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The authors have presented several radiologics aspects of benign tumors insisting on the difficulty to make the limit between benignity and malignity and that in this cases one minute clinical examination can be contributive. Complementaries examinations so are cystography and galactography are often necessary to precise the diagnostic. The authors remind that it is not easy to define radiologics patterns of benignity.
The authors are dealing with the problem of pre-cancerous lesions from data contained in the pathological archives of the Institut Gustave-Roussy. One series consists of 320 cases operated upon for benign lesions or tumors of the breast (Fibroadenomas appearing at a relatively advanced age) of which 4 developed cancers. The past histories of another series of 730 patients having had mastectomies for cancer are examined; 24 of these had been operated upon previously for benign tumours or lesions of the breast. Attention is drawn to a number of histological signs the presence of which in an "a priori" benign lesion should evoke caution: multilayered epithelium of the galactophores glands with an "en flammèche" appearance, tubular adenomatous hyperplasia, irregular lobular hyperplasia, microcalcifications... Despite careful examination of multiple sections, the pathologists decision between benign and malignant lesion continue to be difficult.
The accuracy of needle biopsies with the disposable biopsy needle TRU-cut was compared to the results of the microscopic examinations of excisional biopsies obtained after the needle biopsy in 276 patients. The diagnostic accuracy in relationship to the diameter of the lesion is listed for 140 patients with carcinoma of the breast, for 72 patients with benign tumors of the breast and for 64 patients with well localized palpable fibrocystic disease. In our experience, the following pre-requistes are necessary to obtain a high diagnostic accuracy for the needle biopsy: 1. A well filled circumscribed, well palpable nodule of uniform consistency. 2. A superficial site close to the skin. 3. A diameter of more than 2 cm. 4. Some experience with the use of the instrument. Needle biopsies of the breast are indicated for skin metastases, recurrences in the scar, and for in-operably advanced tumor or patients who should not have general anaesthesia. Needle biopsy as the biopsy method for a primary plan of management is only relatively indicated in large carcinomas of the breast, or smaller tumors located close to the skin, or tumors which are well accessable in a small breast. The needle biopsy is not suited for the diagnosis of benign tumors of the breast, fibroadenomas, lipomas, or papillomas since complete excision of these lesions is the aim of management. In fibrocystic disease, needle biopsy is not indicated. This clinical or radiological localized finding may correlate to variable microscopic entities with different plans of management. The very small portion of the process shown in the needle biopsy is insufficient in fibrocystic disease. An absolute contra-indication to needle biopsy of the breast is the diagnosis of obscure disease on the breast.
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Plasma progesterone and oestradiol levels were estimated in 54 women who were suffering from breast pathology. (There were 18 cases of benign breast dysplasia, 28 cases of cystic disease of the breast and 8 cases of adenofibromata.) All these women had menstrual cycles that were apparently ovulatory, and the blood sampling was carried out on the 4th day after the rise in the temperature plateau. By way of controls, the same estimations were carried out on 20 normal women of the equivalent age at the same stage of the raised plateau. The levels of plasma oestradiol in patients who had breast pathology (136 +/- 75 pg/ml) were not significantly different from those of normal women (120 +/- 50 pg/ml). On the other hand patients with mastopathies had a far lower level of progesterone in the phase of the cycle that was considered to be luteal (5-7 +/- 3-1 ng/ml) in comparison with normal women (13-2 +/- 3-5 ng/ml). From these results the conclusion can be drawn that women who have benign breast disease while they are active from the ovulation point of view show a defect in secretion of progesterone by the corpus luteum. This defect is an isolated one. The physiopathological implications derived from this observation are discussed.
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The relationship of benign breast disease (BBD) and oral contraceptive (OC) use was analyzed in a case-control study conducted in Milan on 288 women with clinically relevant and histologically confirmed BBD (cases) and 285 age matched controls with a spectrum of acute conditions apparently unrelated to OC use. Compared to women who had never used OCs, the relative risk (RR) for users was 1.0 (95% confidence interval: 0.6-1.5). Likewise, there was no siginficant association with duration of use; however, a significantly lower relative risk emerged in women taking OCs during the year before breast biopsy (RR=0.4; 95% confidence interval: 0.2-0.8). The protection in current users increased with increasing duration of use. In spite of this finding, the overall results of the study do not support the hypothesis that OC use protects against development of histologically confirmed and clinically relevant benign breast disease.
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A 27-year-old woman was admitted to our hospital because of headache, fever and right neck pain. Neurological examination revealed mild meningeal signs, and hyper-reflexia in all extremities. In the laboratory tests, white-cell count was 13,000/mm3, rheumatoid factor(RF) and C-reactive protein(CRP) were positive. The cerebro-spinal fluid showed pleocytosis (56/mm3, neutorophils and lymphocytes were 26 and 28, respectively). Thus, she was diagnosed as aseptic meningitis. A few days later, she had weakness and dysesthesia of the right face and the left extremities. Pulse therapy with intravenous methylprednisolone was started. A magnetic resonance imaging (MRI) of the brain showed a hemorrhagic infarction in the right parietal lobe. In hemostatic markers, thrombin-antithrombin III complex(TAT; 106 ng/dl), D-dimer 1234 ng/dl, prothrombin fragment 1 + 2(F1 + 2; 2.36 nmol/L), beta-thromboglobulin (beta TG; 4,300 ng/dl) and platelet factor 4 (PF-4; 1,770 ng/dl) were extremely elevated. On duplex ultrasonography, a low echo lucent plaque was observed at the right internal carotid artery and the mean blood flow velocity in the right carotid artery was decreased. She was placed on oral prednisolone and warfarin for suspected stroke due to hypercoagulability associated with vasculitis. Afterwards, she discharged from our hospital. Two months later, she was readmitted to our hospital because of irregular menses and vaginal bleeding. Endometrial uterus biopsy was conducted, which revealed a grade I endometrioid adenocarcinoma. She was under total uterectomy without tumor recurrence. After the radical operation, white-cell count, RF, CRP, TAT, D-dimer, F1 + 2, and beta TG were normalized, and the mean flow velocity of the right common carotid artery was increased. Thereafter, she did not experience stroke recurrence. Therefore, we speculated that she had stroke due to hypercoagulability in association with malignancy, that is Trousseau's syndrome. We also assumed that aseptic meningitis, brainstem encephalitis associated with vasculitis in this patient are other clinical variants of paraneoplastic syndrome through immunological mechanisms associated with malignancy. We emphasize that patients with Trousseau's syndrome can be associated with other paraneoplastic manifestations such as vasculitis as seen in this patient.
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When young female A X C rats were given 9.6 rads of 0.43-MeV neutrons, 32 of 33 survived a 50-week follow-up period, 2 rats developed a total of 3 mammary adenocarcinomas, and 3 rats developed a total of 4 mammary fibroadenomas. For 25 rats implanted with a 20-mg pellet containing 5 mg diethylstilbestrol and 15 mg cholesterol, average survival was 284 days; 22 rats developed a total of 182 mammary adenocarcinomas, and 21 rats developed a pituitary tumor. When diethylstilbestrol was given 2 days before neutron radiation to 35 rats, the average survival was 239 days; 32 rats developed a total of 842 mammary adenocarcinomas, 1 rat developed a single mammary fibroadenoma, and 34 rats developed a pituitary tumor. All of the 31 control rats survived the 50-week study period, and none developed tumors. Twenty-one of the rats that received both diethylstilbestrol and neutron radiation and 1 rat that received only diethylstilbestrol exhibited a multiple mammary adenocarcinoma response with a range of 18 to 72 mammary adenocarcinomas per rat. These results were interpreted to mean that a synergistic interaction between diethylstilbestrol and neutron radiation on mammary adenocarcinoma formation occurs in terms of an earlier onset and a larger number of mammary adenocarcinomas. These results confirm and complement a previously reported synergistic interaction between diethylstilbestrol and X-radiation on mammary adenocarcinoma formation in A X C female rats.