Evaluation of Precancerous Breast Lesion Upgrade Rate

Background: Breast imaging guided core-needle biopsy enable the assessment of suspected precancerous lesions. In some precancerous lesion there is a risk of upgrading to cancer after surgical removal. This study was conducted to determine the upgrading rate of CNB-diagnosed precancerous breast lesions. Methods: A retrospective study was conducted to examine the data of patients who had undergone core needle biopsy from April 2016 to March 2019 at the Radiology Department of the Breast Clinic of Motamed Cancer Institute and whose pathological reports were indicative of a precancerous lesion such as atypical ductal hyperplasia, sclerosing adenosis, flat epithelial atypia or papillary lesion and had undergone surgery for this lesion. The upgrading rate and its related factors such as the size of the lesion, patient’s age, family history of breast cancer and method of core-needle biopsy were analyzed in SPSS software. Results: A total of 241 patients were recruited with a pathological report of pre-cancerous predisposing lesions. The mean age of the patients was 42.14 years and the highest upgrading rates in the analysis were observed for papillary lesion (19.3%) and atypical ductal hyperplasia, (21.4%), while the upgrading rates were (1.2% ) for sclerosing adenosis and (0%) for flat epithelial atypia. Data analysis showed that the lesions’ upgrading rate correlated with the lesion’s size (P=0.005).Conclusion: The findings of this study showed that size of the lesions increase the risk of upgrading to cancer, which is much higher in papillary lesion and atypical ductal hyperplasia compared to sclerosing adenosis and flat epithelial atypia. It seems that surgical excision of the entire lesion in patients with larger mass size may decrease the upgrading rate of cancer. Conducting specific studies on each distinct lesion can help yield more conclusive results.

Mixed Invasive Apocrine Papillary/Micropapillary Carcinoma of the Breast: Another Brick in the Triple-Negative Wall

Pure invasive papillary carcinoma (IPC) is a rare subtype of breast carcinoma with good prognosis compared with classical invasive breast carcinoma (IBC) of no special type. The majority of IPC are estrogen receptor and progesterone receptor (ER/PR) positive and HER2 negative (luminal A-like). We report the case of a 72-year-old women who was referred to the Senology Clinic for a routine workup following surgery for an intraductal papilloma. The core needle biopsy (CNB) showed a lesion mainly composed of irregular papillae and micropapillae with apocrine epithelial cells of low-to-intermediate nuclear grade, without a myoepithelial cell layer within the papillae and at the periphery, as demonstrated with multiple immunostains. The diagnosis of apocrine papillary lesion of uncertain malignant potential was made. The subsequent lumpectomy showed an IBC with the same cyto-architectural features as the CNB. In addition, lymphovascular invasion and papillary/micropapillary apocrine in situ lesion were noted. Notably, the tumor was ER/PR and HER2 negative and strongly positive for androgen receptor. A final diagnosis of mixed apocrine papillary/micropapillary carcinoma with triple-negative status was made. To the best of our knowledge, this is the first report of an IBC with these features. Breast pathologists should be aware of this entity when dealing with CNB samples characterized by a complex papillary lesion with apocrine atypia that lacks a myoepithelial cell layer on multiple immunostains. These lesions should be classified at least as of uncertain malignant potential based on the cyto-architectural features prompting a surgery for removal.

Papillary Lesion of the Breast in a Young Girl Suspicious to Juvenile Papillomatosis, Clinical Decision Making in a Multi-disciplinary Team and Review of the Literature

Background: Papillary lesions of the breast are a heterogeneous group of neoplasms, the diagnosis and treatment of which is challenging. Typically surgical excision is recommended for papillary lesions after core needle biopsy (CNB) to rule out concurrent malignancy when a diagnosis of papilloma with atypia is yielded on CNB. For papilloma without atypia, however, making a decision about excision versus observation is challenging.Case Presentation: A 14-year-old female with nipple discharge, and a 2 cm mass in the right breast, with the pathology of intra-ductal papilloma without atypia on CNB presented. The question to be answered by multi-disciplinary team was the best management of this papillary lesion and whether the follow up was adequate or excision was mandatory.Question: What is the best plan for management of the young patient according to the primary pathology report of Juvenile Papillomatosis?Conclusion: Histoathology review of CNB specimen in rare and high risk lesions may have some advantages. On the other hand, in high risk circumstances, the excision of the lesion is recommended. Thus, in this case, the multi-disciplinary team recommended excision of the lesion.

Bladder tumours in children: An interesting case report of TCC with a partial inverted growth pattern

Bladder urothelial carcinoma is typically a disease of older individuals and rarely occurs below the age of 40 years. There is debate and uncertainty in the literature regarding the clinicopathologic and prognostic characteristics of bladder urothelial neoplasms in younger patients compared with older patients, although no consistent age criteria have been used to define "younger" age group categories. We report on a 16 years old girl with transitional cell carcinoma of the bladder with a partial inverted growth pattern who presented with gross hematuria. Ultrasonography revealed a papillary lesion in the bladder; cystoscopic evaluation showed a 15 mm papillary lesion with a thick stalk located in the left bladder wall. Pathologic evaluation of the specimen was reported as “low grade transitional cell carcinoma of the bladder with a partial inverted growth pattern”.