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A case of a subcutaneous fibroadenoma on an arm of an 18-year-old woman is presented. The neoplasm, thought clinically to be a lipoma, may have arisen in ectopic breast tissue. Dermatologists and dermatopathologists should be aware that fibroadenomas histologically identical with those seen in the breast have been observed along the milkline and may also occur in other sites.
Eccrine syringofibroadenoma is an uncommon benign eccrine tumor, which was first described by Mascaro in 1963. It usually develops on the extremities of elderly persons. We report on a 74-year-old man who presented with a 2-year history of a slowly growing lesion on his face. A detailed histologic and immunohistochemical study was performed on the biopsy material. The tumor consisted of epidermal-derived anastomosing thin epithelial cords embedded in a fibrovascular stroma. The epithelial cords contained ductal and cystic structures lined by luminal cells, which were decorated by antibodies against carcinoembryonic antigen, keratin K19, K8, and K18. Antibody to keratin K6 decorated the luminal walls of the acrosyringia. Antibodies to filaggrin decorated the superficial luminal structures. These results suggest dual acrosyringial and dermal duct differentiation in syringofibroadenoma.
Epithelial atypia is rarely encountered in ovarian cystadenofibromas. Ten examples are reported with cytological features identical to serous tumors with low malignant potential. In two neoplasms the epithelium resembled an atypical endometrial hyperplasia, and one of these had squamous metaplasia. These two neoplasms probably qualify as endometrioid tumors of low malignant potential. None of the 10 patients had recurrence following excision of their neoplasm, and no similar patients have been encountered with neoplasms in more advanced stages. Even though aggressive behavior has not yet been established, the histologic features suggest a low degree of malignant potential and long-term follow-up of patients is warranted. Cystadenofibromas iwth epithelial atypia probably have less malignant potential than serous tumors of low malignant potential possessing the same epithelial characteristics because cystadenofibromas with atypia have less epithelial surface area and the epithelium is enveloped by connective tissue more than it is in serous tumors of low malignant potential.
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We studied 49 patients with fibroadenomas with severe atypical epithelial hyperplasia, sometimes suggestive of in situ carcinoma. The term "juvenile fibroadenoma" (JFA) is recommended for these lesions, which occur mainly in adolescent and young women. Twenty-six cases (2%) were obtained through a review of 1,321 consecutive fibroadenomas and 23 were seen in consultation. The 49 patients ranged in age from 10-72 years (average 26 years); 50% were younger than 21 years. This age distribution was significantly lower than that of patients with adult FA (p less than 0.001). Four patterns of atypical epithelial hyperplasia were observed: ductal-laciform, ductal-solid, cystic-papillary and lobular-terminal ductal. Forty-six patients were treated by excision only. Eight years was the average follow-up and 7 years the median follow-up for 28 (57%) patients followed for more than a year (range 1-19 years). Two patients, aged 47 and 59 years at the time of diagnosis of JFA, subsequently developed carcinoma in the contralateral and ipsilateral breast, respectively; all others have remained well. Atypical epithelial proliferation in this setting should be interpreted conservatively. Long-term follow-up is recommended after excision of JFA.
A 69-year-old man with congestive heart failure who had been treated with digoxin for 27 years and spironolactone for 4 years developed bilateral gynecomastia. Excised tissue contained multiple nodules. Histologically, the nodules showed a structural pattern corresponding to fibroadenoma of the female breast. This lesion, called "fibroadenomatoid hyperplasia," is probably caused by treatment with spironolactone. The lesion has not previously been described in tissue from the male breast.
Among 145 patients with the complex of myxomas, spotty pigmentation, endocrine overactivity, and psammomatous melanotic schwannomas, 31 (21%) had mammary lesions. The ages of these 26 females and five males ranged from 6 to 64 years (mean, 30 years). Five patients had breast symptoms. In 21 (81%) of the females, benign mesenchymal lesion(s) were detected pathologically. These were characterized by accumulations of large amounts of ground substance in the lobules that alterated the stroma to a very loose and myxoid tissue. The change involved single lobules (lobular myxoid change), small groups of lobules (nodular myxoid change), and large aggregates of lobules (myxoid fibroadenoma); the interlobular stroma was affected to a lesser degree. The lesions were multicentric and bilateral in eight patients (38%). Because the myxoid breast lesions were familial, were frequent findings in the complex, and were similar histologically to the cardiac and cutaneous myxomas in the complex, they undoubtedly are a component and a pathologic marker of the complex. They were the presenting feature of the complex in six patients (19%). Therefore, discovery of the myxoid breast lesions on pathologic examination should raise suspicion of the complex, and affected patients (and their primary relatives) should be evaluated accordingly.
Atypical duct hyperplasia of the breast is an unusual finding in the adolescent or young adult female. We report nine young women, ages 18-26 years (mean 21) with atypical duct hyperplasia. Clinical presentation was either breast hypertrophy treated by reduction mammoplasty (five patients) or a thickening or mass that was examined via biopsy (four patients). No focal abnormalities were present on gross examination other than two fibroadenomas in one patient. Microscopically, isolated hyperplastic ducts were scattered in a background of prominent stromal collagenization. Each case showed a continuum of ductal changes, from partial to complete involvement by micropapillary and laciform epithelial hyperplasia, which was sometimes markedly atypical. In four, lobules were poorly developed or not present in the available sections. During a follow-up of 5-68 months (mean 39), none developed breast carcinoma. Much longer follow-up is needed to determine if young women with atypical duct hyperplasia are at increased risk for subsequent development of breast carcinoma. Presently, no surgical or medical intervention is recommended, but such patients should perform breast self-examination and be monitored regularly by a physician.
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Antibody to a breast cancer antigen was detected by immunodiffusion or complement fixation in at least one serum sample in 46% of 84 patients with a diagnosis of carcinoma, 34% of 96 patients with fibrocystic disease and 25% of 44 patients with fibroadenoma. A single serum sample obtained from screenees of the Detection Center for Breast Diseases was tested by immunodiffusion only and antibody was found in 3 of 206 screenees (1.5%). Eleven of 13 patients with breast cancer metastatic to lymph nodes and no detectable serum antibody either had recurrence or were dead within 12 months of mastectomy. Fifteen of 18 patients with breast cancer metastatic to lymph nodes and with detectable serum antibody were alive and free of disease for up to 24 months. Histologic slides from patients with a diagnosis of fibrocystic disease or fibroadenoma were reviewed for the presence of ductal epithelial hyperplasia. Ductal epithelial hyperplasia was present in a similar per cent of patients with no detectable serum antibody as those with antibody detected in the serum. Severe sinus histiocytosis of the axillary lymph nodes was present in 45% of those cancer patients with serum antibody and only 11% of those cancer patients with no detectable serum antibody.
In 1244 women with breast symptoms an evaluation by means of palpation was made with respect to diagnosis of malignancy according to a four-grade scale ranging from "definite cancer" to "no cancer." Aspiration biopsy and cytologic examination were then performed in 984 breast lesions. The diagnosis from the cytologic evaluation ranged from benign, through three grades of atypia (slight, moderate, grave) to cancer. A histologic diagnosis was made in 411 cases and in 28% it was cancer. Cancer was found in 92.5% of the patients with a palpatory diagnosis of "definite cancer," and in 50% of those with a palpatory diagnosis of "strong suspicion of cancer." In all patients in whom cancer was diagnosed cytologically, the same diagnosis was made at histology, while 87.5% of those with grave atypia at the cytologic examination were diagnosed histologically as having cancer. A false negative cytologic diagnosis was made in 4% of the cancer cases. With a combination of palpation and cytology, 91% of the cancer cases fell within the groups "definite cancer," "strong suspicion of cancer" (palpation)/"cancer," "grave atypia" (cytology). No patients with cancer were evaluated as "no cancer" (palpation)/"no atypia" (cytology). In this group of 697 patients, however, one cancer was discovered after 7 months. The investigation showed that a thorough palpatory evaluation is a prerequisite for a good result of aspiration biopsy, in particular to meet the risk of a false negative cytologic diagnosis. The cytologic examination revealed cancer in 6 and 12 cases, respectively, when palpation gave no or some suspicion of cancer, and in many cases it was able to eliminate malignancy suspected on palpation. Cytologic atypia indicated cancer in a relatively high per cent, but was also noted in many cases found to be benign histologically. The possibilities of reducing the number of "unnecessary" surgical biopsies by using a combination of palpation and cytology is discussed.
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We report a population-based histopathologic review of primary ovarian neoplasms. No significant changes in incidence were encountered between the 1969 and 1979 review periods. The most frequent single tumor was benign cystic teratoma (26.5%), while the coelomic-derived "epithelial" tumors constituted the most frequent group (57.6% of all tumors and 93.8% of all malignant tumors). The high frequency of borderline tumors reported by others in nonpopulation-based material is confirmed, and the usual disseminated state of invasive carcinomas at the time of diagnosis is noted. Other data concerning incidence and bilaterality rates, patient ages, multiple primary malignancies, and problems in differential diagnosis and tumor grading are discussed.
The emergence in recent years of new concepts and entities pertaining to ovarian endometrioid neoplasia has led to a reappraisal of the subject. In this reappraisal, the double listing of benign endometrioid lesions as both "tumors" and "tumor-like" lesions, as it appears in the World Health Organization (WHO) classification, is being avoided and they are all listed under one heading. Clear cell tumors, which, in the WHO classification, are not listed under endometrioid neoplasia, are included among the latter in the proposed classification. Recently described entities are reviewed, as are those previously listed but not well documented. Some of the WHO listed endometrioid tumors of low malignant potential are omitted from the present discussion, as histologic and clinical data pertaining to such neoplasms are still not available.