, Bangalore, 560054 India
| | - Shetty Jeevak
- M.S.Ramaiah Medical College, MSR Nagar, Gokula post, Bangalore, 560054 India
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Abstract
INTRODUCTION Benign Osseous metaplasia of the breast is rare, with only a few cases reported in the literature. Here we present a case of benign osseous metaplasia of the breast presenting as a breast lump. CASE PRESENTATION 38-year-old previously well woman presented with a one-year history of bilateral breast pain and a left-sided breast lump. Ultrasound and mammography suggested calcified fibroadenoma. An ultrasound-guided true cut biopsy revealed fibrous tissue containing foci of adenosis in the presence of a myoepithelial cell layer. Excision biopsy was performed, and histopathological examination showed bone matrix deposition occupying most of the nodule with peripheral hyalinized tissue but no evidence of malignancy. A diagnosis of benign osseous metaplasia of the breast was made, and the patient recovered well without recurrence after lump excision. DISCUSSION Only a few cases of osseous metaplasia are reported in the literature. Most reported cases are malignant, such as in fibrosarcoma, malignant mesenchymoma, osteoid sarcoma, osteogenic sarcoma, and osteochondrosarcoma.Very few cases of osseous sarcoma are reported in benign lesions such as fibroadenoma, pleomorphic adenoma, benign mesenchymoma, phyllodes tumor, and amyloid tumor of the breast. Joshi et al. first reported a case of benign osseous metaplasia of the breast presenting as breast lump in an HIV-positive patient [18]. We, therefore, consider this case to be the second case report of benign osseous metaplasia of the breast presenting as a breast lump, but the patient had no chronic illness. CONCLUSION A breast lump can be the first presentation of benign osseous metaplasia.
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Affiliation(s)
- Hassan Alyami
- Consultant General Surgery at King Fahad Military Medical Complex Dharan
| | - Emad Al-Osail
- General Surgery Resident at King Fahad Military Medical Complex Dharan.
| | - Shawgi Harbi
- Consultant Histopathology at King Fahad Military Medical Complex Dharan
| | - Mohammed Bu Bshait
- Senior Registrar General Surgery, Department of Surgery, King Faisal University
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Spinelli Varella MA, Teixeira da Cruz J, Rauber A, Varella IS, Fleck JF, Moreira LF. Role of BI-RADS Ultrasound Subcategories 4A to 4C in Predicting Breast Cancer. Clin Breast Cancer 2017; 18:e507-e511. [PMID: 29066139 DOI: 10.1016/j.clbc.2017.09.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 09/01/2017] [Accepted: 09/07/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Breast Imaging Reporting and Data System (BI-RADS) ultrasound (US) categorization revised in 2013 by the American College of Radiology resulted in unquestionable standardization of reports and confirmed category 3 and 5 as benign and malignant lesions, respectively. In contrast, suspected images (category 4) have subcategorization criteria, although theses have been detailed difficult to apply. The aim of the present study was to determine the role of the US 4A to 4C BI-RADS subcategories in predicting malignancy. PATIENTS AND METHODS We performed a cross-sectional study of diagnostic tests to estimate the performance of the US BI-RADS categorization to clearly differentiate benign from malignant lesions. A total of 975 US examinations performed at the Hospital Femina, Grupo Hospitalar Conceição teaching hospitals from January 2012 through March 2015 were included in the present study. The US BI-RADS lexicon was used to classify the examination findings. Suspicious lesions underwent core needle biopsy, and the US and histology reports were compared to determine the performance using receiver operating characteristic curves. RESULTS Overall, the BI-RADS US categorization showed good discriminating accuracy with a receiver operating characteristic curve of 91% (95% confidence interval [CI], 88%-93%). However, BI-RADS subcategory 4b had a positive predictive value of 25% (95% CI, 20%-31%) and subcategory 4A had a positive predictive value of only 6% (95% CI, 3.5%-9.8%). CONCLUSION Our results have shown that US BI-RADS subcategories 4A and 4B are clearly unfit for use in screening tests, because they cannot rule out the need for biopsy. Therefore, management will not be improved by subcategorizing category 4, because all suspicious lesions will still require definite biopsy.
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Affiliation(s)
- Miguel Angelo Spinelli Varella
- Postgraduate Programme of Surgery, Faculty of Medicine, Rio Grande do Sul Federal University; Department of General and Breast Surgery, Hospital Femina, Grupo Hospitalar Conceição, Ministério da Saúde, Porto Alegre, Brazil.
| | - Jackson Teixeira da Cruz
- Department of Radiology, Ultrasonography Section, Hospital Femina, Grupo Hospitalar Conceição, Ministério da Saúde, Porto Alegre, Brazil
| | - Andrea Rauber
- Department of Gynecology and Obstetrics, Hospital Femina, Grupo Hospitalar Conceição, Ministério da Saúde, Porto Alegre, Brazil
| | - Ivana Santos Varella
- Postgraduate Programme of Epidemiology, Faculty of Medicine, Rio Grande do Sul Federal University; Núcleo de Epidemiologia Hospitalar do Grupo Hospitalar Conceição, Ministério da Saúde, Porto Alegre, Brazil
| | - James Freitas Fleck
- Department of Clinical Oncology, Rio Grande do Sul Federal University; Brazilian Research Council (Conselho Nacional de Pesquisa), Porto Alegre, Brazil
| | - Luis Fernando Moreira
- Department of Surgery, Postgraduate Programme of Surgery, Faculty of Medicine, Rio Grande do Sul Federal University and Hospital de Clínicas de Porto Alegre University Attached Hospital, Porto Alegre, Brazil
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15
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Mahmud MU, Sheuly SB, Bhuiyan NH, Chowdhury R, Ali R. Giant epidermoid cyst in the breast: A common benign lesion at a rare site-A case report. Int J Surg Case Rep 2017; 36:130-2. [PMID: 28570880 DOI: 10.1016/j.ijscr.2017.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/06/2017] [Accepted: 05/07/2017] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Epidermoid cyst is a common clinical entity and it can occur anywhere in the body. But its occurrence and huge size in the breast is very rare and more liable to develop complications, including malignant transformation. PRESENTATION OF CASE We present here an unusual case of a giant epidermoid cyst in the breast, which is about 7cm in greatest dimension. After proper preoperative diagnosis by clinical, imaging and histopathological findings, it was managed by total excision. DISCUSSION Imaging and fine needle aspiration cytology is essential for accurate preoperative diagnosis. However, it is often very difficult to differentiate it from other benign and malignant conditions of breast. Infection and malignant transformation are its potential complications. Total excision along with its capsule is the treatment of an epidermoid cyst. CONCLUSION Epidermoid cyst is an important differential diagnosis while managing benign breast disease.
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Abstract
A 52-year-old woman was found to have a lung mass and bilateral breast lesions on computed tomography (CT). Subsequent positron emission tomography/CT demonstrated marked uptake in the lung mass and mild uptake within the breast lesions. A diagnostic mammogram and targeted ultrasound were performed to exclude primary breast malignancy or metastases from presumed pulmonary malignancy. A pertinent history of recent intravenous drug use with heroin injection into bilateral breasts, together with imaging features, facilitated diagnosis of fat necrosis. Fat necrosis is a common diagnosis in breast imaging and may be an incidental finding on positron emission tomography/CT in the oncologic setting. The presence of fat along with suggestive clinical history can lead to the diagnosis and appropriate assignment of either benign, breast imaging-reporting and data system (BI-RADS) 2, or probably benign, BI-RADS 3, category with short interval follow-up. Appropriate work-up of incidental fluorodeoxyglucose-avid breast masses with diagnostic mammogram ± ultrasound is warranted to avoid incorrect interpretation as neoplastic processes.
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Affiliation(s)
- Lauren Kay Toney
- Division of Nuclear Medicine, Department of Radiology, University of Washington School of Medicine, Box 357115, Seattle, WA, 98195-7115, USA
| | - Diana L Lam
- Division of Breast Imaging, Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
| | - Habib Rahbar
- Division of Breast Imaging, Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
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17
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Kalipatnapu S, Samuel V, Johnson M, Perookavil Daniel K. A Case Report of a Giant Tubular Adenoma With a Concurrent Fibroadenoma of the Breast. World J Oncol 2015; 6:502-503. [PMID: 28983355 PMCID: PMC5624680 DOI: 10.14740/wjon954e] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2015] [Indexed: 11/11/2022] Open
Abstract
Tubular adenomas are rare benign epithelial tumors of the breast. Only a handful of cases have been reported in literature. We describe a very rare case of a giant tubular adenoma with a concurrent fibroadenoma in a young woman.
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Affiliation(s)
- Sasank Kalipatnapu
- Department of General Surgery, Christian Medical College, Vellore, Tamilnadu, India
| | - Vimalin Samuel
- Department of General Surgery, Christian Medical College, Vellore, Tamilnadu, India
| | - Martha Johnson
- Department of Pathology, Christian Fellowship Hospital, Oddanchatram, Dindigul District, Tamilnadu, India
| | - Koshy Perookavil Daniel
- Department of Surgery, Christian Fellowship Hospital, Oddanchatram, Dindigul District, Tamilnadu, India
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18
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Zegpi MS, Downey C, Vial-Letelier V. [Mammary duct ectasia in children: A case report]. ACTA ACUST UNITED AC 2015; 86:287-90. [PMID: 26363703 DOI: 10.1016/j.rchipe.2015.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 07/05/2015] [Accepted: 07/10/2015] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Bloody nipple discharge is an infrequent symptom during childhood. The most common cause in this population is mammary duct ectasia (MDE), which is a benign and self-limiting condition, that is characterized by dilatation of the mammary ducts, fibrosis and periductal inflammation. OBJECTIVE Report of a case of MDE in order to improve physicians' diagnosis accuracy and avoid aggressive studies and treatments. CASE REPORT Six-months old male healthy infant, exclusively breastfeeded, that visited our clinic with a lump beneath his right nipple and bloody discharge from the same nipple. An ultrasound was performed which showed a multicystic lesion suggestive of MDE. Watchful waiting was decided as treatment, with good evolution after six months of follow up. CONCLUSIONS The MDE is the leading cause of bloody discharge in pediatric population, being a benign condition that resolves spontaneously before nine months. The knowledge of this condition is essential so as to accurately diagnose and treat it.
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Abstract
INTRODUCTION The commonest clinical presentation in majority of breast pathology is a lump. A definite diagnosis of breast lump is very important for the surgeon to decide on the final course of treatment and also saves the patient from unnecessary physical, emotional and psychological trauma if there is a definite preoperative diagnosis of benign lesion. The present study was done to evaluate the effectiveness and relevance of "TRIPLE TEST"in diagnosis of carcinoma breast in rural labour class population. MATERIALS AND METHODS The present study was a prospective study conducted on patients over 35 years of age having palpable breast lumps presenting in the out patient department of general surgery, ESI Hospital Basaidarapur New Delhi, India. The duration of study was from May 2007 to June 2009 and a total of 100 cases were studied. Each patient was subjected to a detailed history, clinical breast examination ,diagnostic mammography and FNAC. In this study, the results of each modality was divided in three groups: benign, suspicious and malignant. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of each test was calculated individually and as combined. RESULT Out of 100 patients enrolled in this study, 60 cases were benign and 40 cases were of malignant breast disease. The age of patients with carcinoma breast in the series varied from 35 years to 70 years. The highest incidence of malignancy noted was 30% in 41-50 years age group (4(th) decade) followed by 27.5% in 51-60 years age group (5(th) decade). The sensitivity of clinical examination was found to be 75%, specificity was 83.3%, positive predictive value (PPV) of 75% and diagnostic accuracy of 80%. The sensitivity, specificity, positive predictive value and diagnostic accuracy of mammography was calculated and was found to be 94.9% , 90% , 86% and 92% respectively. The sensitivity, specificity, positive predictive value and diagnostic accuracy of FNAC was 94.7%, 98.3%, 97.3% and 96.6% respectively. Out of 100 cases triple test was concordant (all three test either benign or malignant) in 80 cases, all the benign cases detected by triple test were benign on final biopsy i.e. 100% specificity and 100% negative predictive value. CONCLUSION TTS is an accurate and least invasive diagnostic test based on which definitive treatment can be initiated.
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Affiliation(s)
- Suman Kharkwal
- Assistant Professor, Department of Surgery, ESI PGIMSR Basaidarapur, New Delhi, India
| | - Sameer
- Senior Medical Officer, Department of Surgery, ESI PGIMSR Basaidarapur, New Delhi, India
| | - Arindam Mukherjee
- Senior Resident, Department of Surgery, ESI PGIMSR Basaidarapur, New Delhi, India
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20
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Abstract
Imaging features of fat necrosis vary depending on its stage of evolution and can mimic malignancy in late stages. Imaging may suffice to differentiate fat necrosis in the early stages from malignancy and thus avoid unnecessary biopsy. In this pictorial essay, we present combination of benign features in mammography and/or ultrasonography (USG) that can lead to imaging diagnosis of fat necrosis. The follow-up imaging features of fat necrosis which mirror its pathophysiological evolution have also been demonstrated. To summarize, in the appropriate clinical setting, no mammographic features suspicious for malignancy should be present. When the typical mammographic features are not present, USG can aid with the diagnosis and follow up USG can confirm it.
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Affiliation(s)
- Vidya S Upadhyaya
- Department of Radiology, K.S. Hegde Medical Academy, Deralakatte, Mangalore, Karnataka, India
| | - Raghuraj Uppoor
- Department of Radiology, K.S. Hegde Medical Academy, Deralakatte, Mangalore, Karnataka, India
| | - Lathika Shetty
- Department of Radiology, K.S. Hegde Medical Academy, Deralakatte, Mangalore, Karnataka, India
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Van Tongel A, Begum R, Atoun E, Levy O. Breast Lump as an Unusual Manifestation of Massive Rotator Cuff Tear. Shoulder Elbow 2014; 6:44-6. [PMID: 27582909 PMCID: PMC4986657 DOI: 10.1111/sae.12045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 08/21/2013] [Indexed: 11/29/2022]
Abstract
Acromioclavicular joint cysts have been reported in association with extensive rotator cuff tears. However, cysts related to rotator cuff pathology can aslo form in other areas. In this case report, we describe the presentation of a large breast cyst associated with rotator cuff arthropathy mimicking a rapidly enlarging breast tumor.
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Affiliation(s)
- Alexander Van Tongel
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Gent, Belgium,
Correspondence: Alexander Van Tongel, Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, 9000 Gent, Belgium. Tel.: +32 93321020. Fax: +32 93324975. E-mail:
| | - Ruzi Begum
- Reading Shoulder Unit, Royal Berkshire Hospital, Reading, UK
| | - Ehud Atoun
- Reading Shoulder Unit, Royal Berkshire Hospital, Reading, UK
| | - Ofer Levy
- Reading Shoulder Unit, Royal Berkshire Hospital, Reading, UK
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22
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Varghese SS, Sasidharan B, Kandasamy S, Manipadam MT, Backianathan S. Alveolar Soft Part Sarcoma-A Histological Surprise in a Male Patient who was Suspected to have Breast Cancer. J Clin Diagn Res 2013; 7:749-51. [PMID: 23730668 DOI: 10.7860/jcdr/2013/5510.2903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 01/15/2013] [Indexed: 11/24/2022]
Abstract
Alveolar Soft Part Sarcoma (ASPS) is a very rare type of soft tissue sarcoma. Its cell of origin is unclear. It usually presents in the second to fourth decade of life. The most common reported sites of ASPS are the lower extremities, the head and the neck. Because of the rarity of this disease, there is no standard treatment plan. Surgical excision with negative margins is considered as the treatment of choice. We are reporting a rare presentation of ASPS as a male breast lump.
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Affiliation(s)
- Sunitha Susan Varghese
- Assistant Professor, Department of Radiation Oncology, Unit 1, CMC , Vellore, Tamil nadu, India
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23
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Ng CH, Nur-Aishah T, Yip CH. Is it Necessary to Excise All Breast Lesions? Experience from a University-Based Breast Unit. Malays Fam Physician 2009; 4:66-70. [PMID: 25606166 PMCID: PMC4267038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Breast cancer is becoming more important in Asia since it affect the younger age group. Question arises whether it is safe for breast lesions to be left in-situ if all the elements in triple assessment are benign. The aim of this study is to audit all the excision biopsies of breast lumps done in the University Malaya Medical Centre (UMMC), to review the association of age with the type of pathological finding and to evaluate the rate of carcinoma in these biopsies. METHODS We conducted a retrospective study of all women who had excision biopsy of a breast lump in the University Malaya Medical Centre from January 2005 to December 2006. All patients with malignant preoperative biopsies were excluded. RESULTS Of 717 lesions in 664 patients, 459 (64%) were fibroadenoma, 114 (15.9%) were fibrocystic disease, 20 (2.8%) were phylloides tumour, 27 (3.8%) were papilloma, 59 (8.2%) were malignant and 38 (5.3%) were of other pathology. Of the 717 open biopsies, 449 (62.6%) had fine-needle aspiration cytology (FNAC), 31 (4.3%) had core needle biopsy (CNB), while 14 (2.0%) had both FNAC and CNB done prior to excision biopsy. 251 (35%) had neither FNAC nor CNB. The incidence of fibroadenoma decreased with increasing age and the incidence of fibrocystic changes and papilloma increased with increasing age. There was no association of age with phylloides tumour. The incidence of unexpected malignancy increased with increasing age. The incidence rates were 0.3%, 4.5%, 19.4%, 29.7% and 29.6% for the age group below 30, 30-39, 40-49, 50-59 and above 60 years of age respectively. Of the 59 malignant lesions, FNAC was performed on 47 (79.7%) and CNB on 16 (27.1%). 9 had both FNAC and CNB and 3 had neither FNAC nor CNB. Out of the 56 lesions where FNAC/CNB were done, 23 (41.1%) were reported as benign, 20 (35.7%) as suspicious, 4 (7.1%) as atypical, 5 (8.9%) as inadequate, 2 (3.6%) as equivocal and 2 (3.6%) as lymphoid lesions. Out of the 23 prior biopsies reported as benign, 22 were in the age group above 40. CONCLUSIONS In conclusion, the rate of unexpected malignancy in open biopsies increases with age. It is recommended that all women above the age of 40 presenting with a palpable breast lump or a suspicious non-palpable abnormality on screening mammogram to have their lump excised even though the lump is benign on FNAC or CNB. However, women age of 30 to 39 should also have the lump excised in the presence of other risk factors such as family history of breast cancer.
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