scholarly journals Papillary Secretion. Diagnostic Assessment and Treatment

2002 ◽  
Vol 91 (3) ◽  
pp. 246-250
Author(s):  
C. Ingvar
Keyword(s):  
Breast Imaging ◽  
Fine Needle Biopsy ◽  
Radical Excision ◽  
Common Symptom ◽  
Breast Clinic ◽  
Abnormal Finding ◽  
Mammary Duct ◽  
Assessment And Treatment ◽  
Underlying Causes

Papillary secretion is a common symptom in the breast clinic with many different underlying causes like intraductal papilloma, mammary duct ectasia, infected cysts and abscesses, breast cancer/carcinoma in situ (CIS) and rarely pituitary adenoma. The association with cancer/CIS is one of the two main concerns of the patient and must always be ruled out. The second item is that spontaneous and ongoing discharge causes embarrassment due to staining the clothes. Physical examination of the breast, imaging with mammography and ultrasonography should always be done and fine needle biopsy/core biopsy used with wide indications whenever there is any abnormal finding. With the use of modern ultrasonography in the combination with guided biopsy the use for ductography has diminished and might be saved for single duct investigations, especially if papilloma or single duct involvement is suspected. Surgery (when undertaken) due to benign discharge, should aim for radical excision of the underlying cause of the discharge sometimes only a dilated single duct with or without a papilloma or excision of the central ducts as in case of mammary duct ectasia. Discharge should be consistent, spontaneous and disturbing otherwise surgery should not be recommended in the absence of a suspicion of malignancy (negative triple test).

Patterns of malignant non-mass enhancement on 3-T breast MRI help predict invasiveness: using the BI-RADS lexicon fifth edition

2018 ◽  
Vol 59 (11) ◽  
pp. 1292-1299 ◽  
Author(s):  
Seung Min Lee ◽  
Kyung Jin Nam ◽  
Ki Seok Choo ◽  
Jin You Kim ◽  
Dong Wook Jeong ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Imaging ◽  
Ductal Carcinoma ◽  
Breast Mri ◽  
Ki 67 ◽  
Factors Associated ◽  
Assessment And Treatment ◽  
Magnetic Resonance Imaging Mri ◽  
Mass Enhancement

Background Non-mass enhancements (NME) with invasive components account for 10–42% of total malignant NMEs. The factors associated with invasiveness on magnetic resonance imaging (MRI) could be useful for clinical assessment and treatment. Purpose To evaluate the clinical significances of the distributions and internal enhancement patterns (IEP) of malignant NMEs on 3-T breast MRI. Material and Methods A total of 448 consecutive women with newly diagnosed breast cancer that had undergone preoperative MRI and surgery between February 2013 and March 2016 were identified. After exclusions, 72 malignant NMEs without a mass in 72 women (mean age = 51.5 years) were included. Two readers independently assessed distributions and IEPs of NME, according to the Breast Imaging Reporting and Data System lexicon fifth edition. Collected data included the presence of invasion and histopathologic factors. Results A clustered ring IEP was significantly associated with invasive cancer (75.0%, P = 0.001, Reader1; 72.9%, P < 0.001, Reader 2), absence of necrosis (79.0%, P < 0.001; 72.1%, P < 0.001, respectively), and high Ki-67 expression (74.2%, P = 0.048; 74.2%, P = 0.003, respectively). A clumped IEP was related to ductal carcinoma in situ (33.3%, P = 0.025; 50.0%, P = 0.001, respectively), absence of lymph node metastasis (24.1%, P = 0.029; 31.5%, P = 0.030, respectively), and presence of necrosis (34.5%, P = 0.003; 44.8%, P = 0.001, respectively). Conclusion The presence of a clustered ring IEP in patients with breast cancer was found to be significantly associated with invasive breast cancer and high Ki-67 expression.

scholarly journals Encapsulated Papillary Carcinoma of the Breast: Imaging Features with Histopathologic Correlation

2020 ◽  
Vol 2 (6) ◽  
pp. 590-597
Author(s):  
Sarah E Bonnet ◽  
Gloria J Carter ◽  
Wendie A Berg
Keyword(s):  
Papillary Carcinoma ◽  
Core Needle Biopsy ◽  
Needle Biopsy ◽  
Breast Imaging ◽  
Ductal Carcinoma ◽  
Imaging Features ◽  
Term Survival ◽  
Core Needle ◽  
Cystic Component

Abstract Encapsulated papillary carcinoma (EPC) is a rare, clinically indolent breast malignancy most common in postmenopausal women. Absence of myoepithelial cells at the periphery is a characteristic feature. Mammographically, EPC typically presents as a mostly circumscribed, noncalcified, dense mass that can have focally indistinct margins when there is associated frank invasive carcinoma. Ultrasound shows a circumscribed solid or complex cystic and solid mass, and occasional hemorrhage in the cystic component may produce a fluid-debris level; the solid components typically show intense washout enhancement on MRI. Color Doppler may demonstrate a prominent vascular pedicle and blood flow within solid papillary fronds. Encapsulated papillary carcinoma can exist in pure form; however, EPC is often associated with conventional ductal carcinoma in-situ and/or invasive ductal carcinoma, no special type. Adjacent in-situ and invasive disease may be only focally present at the periphery of EPC and potentially unsampled at core-needle biopsy. In order to facilitate diagnosis, the mass wall should be included on core-needle biopsy, which will show absence of myoepithelial markers. Staging and prognosis are determined by any associated frankly invasive component, with usually excellent long-term survival and rare distant metastases.

scholarly journals Detected Changes in Precipitation Extremes at Their Native Scales Derived from In Situ Measurements

2019 ◽  
Vol 32 (23) ◽  
pp. 8087-8109 ◽  
Author(s):  
Mark D. Risser ◽  
Christopher J. Paciorek ◽  
Travis A. O’Brien ◽  
Michael F. Wehner ◽  
William D. Collins
Keyword(s):  
Extreme Precipitation ◽  
Seasonal Changes ◽  
Signal To Noise Ratio ◽  
Statistical Technique ◽  
In Situ Measurements ◽  
Absolute Sense ◽  
Underlying Causes ◽  
Changes Over Time ◽  
Future Work

Abstract The gridding of daily accumulated precipitation—especially extremes—from ground-based station observations is problematic due to the fractal nature of precipitation, and therefore estimates of long period return values and their changes based on such gridded daily datasets are generally underestimated. In this paper, we characterize high-resolution changes in observed extreme precipitation from 1950 to 2017 for the contiguous United States (CONUS) based on in situ measurements only. Our analysis utilizes spatial statistical methods that allow us to derive gridded estimates that do not smooth extreme daily measurements and are consistent with statistics from the original station data while increasing the resulting signal-to-noise ratio. Furthermore, we use a robust statistical technique to identify significant pointwise changes in the climatology of extreme precipitation while carefully controlling the rate of false positives. We present and discuss seasonal changes in the statistics of extreme precipitation: the largest and most spatially coherent pointwise changes are in fall (SON), with approximately 33% of CONUS exhibiting significant changes (in an absolute sense). Other seasons display very few meaningful pointwise changes (in either a relative or absolute sense), illustrating the difficulty in detecting pointwise changes in extreme precipitation based on in situ measurements. While our main result involves seasonal changes, we also present and discuss annual changes in the statistics of extreme precipitation. In this paper we only seek to detect changes over time and leave attribution of the underlying causes of these changes for future work.

scholarly journals Breast imaging in patients with nipple discharge

2017 ◽  
Vol 50 (6) ◽  
pp. 383-388 ◽  
Author(s):  
Ivie Braga de Paula ◽  
Adriene Moraes Campos
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Breast Imaging ◽  
Ductal Carcinoma ◽  
Imaging Finding ◽  
Magnetic Resonance Imaging Finding ◽  
Nipple Discharge ◽  
Common Symptom ◽  
Resonance Imaging ◽  
Risk Of Malignancy

Abstract Nipple discharge is a common symptom in clinical practice, representing the third leading breast complaint, after pain and lumps. It is usually limited and has a benign etiology. The risk of malignancy is higher when the discharge is uniductal, unilateral, spontaneous, persistent, bloody, or serous, as well as when it is accompanied by a breast mass. The most common causes of pathologic nipple discharge are papilloma and ductal ectasia. However, there is a 5% risk of malignancy, mainly ductal carcinoma in situ. The clinical examination is an essential part of the patient evaluation, allowing benign nipple discharge to be distinguished from suspicious nipple discharge, which calls for imaging. Mammography and ultrasound should be used together as first-line imaging methods. However, mammography has low sensitivity in cases of nipple discharge, because, typically, the lesions are small, are retroareolar, and contain no calcifications. Because the reported sensitivity and specificity of ultrasound, it is important to use the correct technique to search for intraductal lesions in the retroareolar region. Recent studies recommend the use of magnetic resonance imaging in cases of suspicious nipple discharge in which the mammography and ultrasound findings are normal. The most common magnetic resonance imaging finding is non-mass enhancement. Surgery is no longer the only solution for patients with suspicious nipple discharge, because short-time follow-up can be safely proposed.

scholarly journals A Case of Renal Primitive Neuroectodermal Tumor Confirmed by Fluorescence in situ Hybridization

2015 ◽  
Vol 8 (1) ◽  
pp. 205-211 ◽  
Author(s):  
Toshiki Etani ◽  
Taku Naiki ◽  
Ryosuke Ando ◽  
Keitaro Iida ◽  
Aya Naiki-Ito ◽  
...  
Keyword(s):  
In Situ Hybridization ◽  
Fluorescence In Situ Hybridization ◽  
Primitive Neuroectodermal Tumor ◽  
Left Kidney ◽  
Final Diagnosis ◽  
Fine Needle Biopsy ◽  
Neuroectodermal Tumor ◽  
Transmission Electron ◽  
Resected Tumor

Primitive neuroectodermal tumor (PNET) is a member of the Ewing's sarcoma family of tumors (ESFT). We report a case of PNET in a 66-year-old male who presented with a large solid tumor within the parenchyma of the middle pole of the left kidney with metastases to the left adrenal gland and right ischium. A fine-needle biopsy was performed and showed a small round cell tumor. Results of immunohistochemical staining suggested this tumor belonged to ESFT. Preoperative VDC-IE (combined vincristine, doxorubicin and cyclophosphamide followed by another combination of ifosfamide and etoposide) chemotherapy and left radical nephrectomy and adrenalectomy were performed. The histopathological findings of the resected tumor were similar to those in the biopsy specimen, but the results of AE1/AE3 were different. For the diagnosis, fluorescence in situ hybridization was performed. Split signals of the EWSR1 gene were detected, and transmission electron microscopy showed neuroendocrine granules and microtubules. The final diagnosis of this tumor was PNET of the kidney.

Diagnosis of Papillary Breast Lesions on Core Needle Biopsy: Upgrade Rates and Interobserver Variability

2019 ◽  
Vol 27 (7) ◽  
pp. 736-743 ◽  
Author(s):  
Lianqun Qiu ◽  
Daniel D. Mais ◽  
Marlo Nicolas ◽  
Jennifer Nanyes ◽  
Kenneth Kist ◽  
...  
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Breast Imaging ◽  
Interobserver Variability ◽  
Ductal Carcinoma ◽  
Atypical Ductal Hyperplasia ◽  
Breast Lesions ◽  
Ductal Hyperplasia ◽  
Papillary Lesions

The histologic distinction between papillary breast lesions remains challenging, especially with core biopsy (CB) specimens. A retrospective review of the clinical, imaging, and histologic findings was performed for patients with papillary breast lesions on CB from 2013 to 2017. The interpretation accuracy was expressed as upgrade rate relative to the excision diagnosis. Diagnostic reproducibility with and without immunohistochemistry was analyzed as interobserver variability among 3 board-certified pathologists. Among 57 papillary lesions with biopsies and excisions available for review, the upgrade rates were 0% for benign papilloma, 30% for papilloma with atypical ductal hyperplasia, and 25% for papilloma with ductal carcinoma in situ, resulting in an overall upgrade rate of 11.1%. There were no statistical differences between patients in an upgrade group and others, when comparing the patient age, clinical presentation, BI-RADS (Breast Imaging Reporting and Database System) category, location, and histologic grade. The overall interobserver variability of the 60 consecutive core biopsies of papillary breast lesions by morphology alone was in the “substantial” agreement range (κ = 0.79, 86% agreement), with an excellent κ score of 0.88 for papilloma (92% agreement). “Substantial” and “fair” κ values were seen for papilloma with atypical ductal hyperplasia/ductal carcinoma in situ (0.74, 84% agreement) and invasive carcinoma (0.40, 60% agreement). Use of immunohistochemical stains improved the κ values into “excellent” range (0.92, 94% agreement). Our study favors a conservative approach in the management of benign papillomas, at least in cases of good radiologic-pathologic concordance. Papillary breast lesions with atypia/malignancy show lower diagnostic reproducibility on CB, and utility of immunohistochemistry is recommended in challenging cases.

Quantifying Mammary Duct Carcinoma In Situ

2000 ◽  
Vol 113 (suppl_1) ◽  
pp. S30-S37
Author(s):  
Anjali Saqi ◽  
Michael P. Osborne ◽  
Ruth Rosenblatt ◽  
Sandra J. Shin ◽  
Syed A. Hoda
Keyword(s):  
Carcinoma In Situ ◽  
Duct Carcinoma ◽  
Mammary Duct

scholarly journals The influence of clinicopathological features on the predictive accuracy of conventional breast imaging in determining the extent of screen-detected high-grade pure ductal carcinoma in situ

2011 ◽  
Vol 93 (5) ◽  
pp. 385-390 ◽  
Author(s):  
L Hayward ◽  
RS Oeppen ◽  
AV Grima ◽  
GT Royle ◽  
CM Rubin ◽  
...  
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Breast Imaging ◽  
Predictive Accuracy ◽  
Ductal Carcinoma ◽  
Preoperative Staging ◽  
Invasive Disease ◽  
High Grade ◽  
Excision Rate

INTRODUCTION The extent of calcified ductal carcinoma in situ (DCIS) detected by screening mammography is a determinant for treatment with breast conserving surgery (BCS). However, DCIS may be uncalcified and almost a quarter of patients with DCIS treated initially by BCS either require a second operation or are found to have unexpected invasive disease following surgery. Identification of these cases might guide selective implementation of additional diagnostic procedures. METHODS A retrospective review of patients with a preoperative diagnosis of pure high-grade DCIS at the Southampton and Salisbury Breast Screening Unit over a ten-year period was carried out. Mammograms were reviewed independently by a consultant radiologist and additional factors including the Breast Imaging Reporting and Data System (BI-RADS®) breast density score, DCIS extent and disease location within the breast recorded. RESULTS Unexpected invasive disease was found in 35 of 144 patients (24%). Within our unit the re-excision rate for all screen-detected DCIS is currently 23% but for patients included in this study with high-grade DCIS the re-excision rate was 39% (34/87). The extent of DCIS (p=0.008) and lack of expression of the oestrogen receptor (ER) predicted the requirement for re-excision in both univariate (p=0.004) and multivariate analysis (p=0.005). CONCLUSIONS High-grade DCIS may be focally uncalcified, leading to underestimation of disease extent, which might be related to ER status. Invasive foci associated with high-grade DCIS are often mammographically occult. Exploration of additional biomarkers and targeted use of further diagnostic techniques may improve the preoperative staging of DCIS.

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