[Wirsung's fibroadenoma and chronic pancreatitis].
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A case of a 30-year-old patient with a serous papillary borderline tumor of the right ovary who underwent a simple mono-lateral salpingo-oophorectomy is presented. Conservative surgery allowed a subsequent pregnancy with spontaneous delivery 27 months later.
The study of the DNA content in nuclei of the mammary gland epithelium in 18 females with fibroadenomatosis, followed by breast cancer, and in 47 patients showing fibroadenomatosis, but no cancer subsequently, indicated that the presence of aneuploid cells in fibroadenomatous foci may be regarded as one of high risk factors of breast cancer incidence. In these patients the risk for breast cancer is 9 times as that in the remaining subjects with fibroadenomatosis.
In this paper the authors described those of the breast fine needle aspirates which were difficult for interpretation e.g. clear-cut differentiation between benign and malignant character of the lesion could not be made. There were 40 such cases (1.96%) out of 2332 breast tumors biopsied between 1987-1989. In the cases that proved to be malignant on histology the authors described cytological features which speak in favour of malignancy. In the group of smears which proved to be benign on histology the authors described the features that imitate atypia and should not be misdiagnosed as malignant. The described criteria may be of some help in cytological diagnosis of breast masses.
The distribution pattern of vimentin in mammary gland lesions, including benign lesions (36 cases) and adenocarcinomas (40 cases), was studied with the use of a monoclonal antibody. In myoepithelial cells of mastopathy, the positive vimentin staining was seen in 6 cases (33.3%). Gynecomastia showed strong vimentin expression in myoepithelial cells. Fibroadenomas (14 cases) expressed positive vimentin staining in 8 cases (57.1%) with various staining intensities in myoepithelial cells. Lactating mammary gland tissue was positive for vimentin staining in narrow myoepithelium. In adenocarcinoma, positive reactions in tumor cells were found in 17 cases (41.2%) of solid tubular, 12 cases (33.3%) of papillo-tubular, and 11 cases (54.5%) of scirrhous carcinomas. The staining intensity for vimentin was weak in modified myoepithelial cells and neoplastic cells. Malignant cells in mammary carcinomas with vimentin reactivity usually expressed keratin staining; thus a co-expression of vimentin and keratin was found in mammary carcinomas.
The fixation in ethanol or formalin for trypsin digestion in immunohistochemical detection of cytokeratins and vimentin was assessed in a case of ovarian cystadenofibrocarcinoma. Superior reactivity for both markers was achieved in ethanol-fixed sections, even in samples stocked up to 60 days. Cytokeratin reaction in formalin-fixed sections was better when trypsin was used. However, this digestion was deleterious to vimentin detection. These data are presented to alert surgeons and oncologists on the relevance of fixation of specimens suspicious for neoplasia, since different epitopes may require different fixatives and the inadequate choice in the operative room may impart difficulties when immunohistochemistry is necessary.
Adenolipoma of the breast is a rare tumor. Two cases are described here and the literature is reviewed. Case 1 was a 52-year-old woman who had a 3-cm-long elastic hard tumor in the left breast. Case 2 was a 40-year-old woman who had a 3-cm-long elastic soft tumor in the left breast. In each case, mammography revealed well demarcated soft tissue density. Ultrasonography demonstrated well defined tumors composed of echogenic and sonolucent areas. These tumors were easily enucleated at surgery. Histologically, the tumors consisted of mammary ducts, fibrous stroma and adipose tissue, findings which are characteristic of mammary adenolipoma. An adenolipoma may still be misdiagnosed as a fibroadenoma or a fibrocystic disease. Characteristic findings of mammography and ultrasonography are emphasized.
Five biphasic tumors, four fibroadenomas and one cystosarcoma phyllodes, are reported in the male breast. Gynecomastia and lobular development were present in all five cases. The rarity of fibroadenoma and cystosarcoma phyllodes in men is attributed to the absence of lobules in the normal male breast. We propose that lobular development precedes biphasic tumors in the male breast. The development of lobules apparently requires a certain length and/or intensity of endogenous or exogenous estrogenic stimulation not frequently attained at the levels that commonly induce gynecomastia.
AgNOR staining technique was applied to facilitate the pathologic differential diagnosis of 74 breast tumors and 95 non-Hodgkin's lymphoma (NHL). The results showed that the mean AgNOR count per nucleus was significantly different between benign and malignant tumors (P less than 0.01). An AgNOR count per cell less than 3 indicated benign breast lesion and more than 5 implied malignancy. In NHL, AgNOR count that nucleolus less than 4 was indicative of low-grade while more than 6 of high-grade malignancy. In 45 NHL patients followed up, the AgNOR count/cell was high in 28 patients with short survivals than otherwise (17 patients). These observations suggest that the AgNOR could provide useful information about the nucleolus activity in hyperplastic and neoplastic conditions. Electron microscopically, argyrophilic protein was irregular in shape and highly stained with silver in the fibrillar centers and the dense fibrillar component in NHL tumor cells as compared to that seen in normal lymphocytes. This further implies that the NOR Proteins could be used as a marker of ribosomal DNA and its level of transcription is higher in the malignant tumors.
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Immunoreactive endothelin 1 (irET-1) concentrations were measured in extracts prepared from 4 phyllodes tumors and 14 fibroadenomas. irET-1 was detectable in all tissue extracts by specific radioimmunoassay, and the mean concentration of irET-1 was 18-fold and 27-fold higher in tissue extracts from phyllodes tumors than in those from intracanalicular fibroadenomas and pericanalicular fibroadenomas, respectively. Reverse-phase high-performance liquid chromatography coupled with radioimmunoassay in the extracts from phyllodes tumors revealed one major irET-1 component corresponding to human standard ET-1. Furthermore, immunocytochemical staining for ET-1 revealed that numerous ET-1-immunoreactive cells were seen in the epithelial cells but not in the stromal cells, suggesting that ET-1 is synthesized by the epithelial component of phyllodes tumors. A possible paracrine role of ET-1 in the growth of this rare tumor which is characterized by its prominent stromal cellularity is discussed.
Histopathological study for stromal cellular response was made on 200 cases of benign and dysplastic lesions and malignancy of breast. Infiltrations with lymphocytes and plasma cells were observed in 64% cases of fibroadenoma, 66.6% cases of giant fibroadenoma, 61% cases of mammary dysplasia and 33.3% cases of gynaecomastia. While mast cell infiltration was not observed in giant fibroadenoma, its presence was observed in 92% cases of fibroadenoma, 77.8% cases of mammary dysplasia and 33.3% cases of gynaecomastia. Lymphocytes and plasma cells infiltrations were observed in 100% of cases of invasive duct carcinoma, medullary carcinoma and fibrosarcoma. Comedocarcinoma showed infiltration with these cells in 75% of cases while that for colloid carcinoma and Paget's disease of breast were observed in 50% of cases of each. Infiltrations with mast cells were observed in 92.3% cases of invasive duct carcinoma, 75% cases of comedocarcinoma and 25% cases of medullary carcinoma. Other malignant conditions of breast did not show mast cell infiltration. Degree of infiltration with lymphocytes and plasma cells was mainly of low grade in benign and dysplastic lesions compared to high degree of infiltration in malignancy. Mast cell infiltration was of low degree in both the types of lesions.
The fine needle aspiration cytology of the breast is the only way for the morphological examination of suspicious palpable lesions without surgical procedure. The cytological examination is able to produce clinical relevant results on the basis of typical microscopical pictures especially in breast carcinoma, fibroadenoma, and cysts. However it must be taken into account that not all breast tumors can be detected by fine needle aspiration cytology. Therefore negative and doubtful results have to be interpreted in connection with clinical and mammographic findings. An essential condition for good results is an effective punction technique to obtain representative probes of cell material. In case punction and cytological examination are not performed by the same investigator there is the risk that an inadequate punction technique is not noticed and leads to unsatisfactory cytological results. In connection with clinical and mammographic examinations the fine needle aspiration cytology can be used as alternative diagnostic way and replace the conventional breast tumor diagnostic procedure by surgical biopsy and frozen section, if the necessary requirements are fulfilled. This includes a high standard of clinical, mammographic and cytological examinations and a critical summarizing interpretation of the examination results.
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