Infiltrating duct cell carcinoma in lactating adenoma: A rare case in pair

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.

Giant Lactating Adenoma With Fibroadenomated Changes

Lactating adenomas (LAs) are uncommon benign breast tumors that typically occur in the late pregnancy or lactation period and are among the most prevalent breast lesions during puerperium. They commonly present with a painless, rapidly growing, large, mobile breast lump either late in pregnancy or the postpartum period. Despite being a condition, a core biopsy is almost always required to exclude malignancy. We are presenting a case of a 34-year-old patient who was referred to our unit with a progressive increase in size of the pre-existing right breast lump that has been there before pregnancy. Due to the massive increase in size in a short period, the lump was removed shortly after delivery with an acceptable cosmetic outcome.

Giant Lactating Adenoma - Size of a Shot Put Ball

Lactating adenomas are benign breast tumours which normally present in the peripartum period. Aetiology, pathogenesis, best diagnostic modality and management are not yet clear in the literature. We present a case of a 32-year-old pregnant patient who was re-referred to us with a progressively increasing left breast lesion, pre-existing prior to pregnancy, which was found to be a huge lactating adenoma.

Imaging of Lactating Adenoma: Differential Diagnosis of Solid Mass Lesion in a Lactating Woman

Lactating adenoma is an uncommon palpable breast lesion occurring in the late pregnancy or lactation period and is commonly found in young primiparous women in the second or third decade of life. Although a benign condition, sometimes, core biopsy is required to exclude malignancy. Approximately 3% of all breast cancers occur in women who are pregnant; and hence, a breast mass in this group of women must be investigated. The main differential diagnosis for a palpable solid breast mass is lobular hyperplasia which is a normal physiological event, fibroadenoma, focal mastitis, lactating adenoma, tubular adenoma, phyllodes tumor, and breast carcinoma. Here, we present a case of lactating adenoma of the breast at 6 months’ postpartum in a 24-year-old primiparous woman.

[Possibilities of cytological diagnostics of lactated breast adenoma. Clinical report.]

We describe a case of lactating adenoma in pregnant woman, 32 week of gestation. Typical features of disease presented in this article was revealed by clinical and microscopic methods and it make possible to diagnose the process before operation. The diagnosis was confirmed by histological investigation of surgical material.

Specimen Identification Errors in Breast Biopsies: Age Matters. Report of Two Near-Miss Events and Review of the Literature

The consequences of patient identification errors due to specimen mislabeling can be deleterious. We describe two near-miss events involving mislabeled breast specimens from two patients who sought treatment at our institution. In both cases, microscopic review of the slides identified inconsistencies between the histologic findings and patient age, unveiling specimen identification errors. By correlating the clinical information with the microscopic findings, we identified mistakes that had occurred at the time of specimen accessioning at the original laboratories. In both cases, thanks to a timely reassignment of the specimens, the patients suffered no harm. These cases highlight the importance of routine clinical and pathologic correlation as a critical component of quality assurance and patient safety. A review of possible specimen identification errors in the anatomic pathology setting is presented.

Lactating Adenoma of the Breast

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.

Giant benign phyllodes tumor with lactating changes in pregnancy: a case report

BACKGROUND

Phyllodes tumor in pregnancy is extremely rare. We present the first case ever reported of a giant benign phyllodes tumor with lactating changes during pregnancy.

PRESENTATION OF CASE

A 36-year-old female patient at the 32nd week of pregnancy presented with a huge mass in left breast for 5-6 months. Physical examination revealed a firm palpable 20 cm mass occupying the whole left breast. Ultrasound guided core needle biopsy demonstrated a fibroepithelial lesion suggestive of benign phyllodes tumor. She was scheduled for mastectomy three weeks after birth delivery. The microscopic examination of the resected specimen revealed the mass consisted mainly of lactating components with areas of hypercellular stroma and epithelial proliferation in leaf-like pattern. Finally, the pathological report confirmed a giant benign phyllodes tumor with lactating changes and frees all surgical margins.

DISCUSSION

Phyllodes tumor in pregnancy is rare with just nine cases reported. It is unknown if the rapidly growing mass in pregnant patient is hormone-dependent. This is the first report of a giant benign phyllodes tumor with lactating changes in pregnant patient. In these large phyllodes tumors, heterogeneous stromal components are common. It is occasionally difficult to distinguish between benign phyllodes tumor with lactating changes and lactating adenoma. Because the surgical treatment and local recurrence rate are different between these two diseases, we need to clearly differentiate benign phyllodes tumors from other benign breast diseases.

CONCLUSIONS

This case emphasizes the heterogeneity of giant phyllodes tumors. Therefore, it is important to thoroughly examine the resected specimen for possible additional components. The key point is that adequate and clear surgical margins in any phyllodes tumors must be achieved to reduce local recurrence.

Fine needle aspiration of breast masses in pregnant and lactating women: experience with 28 cases emphasizing Thinprep findings

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).

Vulvar lactating adenoma associated to a fibroadenoma: common neoplasms in an uncommon site

Ectopic breast tissue is defined as glands located outside of the breast. Ectopic breast tissue should be excised because it may develop benign (fibroadenoma) or malignant pathologic processes. Less than forty cases of fibroadenomas have been reported in the literature. Although lactation changes can occur, lactating adenoma in the vulva are extremely rare. Only four cases have been reported. We report a case of a young woman who presented with vulvar mass during her lactation. The mass was excised, and histology confirmed vulvar lactating adenoma associated with fibroadenoma. This is the first case of vulvar heterotopic breast lesion associating lactating adenoma and fibroadenoma.