Fibroadenoma

Eccrine syringofibroadenoma (ESFA) is a histological entity. It has been widely debated as to whether ESFA is a true neoplasm, a hamartoma or a form of reactive hyperplasia. ESFA should not be considered a homogenous condition and there are five clinical subtypes: (i) multiple ESFA associated with ectodermal dysplasia, (ii) multiple ESFA without cutaneous features (both hamartomatous), (iii) unilateral linear ESFA (naevoid), (iv) solitary ESFA (neoplastic) and (v) reactive ESFA, which seems to start off as pathologically hyperplastic and then become hamartomatous. We report a patient with reactive ESFA secondary to lepromatous leprosy, showing spontaneous involution in an area of her lesions. Reactive ESFA represents a hyperplastic and hamartomatous process, and may be more appropriately known as reactive eccrine syringofibroadenomatosis. The risk of malignancy is low in reactive ESFA, and monitoring instead of excision is a reasonable option.

We analysed telomerase activity in normal, benign and malignant breast tissues and in fine needle aspirates by a PCR-based assay. The tissue samples we used in this assay consisted of 20 cryostat sections, zyxwvutsr I0 pm thick, from each breast 'To whom correspondence and reprint requests should be sent, at

Fibroadenomas commonly found by palpation and routine mammography account for approximately 20% of open surgical breast biopsies. Alternatives to open surgery include tumor removal using an automated coring device and tumor ablation using heating or cooling elements. We report our initial experience with cryoablation of biopsy-proven benign fibroadenomas. A table-top cryoablation system employing a 2.4-mm cryoprobe was used to treat biopsy-proven benign fibroadenomas up to 4 cm in maximum diameter in a prospective nonrandomized fashion. The cryoprobe was placed under ultrasound guidance. Using a treatment algorithm based on fibroadenoma size, all tumors were subjected to two freeze cycles with an interposing thaw. Skin appearance and temperature, probe temperature, iceball size, and patient comfort were closely monitored during the procedure. Follow-up examinations including ultrasonography and photographs were scheduled for up to 12 months postablation. Fifty patients with 57 core biopsy-proven benign fibroadenomas were treated. Seven early cases were treated in an ambulatory surgery center setting. The remaining procedures were completely office-based using only local anesthetic. Tumor diameter varied from 7 mm to 42 mm (mean 21 mm). The iceball engulfed the target lesion in each case. Transient postoperative side effects were local swelling and ecchymosis. Postoperative discomfort rarely required medication beyond acetaminophen or ibuprofen. Lesions showed progressive shrinkage and disappearance over 3 to 12 months. No skin injury was noted and appearance remained excellent. Patient satisfaction was excellent. With office-based use of ultrasound-guided cryoablation for fibroadenomas there was little or no pain, target lesions were reduced in size or eliminated, scarring was minimal, cosmesis outstanding, and patient satisfaction was excellent. Cryoablation offers a useful office-based alternative to surgical excision of benign fibroadenomas.

Acoustic radiation force impulse (ARFI) imaging involves the mechanical excitation of tissue using localized, impulsive radiation force. This results in shear-wave propagation away from the region of excitation. Using a single diagnostic transducer on a modified commercial ultrasound (US) scanner with conventional beam-forming architecture, repeated excitations with multiple look directions facilitate imaging shear-wave propagation. Direct inversion methods are then applied to estimate the associated Young's modulus. Shear-wave images are generated in tissue-mimicking phantoms, ex vivo human breast tissue and in vivo in the human abdomen. Mean Young's modulus values of between 3.8 and 5.6 kPa, 11.7 kPa and 14.0 kPa were estimated for fat, fibroadenoma and skin, respectively. Reasonable agreement is demonstrated between structures in matched B-mode and reconstructed modulus images. Although the relatively small magnitude of the displacement data presents some challenges, the reconstructions suggest the clinical feasibility of radiation force induced shear-wave imaging. (

Phyllodes tumor is an extremely rare tumor of the breast. It occurs in females in the third and fourth decades. The difficulty in distinguishing between phyllodes tumors and benign fibroadenoma may lead to misdiagnosis. Lymph node involvement is rarely described in phyllodes tumors; for this reason, sentinel node biopsy may be warranted. We present a case of a 33-year-old woman affected by huge tumor of the right breast with ulceration in the skin with a rapid tumor growth and with omolateral axillary metastasis.

Cytogenetic analysis of 25 breast fibroadenomas (FA) showed clonal chromosome alterations in three cases. Insertion (12;?) (q15;?) and deletion (2) (q14q31 or q32) were detected as a sole change in cases I and 3, respectively. Case 2 displayed the karyotype 45, XX,t(1;16)(q25;q23;,add (7)(p14), rea(15), -1Z The present findings are discussed together with the reports on FA in the literature.

Introduction: Fibroadenomas are the most common benign breast tumors in young women. Infarction is rarely observed in fibroadenomas and when present, it is usually associated with pregnancy or lactation. Infarction can exceptionally occur as a complication of previous fine-needle aspiration biopsy or during lactation and pregnancy. Materials and methods: Retrospective review of 650 cases of fibroadenomas diagnosed at our institution during the 8-years period identified two cases of fibroadenomas with infarction (rate~0.3%). Results: Two partially infarcted fibroadenomas were diagnosed on core biopsy and frozen section in an adolescent girl (13 years old) and in a young woman (25 years old), respectively. No preceding fine-needle aspiration biopsy was performed in these cases, nor were the patients pregnant or lactating at the time of the diagnosis. Conclusion: Spontaneous infarction within fibroadenoma is a rare phenomenon in younger patients. The presence of necrosis on core biopsy or frozen section should be cautiously interpreted and is not a sign of malignancy. Virtual Slides: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/ vs/1556060549847356

Fibroadenoma accounts for 50−60% of all breast mass lesions in adolescents. It usually presents as a unilateral palpable breast mass. In contrast, bloody nipple discharge rarely occurs in childhood. We report the case of a 12-year-old pubertal girl who presented with a solitary breast mass and bloody nipple discharge. Physical examination and ultrasound showed a right breast subareolar homogenous mass, about 2.5 cm in diameter, near the lactiferous duct. Histologic diagnosis of the mass revealed a juvenile fibroadenoma with infarction and hemorrhage. The unusual clinical presentation and possible etiology in this patient is described, and the proper management of bloody nipple discharge in pediatric patients is discussed in association with a literature review.

A prospective clinical parametric study comprising women afflicted by breast cancer and otherwise healthy participants was undertaken. The mean plasmatic concentration of putative leucine amino peptidase and nucleoside diphosphate phosphotransferase enzymatic complex in breast cancer cases was significantly elevated [43.9 ± 2.8 µg ml −1 (n = 9)] when compared to those found in otherwise healthy women [8.07 ± 0.14 µg ml −1 (n = 8)]. Women without images compatible with any tumours (n = 13) had a mean concentration of 10.77 ± 1.49 µg ml −1 . The mean value obtained in women with fibroadenomas was 10.15 ± 0.81 µg ml −1 (n = 6) and with cystic fibrosis mastopathy 8.75 ± 0.28 µg ml −1 (n = 7). The efficacy of a tandem quantitative biodiagnostic system as a parametric screening tool for the early detection of breast cancer is underlined, raising the possibility of increasing the cost effectiveness of current imaging non-parametric technologies.

Elastography is a technique to assess the viscoelastic properties of tissue by measuring an acoustic wave propagating though the object. Here, the technique is applied in the course of standard MR mammography to 15 patients with different pathologies (six breast cancer cases, six fibroadenoma cases and three mastopathy cases). Low-frequency mechanical waves are coupled longitudinally into the tissue in order to obtain sufficient wave amplitude throughout the entire breast. This leads to the presence of a substantial fraction of compressional waves, which contribute to the total displacement field. It is shown theoretically that the correct evaluation of these contributions from the compressional wave is rather difficult due to the almost incompressible nature of tissue. To overcome this problem, it is proposed to apply the curl-operator to the measured displacement field in order to completely remove contributions from the compressional wave. Results from simulations and a breast phantom demonstrate the feasibility of the technique. The in vivo results show a good separation between breast cancer and benign fibroadenoma utilizing the shear modulus. Breast cancer appears on average 2.2 ( P b.001) times stiffer. All breast cancer cases showed a good delineation to the surrounding breast tissue with an average elevation of a factor of 3.3 ( P b 1.4Â10 À6 ). The results as obtained for the shear viscosity do not indicate to be useful for separating benign from malignant lesions. D

Fibroadenoma (FA) and phyllodes tumor (PT) of the breast are biphasic tumors composed of variable proportions of epithelial and stromal cells. We identified a case of synchronous FA and PT in the same breast mass. Using laser capture microdissection, loss of heterozygosity analysis was performed on these components to gain potential insight into the histogenetic relationship between FA and PT. Genomic DNA was analyzed at 10 microsatellite loci by polymerase chain reaction. Both tumors showed allelic loss at D7S522. In addition, phylloid tumor showed allelic loss at TP53 and D22S264, not observed in FA. Our data suggest that FA and PT are clonally related and allelic loss at TP53 and D22S264 may be implicated in the progression of FA to phyllode tumor.

The frequency-dependent ultrasound backscatter from tissues contains information about the microstructure that can be quantified. In many cases, the anatomic microstructure details responsible for ultrasonic scattering remain unidentified. However, their identification would lead to potentially improved methodologies for characterizing tissue and diagnosing disease from ultrasonic backscatter measurements. Recently, three-dimensional ͑3D͒ acoustic models of tissue microstructure, termed 3D impedance maps ͑3DZMs͒, were introduced to help to identify scattering sources ͓J. Mamou, M. L. Oelze, W. D. O'Brien, Jr., and J. F. Zachary, "Identifying ultrasonic scattering sites from 3D impedance maps," J. Acoust. Soc. Am. 117, 413-423 ͑2005͔͒. In the current study, new 3DZM methodologies are used to model and identify scattering structures. New processing procedures ͑e.g., registration, interpolations͒ are presented that allow more accurate 3DZMs to be constructed from histology. New strategies are proposed to construct scattering models ͓i.e., form factor ͑FF͔͒ from 3DZMs. These new methods are tested on simulated 3DZMs, and then used to evaluate 3DZMs from three different rodent tumor models. Simulation results demonstrate the ability of the extended strategies to accurately predict FFs and estimate scatterer properties. Using the 3DZM methods, distinct FFs and scatterer properties were obtained for each tumor examined.

Fibroepithelial lesions (FELs) are the most frequent breast tumors in adolescent females. The pubertal hormonal surge could impact the growth and microscopic appearance of FELs in this age group. In this study, we evaluate the morphology and clinical behavior of FELs in adolescents. We searched the 1992-2012 pathology data base for FELs in females 18 years old or younger (F ≤18 years). Seven FELs from 1975 to 1983 were also included. Three pathologists reviewed all available material. Patient (pt) characteristics and follow-up information were obtained from electronic medical records. Forty-eight F ≤18 years had 54 FELs with available slides. Thirty (67%) pts were Caucasian, 12 (27%) African-American, two (4%) Hispanic, one (2%) Asian; three were of unknown race/ethnicity. Median age at diagnosis was 16 years. Median age at menarche was 12 years; most (96%) FELs occurred after menarche (median interval 48 months). All patients underwent lumpectomy; one required subsequent mastectomy. The FELs were 34 fibroadenomas (FAs) (11 usual, 23 juvenile), and 20 phyllodes tumors (PTs) (16 benign, one borderline and three malignant). Eight (35%) juvenile FAs showed slight intratumoral heterogeneity. The mean mitotic rate was 1.3 mitoses/10 high-power fields (HPFs) (range, 0-6) in usual FAs, 1.8/10 HPFs in juvenile FAs, 3.1/10 HPFs in benign PTs, 10/10 HPFs in the borderline PT and 17/10 HPFs in malignant PTs. The mean follow-up for 29 pts with 33 FELs was 44 months. Two (10%) PTs recurred locally (a benign PT at 18 months, and a borderline PT at 11 months). Both recurrent PTs had microscopic margins <1 mm. Mitotic activity in FAs from adolescents can be substantial and this finding should be interpreted cautiously. Awareness of the morphologic features of FELs in adolescents is important to avoid overdiagnosis of PTs, which can lead to additional unnecessary and potentially disfiguring surgery. n

Techniques of Doppler ultrasonography (US) have been available to clinicians for nearly 40 years. The Doppler effect as developed by sound propagation in human tissues and with the velocities observed for the human vasculature produces shifts in the frequencies of returning echo signals. These signals can be processed in a manner that allows the observer to determine the condition of the blood flow. The instrumentation for Doppler US has evolved to accommodate the expanding clinical use of US. Each development (eg, pulsed-wave Doppler US, color flow imaging) has been motivated by a desire to provide more clinical information about flow in the body. The algorithms used are complex, but increasingly powerful microelectronics have made these methods a reality at a reasonable cost. Users of Doppler US techniques must be aware of the complicated aspects of flow in the body, especially with regard to detection of disease in the human vasculature. The continuing development of US equipment aims to provide a greater understanding of hemodynamics and the relationship between blood flow and various disease processes. ). 2 ‫.ء9‬ Vascular system, location unspecified © RSNA, 2003 RadioGraphics RG f Volume 23 • Number 5 Boote 1317 . A quadrature detector is used to determine the direction (forward or reverse) of the Doppler shift frequencies. The Doppler signal is split into two channels, then mixed with a reference frequency (f ref ). On one side, this reference signal is shifted by 90°(one quarter of a period). The resulting signals are filtered with a low-pass filter. The relative phases of the two sides are compared to produce forward (f Dfor ) and reverse (f Drev ) flow channels. These two channels may be output to left and right speakers to allow the operator to hear the Doppler shift frequencies in stereo.

This study was conducted to characterize the spatial distribution of blood vessels in breast fibroadenomas. Methods. We performed a prospective study to map the anatomic distribution of the vessels in 29 fibroadenomas of the breast using color Doppler sonography. We categorized the detected vessels according to their location in or on the fibroadenoma, counted the different types of vessels, and tested for correlations between vessel distributions or numbers and histopathologic findings. Results. Blood flow was demonstrated in 24/29 (83%) of fibroadenomas. We found 3 vessel types: feeding vessels, which are prominent vessels leading from the surrounding breast tissue into the fibroadenoma; capsular vessels, which are located within the tissue capsule; and segmental vessels, which are located within the fibrous septa of the fibroadenoma. Capsular and segmental vessels were demonstrated in 23/24 (96%) and 24/24 (100%) of the cases, respectively. Feeding vessels were seen in 12/24 (50%) of the cases. Histopathologic analysis revealed the same location and distribution of the vessels as color Doppler imaging. However, there was no correlation between numbers of vessels counted on sonograms and on histopathologic specimens. Conclusions. Examination of the vascularity demonstrated on color Doppler imaging helps in the diagnosis of benign breast neoplasms such as fibroadenomas.

Aims Neurofibromin 1 (NF1) as a tumour suppressor gene can give rise to several transcripts by an alternative splicing event, generated at least for CELF cofactors. At present, the NF1 isoforms and CELF splicing transcripts in sporadic breast cancer are unknown. The aim of the authors was to detect NF1 gene expression, the NF1 isoform ratio and the CELF transcripts present in sporadic breast cancer. Methods Neurofibromin and RAS expression were analysed on tissue microarrays containing sporadic breast cancer (n¼22), benign lesions (n¼18, including six fibroadenomas, six fibrocystic changes and six ductal hyperplasias) and normal breast tissue (n¼6) by immunohistochemistry assay. NF1 and CELF 3e6 RNA expression was performed by end point reverse transcription-PCR in the breast samples. Results NF1 and RAS expression in breast tissues showed no differential expression by immunohistochemistry results. Interestingly, the authors observed a shift transition in the isoform transcripts, from type II in normal breast tissue to type I isoform in breast carcinomas. CELF cofactor expression failed to be related with the shift transition of NF1 in breast tissues. Conclusions These data suggest that there is a tendency for an NF1 expression shift transition from type II to type I isoform, which could comprise a significant event in the development and progression of sporadic breast cancer. This shift transition may not be related with CELF cofactors.

BACKGROUND: The oncologic efficacy of breast-conserving therapies has been established in recent decades. Oncoplastic breast surgery (OBS), as a leap forward in breast conservation, offers concomitant techniques of oncologic and plastic surgeries that grant better esthetic results. The outcomes of our oncoplastic surgeries from 2007 to 2012 are reported.

Breast masses are uncommon in children and adolescent. Giant fibroadenoma account for 0.5%-2% of all fibroadenoma& (and the) exact etiology is not known. Fibroadenomas tend to grow slowly and often reach a maximum diameter of 2-3 cm in size. Among breast masses pathologic lesion such as giant fibroadenoma, phylloides tumor and virginal breast hypertrophy (juvenile macromastia) rapidly & massively increase in size over a short time. We present a case of giant fibroadenoma having florid adenomyoepithelial adenosis with focal microglandular adenosis.

The collection of IR spectra through microscope optics and the visualization of the IR data by IR imaging represent a visualization approach, which uses infrared spectral features as a native intrinsic contrast mechanism. To illustrate the potential of this spectroscopic methodology in breast cancer research, we have acquired IR-microspectroscopic data from benign and malignant lesions in breast tissue sections by point microscopy with spot sizes of 30-40 μm. Four classes of distinct breast tissue spectra were defined and stored in the data base: fibroadenoma (a total of 1175 spectra from 14 patients), ductal carcinoma in situ (a total of 1349 spectra from 8 patients), connective tissue (a total of 464 spectra), and adipose tissue (a total of 146 spectra). Artifical neural network analysis, a supervised pattern recognition method, was used to develop an automated classifier to separate the four classes. After training the artifical neural network classifier, infrared spectra of independent external validation data sets ("unknown spectra") were analyzed. In this way, all spectra (a total of 386) taken from micro areas inside the epithelium of fibroadenomas from 4 patients were correctly classified. Out of the 421 spectra taken from micro areas of the in situ component of invasive ductal carcinomas of 3 patients, 93% were correctly identified. Based on these results, the potential of the IR-microspectroscopic approach for diagnosing breast tissue lesions is discussed.

& Abstract: Giant fibroadenomas can produce breast deformity and should be excised. Several techniques have been discussed, including a sub-mammary incision, which often leave a disfiguring scar. We describe a new technique for removal of such large masses via a small cosmetic circumareolar incision. &

Mechanical imaging yields tissue elasticity map and provides quantitative characterization of a detected pathology. The changes in the surface stress patterns as a function of applied load provide information about the elastic composition and geometry of the underlying tissue structures. The objective of this study is the clinical evaluation of breast mechanical imager for breast lesion characterization and differentiation between benign and malignant lesions. The breast mechanical imager includes a probe with pressure sensor array, an electronic unit providing data acquisition from the pressure sensors and communication with a touch-screen laptop computer. We have developed an examination procedure and algorithms to provide assessment of breast lesion features such as hardness related parameters, mobility, and shape. A statistical Bayesian classifier was constructed to distinguish between benign and malignant lesions by utilizing all the listed features as the input. Clinical results for 179 cases, collected at four different clinical sites, have demonstrated that the breast mechanical imager provides a reliable image formation of breast tissue abnormalities and calculation of lesion features. Malignant breast lesions (histologically confirmed) demonstrated increased hardness and strain hardening as well as decreased mobility and longer boundary length in comparison with benign lesions. Statistical analysis of differentiation capability for 147 benign and 32 malignant lesions revealed an average sensitivity of 91.4% and specificity of 86.8% with a standard deviation of ±6.1%. The area under the receiver operating characteristic curve characterizing benign and malignant lesion discrimination is 86.1% with the confidence interval ranging from 80.3 to 90.9%, with a significance level of P = 0.0001 (area = 50%). The multisite clinical study demonstrated the capability of mechanical imaging for characterization and differentiation of benign and malignant breast lesions. We hypothesize that the breast mechanical imager has the potential to be used as a cost effective device for cancer diagnostics that could reduce the benign biopsy rate, serve as an adjunct to mammography and to be utilized as a screening device for breast cancer detection.

1 From the Departments of Radiology (P.J.L., T.H.), Surgery (M.W., K.C.A., D.B.), and Pathology (A.A., W.S.), and the Karmanos Cancer Center (L.F.G.), Wayne State University School of Medicine, Harper University Hospital, 3990 John R St, Detroit, MI 48201. Received June 19, 2003; revision requested August 27; final revision received August 11, 2004; accepted August 16. Supported in part by a grant from Sanarus Medical, who provided professional and technical fees and equipment free of charges. Address correspondence to P.J.L. (e-mail: [email protected]).

Breast mass Fibroepithelial lesion Phyllodes tumor Core needle biopsy Treatment a b s t r a c t Background: Phyllodes tumors represent less than 1% of all breast neoplasms and can mimic fibroadenoma on core needle biopsy (CNB). The treatment of fibroepithelial (FE) neoplasms identified on CNB is controversial. We sought to identify factors that were associated with phyllodes tumors after CNB suggested FE neoplasm.

Vulvar fibroadenomas are sporadic lesions informed in the literature and a controversy about origin has been discussed widely. We report a case of a 19 years old woman with a large slow growing mass in the right labia majora with the final diagnosis of fibroadenoma with mammary tissue surrounding it and positive hormone receptors. In this case, we support the origin in ectopic mammary tissue.

An estrogen dependency has been suggested for the growth of fibroadenomas: however, thus far, none of the steroid hormone receptors acting on breast tissues has been demonstrated in the stroma of breast fibroepithelial lesions. In this study, the expression of estrogen receptor (ER)-a and -b was investigated by immunohistochemistry in 33 fibroadenomas and in 30 benign, three borderline and seven malignant phyllodes tumors, all with spindle cell growth and in one distant metastasis. In addition, the presence of ER-b mRNA and its variants was evaluated by RT-PCR in microdissected stroma. The possible correlation between hormone receptor expression and differentiation processes of stromal cells was investigated by smooth muscle actin and calponin immunostaining. ER-b was the only hormone receptor expressed by stroma of fibroadenomas and phyllodes tumors, both at protein and mRNA level. The highest percentage of ER-b was observed in fibroadenomas with cellular stroma and in phyllodes tumors. In both lesions, ER-b-positive stromal cells showed expression of smooth muscle actin and/or calponin, as demonstrated by double immunostaining. In addition, the mean age at diagnosis was significantly lower in patients with ER-b-positive vs ER-b-negative fibroadenomas. In contrast, in phyllodes tumors, ER-b expression was higher in older patients. In conclusion, (i) only ER-b is detected in the stroma of fibroadenomas and phyllodes tumors; (ii) its expression correlates with the expression of smooth muscle markers and suggests a role of ER-b in myofibroblastic differentiation of stromal cells. These two results, together with the young age of patients carrying fibroadenomas with highly ER-b-positive stroma cells, may further indicate a hormone-receptor mechanism involved in regulating the growth of fibroadenomas. Conversely, the older age of patients with ER-b-rich phyllodes tumors suggests that mechanisms, probably independent from estrogen stimulation, act on the growth of these tumors.

Background: Debate about the potential effects that surgery might have on cancer cells dormancy and angiogenesis prompted us to investigate the impact of breast surgery on circulating angiogenesis modulating gene transcripts and proteins. Methods: Blood samples from 10 female patients diagnosed with breast cancer and 6 with fibroadenoma were collected before surgery and post-operatively on days 3 and 7 (breast cancer patients only). A set of 84 angiogenesis-associated transcripts were assessed using quantitative PCR arrays, and circulating protein levels (vascular endothelial growth factor A (VEGFA), IL8 and fibroblast growth factor 2 (FGF2) were measured using ELISA in the same samples. The results were investigated against clinicopathological data and patient outcome. Results: Plasma levels of VEGFA and IL8 after surgery were significantly elevated in the breast cancer group compared to the control group (P = 0.038 and P = 0.021, respectively). In the cohort of breast cancer patients, VEGFA increased on day 3 (P = 0.038) and declined on day 7 (P= 0.017), while IL8 did not change on day 3 but showed a significant decline on day 7 (P = 0.02). FGF2 levels did not change significantly over time. Regarding gene transcripts, we detected upregulation of a significant number of angiogenesis-specific genes in patients with breast cancer versus controls: sphingosine kinase 1(SPHK1), epidermal growth factor (EGF), vascular endothelial growth factor C (VEGFC), neuropilin 1 (NRP1), fibroblast growth factor (FGF1), laminin alpha 5 (LAMA5), collagen type IV alpha 3 (COL4A3), IL8, ephrin B2 (EFNB2), ephrin A3 (EFNA3), tyrosine endothelial kinase (TEK), integrin beta 3 (ITGB3), AKT1, thrombospondin 1 (THBS1), chemokine (C-C motif) ligand 11 (CCL11) and TIMP metallopeptidase inhibitor 3 (TIMP3). Surgery induced an altered expression in several keygenes in breast cancer patients. We identified an upregulation of COL4A3 and downregulation of chemokine (C-X-C motif) ligand 9 (CXCL9), EGF, FGF1, Kinase insert domain receptor (KDR), Placental growth factor (PGF), TIMP3 and VEGFC. Conclusion: Breast cancer patients have a different expression profile of circulating angiogenesis biomarkers compared to patients with fibroadenoma. Moreover, mastectomy promotes a transient increase of VEGFA and a shift in the expression patterns of a broad panel of angiogenesis-related circulating gene transcripts.

Dynamic contrast enhanced MRI contrast agent kinetics in malignant tumors are typically complex, requiring multicompartment tumor models for adequate description. For consistent comparisons among tumors or among successive studies of the same tumor, we propose to estimate the total contrast agentaccessible volume fraction of tumor, including blood plasma, v pe , and an average transfer rate constant across all tumor compartments, K trans.av , by fitting a three-compartment tumor model and then calculating the area under the tumor impulseresponse function (= v pe ) and the ratio area under the tumor impulse response function over mean residence time in tumor (= K trans.av ). If the duration of dynamic contrast enhanced MRI was too short to extrapolate the tumor impulse-response function to infinity with any confidence, then conditional parameters v * pe and K trans.av * should be calculated from the available incomplete impulse response function. Median decreases of 33% were found for both v * pe and K trans.av * in glioblastoma patients (n = 16) 24 hours after the administration of bevacizumab (P < 0.001). Median total contrast-enhancing tumor volume was reduced by 18% (P < 0.0001). The combined changes of tumor volume, v * pe , and K trans.av * suggest a reduction of true v pe , possibly accompanied by a reduction of true K trans.av . The proposed method provides estimates of a scale and a shape parameter to describe contrast agent kinetics of varying complexity in a uniform way. Magn Reson Med 64:408-417, 2010.

Benign skin diseases have seldom been treated with radiotherapy, unless resistant to other treatments. Eccrine syringofibroadenoma (ESFA) is a rare benign eccrine tumor. ESFA very rarely presents bilateral lesions, and seldom a nonsurgical treatment has been proposed. An exceptional case of bilateral ESFA of the foot is presented; radiotherapy was effective in treating both lesions with good cosmetic results.

Fibroadenomas are common benign breast conditions among women and account for~50% of breast biopsies performed. Dietary factors are known to influence benign breast conditions in the aggregate, but little is known of their association specifically with fibroadenoma. Our objective in this study was to evaluate the association between dietary and other factors and fibroadenoma risk. A case-control study, nested in a randomized trial of breast self-examination (BSE) in Chinese textile workers in Shanghai, China, was conducted between 1989 and 2000. The study sample included 327 affected women and 1070 controls. Women were administered a FFQ and a questionnaire that elicited reproductive and gynecological history and other information. Odds ratios, as estimates of relative risks, were calculated using multivariate conditional logistic regression. Significant decreasing trends in risk of fibroadenoma were observed with intake of fruits and vegetables and with number of live births, and a reduced risk was also associated with natural menopause, oral contraceptive use, and moderate exercise (walking and gardening). Increased risk of fibroadenoma was associated with heavy physical activity in one's 20s, breast cancer in a first-degree relative, and a history of prior benign breast lumps; and significant increasing trends in risk were observed with numbers of BSE per year and years of education. In conclusion, a diet rich in fruits and vegetables and the use of oral contraceptives may reduce risk of fibroadenoma.

BACKGROUND. Fine-needle aspiration biopsy (FNA) has been successful in diagnosing epithelial lesions of the breast. Its role in the evaluation of spindle cell and mesenchymal lesions of the breast, which include a variety of benign and malignant conditions, is less clear. This article discusses the cytologic features and differential diagnosis of these lesions, as well as the potential diagnostic pitfalls associated with them.

The aim of this study was to determine the effects of low doses of tamoxifen (5 and 10mg/day) for 50 days compared with the standard dose (20 mg/day) on breast biomarkers measured in normal breast tissue from premenopausal patients. A randomised double-blind study was performed using tissue from 56 premenopausal women with a diagnosis of fibroadenoma of the breast. Excisional biopsy was performed on the 50th day of therapy. Normal breast tissue samples were collected during surgery. The patients were divided in groups: A (placebo, n=11); group B (5 mg, n=16), group C (10 mg, n=14) and group D (20 mg, n=15). In this cross-sectional study, differences in the expression of Oestrogen Receptor alpha (ERalpha), Progesterone Receptor (PR), Ki-67, apoptotic bodies and mitotic index between the different groups after treatment can be seen on the normal breast tissue. We believe that a lower dose of tamoxifen could reduce the side-effects associated with treatment without affecting its chemopreventive activity in the breast.

The association of juvenile papillomatosis with carcinoma is proven, but very rare, as there exist several reported cases. A 15-year-old girl with no family history of breast cancer presented with two masses in the left breast. The excisional biopsy on both lumps revealed juvenile fibroadenoma and juvenile papillomatosis epithelial proliferation multiple cystic expanded channels. In some of these channels, cytological features of intraductal carcinoma were observed. We performed a full immunohistochemical examination of the juvenile papillomatosis. The patient refused any further surgical or adjuvant treatment. There are no signs of recurrence in the 15 year follow-up. This case is a diagnostic and therapeutic challenge, taking into account the patient&#39;s age and the controversial treatment recommendations. Good collaboration between surgeons and pathologists is essential for an accurate diagnostic process and aims to avoid under- or overtreatment.

BACKGROUND. Genes encoding enzymes involved in estrogen metabolism are held to be candidate genes for associations with breast disease. In these candidate genes, no critical combination of single-nucleotide polymorphisms (SNPs) for assessing breast carcinoma risk has been reported to date.

The management of nonpalpable, well-defined breast nodules by short-interval, 6-month follow-up mammography is widely accepted. We have, however, been managing these type of lesions with fine-needle aspiration biopsy (FNAB), guided by sonography or stereotaxic approach, in order to reduce the number of follow-up mammograms. We recommended surgical biopsy only in cases with malignant or suspicious cytology. Patients with benign cytology or inadequate sample were included in a 12-month-interval mammography surveillance program. In the series we present, two carcinomas were diagnosed among 145 lesions (1.38 %). Both had shown malignancy in FNAB. Another two cases, suspicious of malignancy in FNAB, finally resulted benign in histology. The remaining 141 nodules, monitored for at least 2 years, or surgically removed at the patient's request, have not shown signs of malignancy, regardless of a diagnosis of either benign or inadequate sample in FNAB. Sensitivity and negative predictive value of FNAB have therefore been 100 % in this series. No notable differences were observed between stereotaxic and sonographic guidance, except the percentage of inadequate samples (20.3 % by sonography; 25.9 % by stereotaxic sampling). We conclude that stereotaxic or sonographic FNAB is a very accurate diagnostic method in lesions of this type, allowing long-interval surveillance of the nodules with nonsuspicious cytological results.

Benign breast diseases have always been neglected in comparison to cancer, despite the fact that there are many more patients with such diseases than patients presenting to a breast clinic for cancer. Like normal breast tissues, benign breast diseases are under a complex system of controls by both systemic hormonal and local factors. In this review, we attempt to present an overview of the latest knowledge concerning the epidemiology, classification, clinical presentation, management, and physiopathology of these disorders.