IMPROVEMENT OF THE ALGORITHM FOR DIFFERENTIAL DIAGNOSIS OF INTRACYSTIC BREAST CANCER AND CYSTIC MASTOPATHY

Breast cancer is one of the most important problems of modern oncology. Intracystic cancer in the structure of malignant breast neoplasms belongs to one of the most rare forms and is a variant of intraductal papillary cancer. The issues of early diagnosis of this pathology remain controversial today. The aim of this work was to improve the algorithm of differential diagnosis of intracystic breast cancer and cystic mastopathy. Within the framework of this study, we examined 153 female patients of the prospective group with suspected breast cyst cancer and analyzed the results of examinations carried out for 59 patients of the retrospective group who were examined and treated for intracystic breast cancer in the period from 2010 to 2015 on the basis of Smolensk Regional Oncological Clinical Dispensary. The standard algorithm for examining the patients with suspected intracystic breast cancer in the framework of this study included multiparametric ultrasound (ultrasound in B-mode, ultrasonic Doppler examination, strain elastography, shear wave elastography) and fine needle aspiration puncture biopsy according to our improved technique with subsequent evaluation of the new algorithm's effectiveness. We drew conclusions on low sensitivity and specificity of the traditional algorithm for examining patients with suspected intracystic breast cancer, about a greater effectiveness of the improved algorithm for this diagnosis and advisability to use fine needle aspiration puncture biopsy using the ozone-oxygen mixture to improve the diagnosis of intracystic cancer at the preoperative stage.

Complex Fibroadenoma: a Cystic Neoplasia Report Case

Fibroadenoma is the most common breast tumor in young woman. It is considered a non-malignant tumor, showing hyaline component and a biphasic stroma and epithelial process, thus, it is similar to phyllode tumor revealing intralobular stroma. The cystic changes in a complex fibroadenoma may mimic a carcinoma, therefore it may represent some problems in images interpretation, and it may enlarge the risk of cancer development. This is a description of a case report with literature review. A 21-year-old female patientwith no history of breast cancer in family, presented a palpable lump in her right breast and clinical examination revealed a mobile, firm, circumscribed lesion in the right inner quadrant, measuring around 8 x 7 cm. An excision had been done under a stereotactic surgery and the structure revealed a nodular surface, measuring 8 x 6.5x 5.5cm. Cut section revealed heterogeneous aspect: cysts with colloid content and white-gray compact fibroblastic areas. Histopathological examination shows hypocellular stroma and few hypercellular areas, without atypia. Epithelial components presenting proliferation of intracanalicular and pericanalicular pattern ducts. Cystic proliferation with epithelial lining and apocrine characteristics without atypia. Because of the variation may be present inside the lesion it is difficult to establish the diagnosis without a biopsy, and a histopathological analysis. Moreover, it is necessary to know the microscope difference between fibroadenoma and the other sort of lesions; furthermore, that heterogeneity represent why that tumor is considered complex Keywords: Women's Health. Breast Neoplasms. Breast Cyst. ResumoFibroadenoma é o tumor de mama mais comum em mulheres jovens. É considerado um tumor não-maligno, apresentando um componente hialino e um estroma bifásico, e processo epitelial, por isso, é similar ao tumor filoide, revelando estroma intralobular. As alterações císticas no fibroadenoma complexo pode mimetizar um carcinoma, isso acarreta alguns problemas na interpretação das imagens, e pode aumentar o risco de desenvolvimento de câncer. Trata-se de um relato de caso de paciente de 21 anos de idade, sem histórico de câncer de mama na família, apresenta uma massa palpável em seio direito. Exame clinico revelou lesão móvel, firme, circunscrita no quadrante interno do seio. Excisão por cirurgia estereotáctica e a estrutura se mostra com superfície multinodular, medindo 8 x 6,5 x 5,5 cm. com aspecto heterogêneo, cistos com conteúdo coloide, e áreas fibrobásticas branco-acinzentada. Exame histológico demonstra-se estroma hipercelular, com áreas hipocelularizadas, sem atipia. Componentes epiteliais apresentando proliferação intercanalicular e intracanicular dos ductos. Proliferação cística com revestimento epitelial e características apócrinas sem atipia. Por conta da variação presente na lesão, pode ser difícil a estabelecimento de um diagnóstico se biópsia e análise histopatológica. Além disso, é fundamental o conhecimento das diferenças microscópicas entre o fibroadenoma e outros tipos de lesões; além disso, a heterogeneidade representa o motivo do tumor ser considerado complexo. Palavras-chave: Saúde da Mulher. Neoplasias da Mama. Cisto Mamário.

MODERN EVALUATION CRITERIA AND CLASSIFICATION BREAST CYST (literature review)

Breast cysts represent a difficult problem in mammology in terms of diagnosis and choice of treatment tactics. The introduction of a system for interpreting and logging the results of ultrasound examination of the mammary glands according to the BI-RADS scale into the daily practice of an ultrasound diagnostic doctor makes it possible to systematize the results obtained, to determine the tactics of optimal examination and management of patients with breast neoplasms, and ensures continuity in the conduct of medical and diagnostic measures.

KYSTE MALIN DU SEIN : UN DIAGNOSTIC A GARDER EN TETE MALIGNANT BREAST CYST: A DIAGNOSIS TO KEEP IN MIND

Most breast cysts are benign , but sometimes they can be malignant indicating a microbiopsia with histological study. They must be characterized by mammography and ultrasound in order to guide management.We report the case of a 47-year-old woman with a large left breast cyst whose histological study was in favour of breast carcinoma.

“A CLINICAL STUDY ON ABERRATIONS OF NORMAL DEVELOPMENT AND INVOLUTION OF BREAST AND ITS MANAGEMENT IN UPPER ASSAM”

ANDI of breast is a common phenomenon. They are more common than breast malignancy. In this study an attempt was made to study the spectrum of diseases that come under ANDI of breast, their clinical presentation, treatment and also to nd out the clinical and cytohistological correlation. Study group includes 152 cases of Upper Assam who attended the Surgery OPD of AMCH during the study period and also all the patients who were admitted in the department of surgery under the clinical diagnosis of ANDI of breast. Conrmation of diagnosis was made on the basis of history, clinical examination, pathological and radiological investigations. Pathological investigations include FNAC and HPE. Radiological investigations include Ultrasonography and mammography. The following observations were made in the present study: Ÿ The commonest disease encountered was broadenoma of breast (14.47%) followed by mastalgia (23.68%) brocystic disease (14.47%) breast cyst (9.87%). The less common are duct ectasia, scleroding adenosus and phyllodes tumour, 9.87% each. Ÿ Majority are present in the second, third and fourth decades of life. All broadenoma, brocystic disease and phyllodes tumour are present in the third decade. Youngest patient was of 11 years and oldest was of 47 years. mean age of presentation was 27.45 years and the standard deviation was 7.13. Ÿ 86.84% had regular menstrual history and 13.16% had irregular menstrual history. Majority were nulliparous (46.05%). The highest parity was 4. Ÿ 94.08% did not give history of OCP use and 98.68% did not give history of lactation. Ÿ The commonest presentation was pain in the breast (76.32%) followed by lump (71.05%). Ÿ Majority cases presented to the hospital within 3-6 months of their onset of symptoms. The minimum duration of symptom was 1 month and the maximum was 12 months. Ÿ Right breast was involved more commonly 961.84%) than the left (38.16%). Ÿ Upper outer quadrant was involved most commonly involved (34.21%) and the least commonly involved was the central quadrant (1.32%). Ÿ The majority of the breast lumps (85.05%) had size less than 5cm in their greatest dimension. 14.95% had size more than 5cm. Ÿ 63.82% of the lumps had rm consistency whereas 6.58% had soft consistency. There was no positive family history in majority of the patients (89.47%). Ÿ The correlation between clinical diagnosis and histopathological diagnosis had the following ndings: For broadenoma the sensitivity of FNAC is 84.9% and HPE is 86.54% .Both have positive predictive value of 100%.For breast cyst the sensitivity of FNAC is 93.3%.For phyllodes tumour the sensitivity of FNAC is 85.7% and HPE is 75%.. Ÿ In the management, 41.45% cases underwent excision followed by aspioration of cyst in 7.89%, microdochectomy in 7.24%, wide local excision in 3.29% and simple mastectomy in 1.97%. Among conservative treatment 14.47%b were given evening primrose oil, 12.50% were given topical analgesic and breast support and danazol was given in 5.26%. The cases were followed up at three monthly interval for a period of one year and there was no recurrence during this period.

Benign cyst of the male breast. An exceedingly rare entity that may pose a diagnostic dilemma. Management and literature review

Cysts represent the most common cause of a breast mass in women. On the contrary, in men, the presence of a benign apocrine cyst is an exceedingly rare occurrence, with only a few cases reported in the literature. We describe herein a case of benign apocrine breast cyst without concurrent gynecomastia in a 41-year-old male. Diagnostic evaluation and management are discussed, along with a review of the literature. Given the extreme rarity of benign breast cysts in males, a thorough investigation is essential in male patients presenting with cystic breast lesions. Diagnostic breast imaging may be challenging. Surgical resection of the cyst should be considered in the presence of atypical imaging features to exclude underlying malignancy.

Visualization of the shear wave on gray-scale ultrasound: experience with a complex breast cyst

Shear wave elastography (SWE) is the newer of the two methods of measuring tissue stiffness using ultrasound. We present the case of a 39-year-old patient with fibrocystic breast disease who presented with a left painful breast lump. The patient underwent a breast ultrasound that depicted a complicated cyst with a “pseudo-solid” content. When the SWE mode was turned on, the ultrasound share wave was observed on the gray-scale image, as surface undulations of the “pseudo-solid” component. To the best of our knowledge, this is the first report of the share wave visualization on a gray-scale image. The impact on patient management is discussed.

Characteristics and Management of Male Breast Parenchymal Cysts

Objective Parenchymal breast cysts are considered to be rare in men and are sparsely described in the literature. The purpose of this study was to review our institution’s experience with male breast cysts in an effort to improve overall understanding and management of this rare entity. Methods An institutional review board–exempt retrospective study was performed. Radiology reports for males who underwent mammogram and/or breast ultrasound at any of our institution’s primary or satellite locations from January 1995 to January 2020 were screened to find males with breast cysts. If cysts were reported and images were available, case review was performed to confirm parenchymal breast cyst(s) and patient characteristics were collated. Results Of 5425 male cases presenting for breast imaging, 19 (0.4%) cases of male breast cysts were confirmed, with a mean patient age of 41.6 years (range: 2–81 years). The most common indication leading to cyst discovery was a palpable lump, corresponding to the site of the cyst in 5 (26.3%) patients and near the site where cyst(s) were ultimately discovered in 7 (36.8%) patients. There were 8 (42.1%) instances of cysts without concurrent gynecomastia. Three (15.8%) men underwent needle sampling. There were no cases of atypia or malignancy on needle biopsy or on subsequent clinical follow-up, with median clinical follow-up of 70.3 months (range: 3.3–259.4 months). Conclusion Male breast parenchymal cysts are rare, but their prevalence is likely underestimated. If detected incidentally or upon targeted evaluation, biopsy may be averted if classic benign cyst features are identified.

SAT-006 A New Concept for the Endocrinology of Pre-Eclampsia: The Role of Spiral Steroids

Background: In 1987, Graves observed that during the 3rd trimester, some patients with pre-eclampsia had high levels of unknown materials that could be detected with assays for digoxin (DLM). In 2018, we characterized a new candidate for the DLM, Ionotropin. It is a phosphocholine (PC) ester of a novel steroid with 23 carbon atoms. As Ionotropin shares structural features (a) with spironolactone (both have spiral lactones in the E-ring) and (b) with digoxin (E-ring lactone and 3α-5β configuration), we have proposed that Ionotropin may function as a potassium (K+) sparing diuretic. This suggestion is supported by the observations that [1] patients who cannot make Ionotropin (7-dehydrosterol reductase deficiency) are K+ wasting and [2] breast cyst fluids with high K+ levels also have high Ionotropin levels. Hypothesis: During the 3rd trimester, fetal requirements for K+ reach a maximum, fetal blood pressure increases and aldosterone signaling is blocked. This blockage leads to fetal sodium (Na+) wasting and is essential for formation of amniotic fluid. These events are consistent with a normal role for an unknown endogenous K+ sparing hormone and would be the basis for a modest elevation of maternal DLM during the 3rd trimester. Our hypothesis is that if any of the functions were inadequate, then the fetal-placental unit would synthesize excess PC-spiral steroids; the woman would exhibit symptoms of K+ sparing hormone excess (hypertension and proteinuria) and would be diagnosed with pre-eclampsia. Experimental Results: We have just reported a pilot study associating elevated PC esters of spiral steroids in women with pre-eclampsia. In brief, 12 of 19 women had elevated levels of at least one of the PC steroids (Z-score > 2) when compared to the levels in 20 pregnant women matched for gestational age and fetal sex. There are two basic mechanisms for this dichotomy: (a) there may be episodic secretion with of a DLM with a short half-life or (b) there may be two different underlying biochemical causes. In prior studies, there has been no indication of episodic secretion of DLM similar to that observed with glucocorticoids, Ionotropin or other PC spiral steroids. Discussion: There are two basic types of K+ sparing diuretics. Type A: Spironolactone functions by regulating the NaK-ATPase. Type B: Triamterene functions by blocking synthesis of epithelial Na+ channels. Thus, Type A would have high levels of spiral steroids and Type B would have low levels of spiral steroids. Type A patients would be expected to have higher risk of long-term consequences when compared to the Type B patients. Conclusion: The recognition of the division of pre-eclampsia into two separate diseases might be the key observation for developing Type-specific diagnosis and therapy. For example, a Type A patient might benefit from a low salt diet but that diet would not be expected to benefit a patient with Type B disease.