Breast/pathology* ; Breast Neoplasms/pathology* ; Carcinoma in Situ/pathology* ; Carcinoma, Lobular/pathology* ; Diagnosis, Differential ; Female ; Humans ; Hyperplasia/pathology*

The initial presentation of breast malignancy as noninvasive carcinoma in an area of sclerosing adenosis is unusual. Especially, lobular carcinoma in situ in sclerosing adenosis sometimes can be a potential source of confusion with invasive lobular carcinoma. We report a case of lobular carcinoma in situ presenting in adenosis exhibiting patterns akin to invasive lobular carcinoma, thus leading to potential misdiagnosis. Overall architecture of the lesion as seen at lower power and immunohistochemistry can be useful to distinguish between sclerosing adenosis with lobular carcinoma in situ and infiltrating lobular carcinoma.
Breast Neoplasms/pathology* ; Carcinoma in Situ/pathology* ; Carcinoma, Lobular/pathology* ; Case Report ; Female ; Fibrocystic Disease of Breast/pathology* ; Human ; Immunohistochemistry ; Middle Age

Objective: To investigate the histopathological and immunohistochemical characteristics of benign apocrine cystic papillary hyperplasia of the breast with loss of myoepithelial cell layer. Methods: The clinical data, histopathological features and immunohistochemical profile of patients with benign apocrine cystic papillary hyperplasia of breast with loss of myoepithelial cell layer from January 2016 to December 2021 were examined, in which six patients were identified. Results: All six patients were female, aged 36-61 years (median 46 years), who presented with a breast mass; three cases were from the left breast and three cases were from the right breast. Microscopic examination of all cases showed breast hyperplasia with apocrine cysts, accompanied by different degrees of micropapillary and papillary hyperplasia of apocrine cells. One case was associated with lobular carcinoma in situ, and one case was associated with apocrine ductal carcinoma in situ with intraductal dissemination in adenosis. Immunohistochemical staining of CK5/6, p63, SMA, SMMHC, Calponin and CD10 showed complete absence of myoepithelial cell layer surrounding ducts in apocrine cystic papillary hyperplasia. Conclusions: The myoepithelial cells of apocrine cystic papillary hyperplasia of the breast may undergo abnormal changes and may even be completely lost. The diagnosis should be comprehensively considered along with cytomorphological and histological features to avoid overdiagnosis.
Female ; Humans ; Epithelial Cells/pathology* ; Hyperplasia/pathology* ; Papilloma/pathology* ; Adult ; Middle Aged ; Mammary Glands, Human/pathology* ; Breast Neoplasms/pathology* ; Carcinoma, Lobular/complications* ; Carcinoma, Ductal/complications*

OBJECTIVETo investigate the pathology, diagnosis and differential diagnosis of carcinomas arising in fibroepithelial neoplasms of the breast.

METHODSMorphological observation and immunohistochemistry using MaxVision method were performed in fifty-four cases of carcinoma arising from fibroepithelial neoplasms of the breast from January 2003 to February 2014.

RESULTSThirty-eight cases of carcinoma arose from fibroadenomas. Twelve cases were classical lobular carcinoma in situ (LCIS). Twenty-one cases were ductal carcinoma in situ (DCIS), including four cases of low-grade, ten cases of intermediate-grade, six cases of high-grade and one case of apocrine. One case was mixed DCIS and LCIS. Three cases were infiltrating ductal carcinoma (IDC) accompanied with DCIS. One case was spindle cell metaplastic carcinoma. Sixteen cases arose from phyllodes tumours. Six cases arose from benign phyllodes tumours, including four cases of low-grade DCIS, one case of high-grade DCIS, and one case of classical LCIS with micro-invasion (diameter 0.9 mm). Three cases arose from borderline phyllodes tumours, including one case of classical LCIS, one case of intermediate-grade DCIS, and one case of invasive lobular carcinoma (ILC) with LCIS. Seven cases arose from malignant phyllodes tumours, including two cases each of low-grade DCIS and intermediate-grade DCIS, one case of high-grade DCIS, one case of apocrine DCIS, and one case of mixed IDC with DCIS. By immunohistochemistry, LCIS and ILC were diffusely positive for ER and PR. Low-grade DCIS was diffusely positive for ER and PR ( > 90%), intermediate-grade DCIS was 70%-90% positive, high-grade DCIS was negative for ER and 20%-30% positive for PR, apocrine DCIS was both negative, and IDC was 40%-90% positive. The spindle cell metaplastic carcinoma was negative for ER and PR, but showed diffuse or scattered positivity for CK5/6 and p63.

CONCLUSIONSCarcinomas arising from fibroepithelial neoplasms of the breast are rare, showing unusual clinical presentation, and are characterized by in situ or invasive carcinomas in a background of fibroepithelial neoplasms. The accurate diagnosis depends on the recognition of the background fibroepithelial neoplasms and assessment of the nature of the epithelial proliferation, supplemented by immunohistochemistry when necessary.

Breast Neoplasms ; pathology ; Carcinoma in Situ ; pathology ; Carcinoma, Ductal, Breast ; pathology ; Carcinoma, Intraductal, Noninfiltrating ; pathology ; Carcinoma, Lobular ; pathology ; Female ; Humans ; Immunohistochemistry ; Neoplasms, Fibroepithelial ; pathology ; Phyllodes Tumor ; pathology ; Rare Diseases ; pathology

PURPOSE: To evaluate the upgrade rate of ultrasonography (US)-guided core-needle biopsy (CNB) of the breast for a pure mucocele-like lesion (MLL), to evaluate the clinical and radiologic features, and to correlate the image-pathologic features further on to guide the management of MLL. METHODS: Between January 2003 and February 2013, 14-gauge US-guided CNB was performed in 18,111 cases. Thirty-two cases associated with MLL were identified, and five cases of MLLs associated with breast carcinoma or with other high-risk breast lesions (i.e., atypical ductal hyperplasia [ADH], papillary lesions, lobular carcinoma in situ, and radial scar complex) were excluded. Among these 27 pure MLLs, 21 cases with surgical or vacuum-assisted excision (VAE) pathology were included in our study. Medical records, mammograms, and ultrasonograms were reviewed for the clinical and radiologic features of the cases. RESULTS: Among the 21 cases with pure MLLs at CNB, the final pathology showed a 0% proportion of cases upgraded to malignancy. All the 21 cases with either surgical or VAE pathology were benign MLLs including three cases of focal involvement of ADH (14.3%). The common features were mammographic features of microcalcifications that were round in shape and had a grouped distribution. The US features included oval shape, circumscribed margin, parallel orientation, complex solid and cystic echo pattern, no posterior feature, and complex solid and cystic echoic masses. The predominant Breast Imaging Reporting and Data System (BIRADS) category was 4A. All the lesions showed image-pathologic concordance. CONCLUSION: For pure MLL on US-guided CNB with image-pathologic concordance, close imaging follow-up might be considered instead of surgical excision.
Biopsy* ; Biopsy, Large-Core Needle ; Breast Neoplasms ; Breast* ; Carcinoma, Lobular ; Cicatrix ; Hyperplasia ; Information Systems ; Medical Records ; Pathology ; Ultrasonography

Many patients suffering from breast carcinoma have metastases at initial diagnosis. The common metastatic sites are skeleton, liver and lung. Metastases to stomach are rare and only three cases have been reported in Korea. The endoscopic features of gastric metastases from breast carcinoma can be divided into three main categories: diffuse infiltration, external compression, and localized tumor deposition with ulceration or with a polypoid mass. However, metastatic gastric lesions which resemble early gastric carcinoma are rare. Typically, gastric metastases are confined to submucosa and muscularis, so that mucosal biopsy specimens might be false-negative. We report a case of gastric metastasis from infiltrative lobular carcinoma of the breast in a 66-year-old woman who had undergone left mastectomy with postoperative radiotherapy 17 years earlier. Initial diagnosis was early gastric carcinoma, signet ring cell type on gastric biopsy findings. However, definitive diagnosis of metastatic breast cancer was confirmed after endoscopic mucosal resection of a presumed primary early gastric carcinoma.
Aged ; Breast Neoplasms/*pathology ; Carcinoma, Lobular/diagnosis/pathology/*secondary ; Diagnosis, Differential ; English Abstract ; Female ; Gastric Mucosa/pathology ; Humans ; Stomach Neoplasms/*diagnosis/pathology/*secondary

PURPOSE: To evaluate the contrast-enhanced MR findings of lesions associated with a radial scar and to compare the MR findings with the histopathology results. MATERIALS AND METHODS: From Mar. 2001 to Sep. 2005, 8 patients with a surgically proven radial scar who had undergone MRI, mammography, and ultrasonography were enrolled in this study. The morphological findings and dynamic enhancement pattern of the time-intensity curve were retrospectively reviewed using non-contrast and contrast-enhanced MRI. Mammography and ultrasonography were also analyzed according to the BI-RADS category and correlated with the histopathological diagnosis. RESULTS: The age of the patients ranged from 42 to 53 years (mean, 47 years). Five patients presented with a left breast lesion and the others presented with a right breast lesion. The histopathological diagnosis associated with the radial scar were fibrocystic changes (n=1), adenosis (n=2), atypical ductal hyperplasia (n=2), lobular carcinoma in situ (n=1), ductal carcinoma in situ (n=1), and invasive ductal carcinoma (n=1). In all patients, architectural distortion without microcalcification was observed with mammography. Irregular shaped hypoechoic lesions with an indistinct, spiculated, or angular margin was observed in all patients with ultrasonography. Posterior shadowing was observed in 4cases. MR enhancement revealed two cases with foci enhancement (adenosis and fibrocystic change), five cases with non-mass-like focal enhancement (fibrocystic change, atypical ductal hyperplasia, lobular carcinoma in situ, ductal carcinoma in situ, invasive ductal carcinoma), and one irregular homogeneous mass enhancement (atypical ducal hyperplasia). The time-signal intensity curves are as follows: persistent type (n=2), adenosis, and fibrocystic changes, respectively; plateu type (n=4), one adenosis, two atypical ductal hyperplasia, and one ductal carcinoma in situ; and washout type (n=2), lobular carcinoma in situ, and invasive ductal carcinoma, respectively. CONCLUSION: Although a combined benign or malignant pathology with a radial scar was not predicted on the preexisting image modality, contrast-enhanced MRI can help to predict a combined benign or malignant pathology with a radial scar using the morphological findings and the dynamic enhancement type of the time-intensity curve.
Breast ; Breast Neoplasms ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Carcinoma, Lobular ; Cicatrix* ; Diagnosis ; Humans ; Hyperplasia ; Magnetic Resonance Imaging ; Mammography ; Pathology ; Retrospective Studies ; Shadowing (Histology) ; Ultrasonography

PURPOSE: To evaluate the contrast-enhanced MR findings of lesions associated with a radial scar and to compare the MR findings with the histopathology results. MATERIALS AND METHODS: From Mar. 2001 to Sep. 2005, 8 patients with a surgically proven radial scar who had undergone MRI, mammography, and ultrasonography were enrolled in this study. The morphological findings and dynamic enhancement pattern of the time-intensity curve were retrospectively reviewed using non-contrast and contrast-enhanced MRI. Mammography and ultrasonography were also analyzed according to the BI-RADS category and correlated with the histopathological diagnosis. RESULTS: The age of the patients ranged from 42 to 53 years (mean, 47 years). Five patients presented with a left breast lesion and the others presented with a right breast lesion. The histopathological diagnosis associated with the radial scar were fibrocystic changes (n=1), adenosis (n=2), atypical ductal hyperplasia (n=2), lobular carcinoma in situ (n=1), ductal carcinoma in situ (n=1), and invasive ductal carcinoma (n=1). In all patients, architectural distortion without microcalcification was observed with mammography. Irregular shaped hypoechoic lesions with an indistinct, spiculated, or angular margin was observed in all patients with ultrasonography. Posterior shadowing was observed in 4cases. MR enhancement revealed two cases with foci enhancement (adenosis and fibrocystic change), five cases with non-mass-like focal enhancement (fibrocystic change, atypical ductal hyperplasia, lobular carcinoma in situ, ductal carcinoma in situ, invasive ductal carcinoma), and one irregular homogeneous mass enhancement (atypical ducal hyperplasia). The time-signal intensity curves are as follows: persistent type (n=2), adenosis, and fibrocystic changes, respectively; plateu type (n=4), one adenosis, two atypical ductal hyperplasia, and one ductal carcinoma in situ; and washout type (n=2), lobular carcinoma in situ, and invasive ductal carcinoma, respectively. CONCLUSION: Although a combined benign or malignant pathology with a radial scar was not predicted on the preexisting image modality, contrast-enhanced MRI can help to predict a combined benign or malignant pathology with a radial scar using the morphological findings and the dynamic enhancement type of the time-intensity curve.
Breast ; Breast Neoplasms ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Carcinoma, Lobular ; Cicatrix* ; Diagnosis ; Humans ; Hyperplasia ; Magnetic Resonance Imaging ; Mammography ; Pathology ; Retrospective Studies ; Shadowing (Histology) ; Ultrasonography

PURPOSE: High false negative results on fine needle aspiration cytology (FNAC) have been reported in the diagnosis of breast cancers, which are small sized, desmoplastic type, infiltrating lobular cancers, tubular cancers, and mucinous cancer. METHODS: From Jan. 1997 to Dec. 1998, we performed 622 FNACs at the Department of Surgery, Korea University Hospital. Among those aspirates, 246 cases were followed by subsequent pathological confirmation and were included in this study. Pathological reports for breast specimens were reviewed for the size, the location, the grade or the pathological subtype, and the presence of fibrosis in the breast lesions. The pathological characteristics were compared statistically with the results of the fine needle aspiration cytology. RESULTS: The likelihood ratios for malignant, suspicious, atypical, benign, and unsatisfactory cytological diagnoses were 98.7, 5.5, 1.1, 0.07, and 0.6, respectively. The absolute and the complete sensitivities for the malignant lesions were 64.5% and 90.3%, respectively. The rate of unsatisfactory diagnosis was 9.3%, and the false-negative rate was 4.3%. The concordance rates of FNAC results were 75% for tumors less than 1 cm in size, 60.7% for 1-2 cm, 76.5% for 2-5 cm, and 50% for greater than 5 cm (p=0.01). The location of the tumor also affected the FNAC result, and the highest concordant rate was found in tumors of the lower outer quadrant of the breast (73.3%, p=0.001). The Bloom-Richardson grade and histologic type of the breast cancer also affected the FNAC result. Low-grade tumors, medullary carcinomas, metaplastic carcinomas, lobular carcinomas, adenoid cystic carcinomas, and mucinous carcinomas usually showed discordant FNAC results. The presence or the absence of fibrotic pathology did not affect the FNAC result (p=0.39). CONCLUSION: The sensitivity of FNAC was 90.3% in the diagnosis of breast cancer and the false negative rate was 4.3%. The greatest concordance of FNAC diagnosis was found in the patients with tumor less than 5 cm in size and located in the axilla and locoregional recurrent area. The FNAC results for breast cancer were frequently incorrect for low-grade tumors and cancers of a rare pathological type.
Adenocarcinoma, Mucinous ; Axilla ; Biopsy, Fine-Needle* ; Brain Stem Neoplasms ; Breast Neoplasms* ; Breast* ; Carcinoma, Adenoid Cystic ; Carcinoma, Lobular ; Diagnosis* ; Fibrosis ; Humans ; Korea ; Mucins ; Pathology

The diagnostic accuracy of fine needle aspiration cytology (FNAC) had been reported about 88-99% in the preoperative diagnosis of breast cancer. High false negative results were reported in the diagnosis of breast cancers, which were small size desmoplastic type, infiltrating lobular cancer, tubular cancer and mucinous cancer. The purpose of this study is to define the possible histopathologic characteristics of breast cancer affecting the results of fine needle aspiration cytology. From Jan. 1997 to Dec. 1998, we performed 622 cases of FNAC at the department of surgery, Korea University Hospital. Among these aspirate, 246 cases were followed by subsequent pathological confirmation and were included in this study. The results of fine needle aspiration cytololgy were classified as benign, suspicious and malignant cells. Pathological reports for breast specimens were reviewed for the size, the location, grade or pathological subtypes and presence or fibrosis in the breast lesions. The pathological characteristics were compared statistically with the results of fine needle aspiration cytology. The likelihood ratios for malignant, suspicious, atypical, benign and unsatisfactory cytological diagnosis were 98.7, 5.5, 1.1 and 0.6, respectively. Absolute and complete sensitivities for the malignant lesions were 64.5% and 90.3%. The specificity was 71.9%. False negative and positive rates were 4.3% and 0.7%. The predictive value for malignant cytology in malignancy was 98.4%. The rate of unsatisfactory diagnosis was 9.3%. The range of tumor size is from 0.6 cm to 6.5 cm. The concordance rates of FNAC results wee 75% of less than 1 cm, 60.7% of 1-2 cm, 76.5% of 2-5 cm, and 50% of greater than 5cm of tumor, respectively (p=0.01). The location of tumor also affect the FNAC result and the highest concordant rate was found in the tumor of lower outer quadrant of breast (73.3%, p=0.001). The Bloom-Richardson grade histologic type of breast cancer also affect the FNAC result. Low grade tumor, medullary carcinoma, metaplastic, carcinoma, lobular carcinoma, adenoid cystic carcinoma and mucinous carcinoma usually showed discordant FNAC results. The presence or absence of fibrotic pathology did not affect the FNAC result (p=0.39) In conclusion, the sensitivity of FNAC was 90.3% in the diagnosis of breast cancer and the false negative rate was 4.3%. The great concordance of FNAC diagnosis was found in the patients with tumor of less than 5cm and located in the axilla and locoregional recurrent area. The FNAC results of breast cancer were frequently incorrect in the low grade tumor and cancer of rare pathological type such as lobular, medullary, mucinous and adenoid cystic carcinoma of breast.
Adenocarcinoma, Mucinous ; Axilla ; Biopsy, Fine-Needle* ; Brain Stem Neoplasms ; Breast Neoplasms* ; Breast* ; Carcinoma, Adenoid Cystic ; Carcinoma, Lobular ; Diagnosis* ; Fibrosis ; Humans ; Korea ; Mucins ; Pathology ; Sensitivity and Specificity