Showing papers on "Breast lumps published in 2004"

The Million Women Study: potential biases do not allow uncritical acceptance of the data

Abstract: Background The findings in the Million Women Study (MWS) have been interpreted by some as providing final and definitive evidence that hormone therapy (HT) (estrogen alone or estrogen plus a progestin) increases the risk of breast cancer.Methods A critical review of the MWS evidence.Critique It is established that women who attend for routine mammography are not representative of the population at large: HT is more common among attenders, as is the occurrence of breast cancer. The MWS cohort comprised women who were invited to enroll when they were scheduled for mammography. Especially in that setting, HT users could more commonly have enrolled because of enhanced anxiety about breast cancer risk, women already aware of breast lumps could also selectively have enrolled – and women who both used HT, and who were aware of breast lumps, could have been the most motivated to participate. Thus, it was possible that the selective detection of as yet undiagnosed breast cancer among HT users could have accounted ...

Male breast cancer--an andrological disease: risk factors and diagnosis.

Abstract: Gynaecomastia, the enlargement of the male breast, is considered as an andrological disease. To date, a review on male breast cancer (MBC) has not been published in an andrological journal. The papers underlying this review were published from authors of different institutions: Clinical Genetics, Dermatology, Gynaecology, Internal Medicine, Oncology, Pathology, Psychiatry, Radiology and Surgery. MBC accounts for approximately 1% of breast cancer patients. A total of 182 men died of breast cancer in 1999, in Germany. In the US, 1500 new cases per year occur. MBC accounts for <5% of surgically removed breast lumps. Diseases with increased oestrogen action increase the risk of MBC. Mutations of distinct genes are estimated to account for up to roughly 10% of MBC. BRCA1 and BRCA2 gene mutations are responsible for approximately 80% of the families with hereditary breast cancer. The diagnosis of MBC is not possible without histological examination. Different diagnostic procedures such as clinical diagnosis, sonography, mammography, fine-needle biopsy and core needle facilitate the decision whether a biopsy is necessary.

The Negative Predicative Value of Breast Fine‐Needle Aspiration Biopsy: The Massachusetts General Hospital Experience

Abstract: Breast fine-needle aspiration biopsy (FNAB) has been increasingly accepted as an important triage tool for the evaluation of breast lumps. We examined the clinical utility and diagnostic accuracy of a negative breast FNAB result by studying 450 breast aspirates in 413 patients (average age 45 years) with a “negative” or benign cytologic interpretation performed at Massachusetts General Hospital over a 4-year period. Of these patients, 121 (29%) underwent subsequent biopsy and 17 (4%) were found to have malignancy (3% of total negative FNABs; 14% with histology). None of these 17 patients had a triple negative test. A cohort of 115 patients had documentation of negative physical, radiologic, and cytologic examinations (the triple negative), none of whom were found to have malignancy on histologic or at least 2-year clinical follow-up (negative predictive value [NPV] = 100% with a triple-negative test). Outside of the triple-negative test, the NPV of a negative breast FNAB is reduced with a false-negative rate of 7%. However, in the setting of a triple-negative test, the NPV in our patient population was 100%, reassuring the patient and clinician that clinical follow-up and not surgical intervention was sufficient for proper patient care.

Computerized training in breast self-examination: a test in a community health center.

Abstract: Fifty-eight women recruited from a community health center completed either a brief interactive multimedia training program on breast self-examination using a breast model and computer guided feedback on accuracy of lump detection or read a National Cancer Institute pamphlet on breast self-examination and breast lumps. Women using the computer program as compared to the pamphlet group reported a higher sense of self-efficacy for being able to perform a breast self-examination immediately after their educational session and 1 month later. However, the increase in self-efficacy for the computer group diminished over 4 weeks, underscoring the importance of an environment that reminds and reinforces learning for women about the performance of regular breast self-examination. The increase in sense of self-efficacy to perform breast self-examination with roughly 20 minutes of computer-based training and the partial maintenance of that self-efficacy 30 days later suggests the utility of incorporating short, focused interventions in busy primary healthcare settings.

Comparison of FNAC and open biopsy in palpable breast lumps.

Abstract: OBJECTIVE To compare the results of FNAC and open biopsy in patients presented with palpable breast lump. DESIGN Comparative study. PLACE AND DURATION OF STUDY Nishtar Hospital, Multan, during the period of October 2001 to October 2003. PATIENTS AND METHODS All female patients, irrespective of their age, who presented with breast lump were included in the study. The patients were divided into two groups, group I & II of clinically benign and clinically malignant respectively. Both groups underwent FNAC. The patients with suspicious FNAC were subjected to excision biopsy in group I patients. Group II patients were advised surgery and final report was made on histopathology. Sensitivity and specificity of the FNAC was determined. RESULTS A total of 89 cases were included in whom both FNAC and histopathology results were available for comparison. Clinically, 54 were benign and 35 were malignant. The cytological diagnosis was unequivocally malignant in 29 patients, suspicious in 3 cases, unequivocally benign in 44 patients and probably benign in 7 patients while specimen was inadequate in 6 patients. Histological diagnosis of these 89 patients showed 55 patients with benign disease and 34 patients having malignant disease. In malignant disease, sensitivity of the FNAC was 85.29% with 100% specificity, 14.7% false negative rate, 100% positive predictive value and 98.79% negative predictive value. CONCLUSION FNAC has good sensitivity (85.29%) and very high specificity (100%). It can replace the open biopsy in majority cases of clinically malignant disease. Although FNAC is slightly less sensitive (80%) in benign diseases, it is highly specific (100%), so it can help to reassure and relieve the anxiety of the patients.

Chest Wall Tumors Presenting as Breast Lumps

Abstract: Two recently seen patients presenting with large breast lumps that proved to be pure mesenchymal tumors arising from the underlying chest wall are presented. One tumor proved to be a giant cell tumor of soft tissue and the other an osteogenic sarcoma. It is suggested that these two cases may not be unique and that some mesenchymal breast tumors might have their origin in the chest wall. Breast computed tomography (CT) scans would help identify similar cases.

Pathogenesis of breast carcinoma

Abstract: Breast cancer usually develops after a series of epithelial changes in the terminal ductolobular unit There are multiple benign causes of breast lumps, the majority of which are not associated with an increased risk of breast cancer Histological changes of pre-malignancy such as atypical hyperplasia and in situ carcinoma can be identified, and these are indications for either close surveillance or further surgery At the time of diagnosis, breast cancers can be staged both clinically and pathologically, and this facilitates international comparisons of results of treatment

Tumorous amyloidosis of the breast associated with disseminated malignant lymphoma

Abstract: We report a 77 year old woman with a 14 year history of lymphoplasmacytic lymphoma initially involving the parotid gland, cervical lymph node, and hilar lymph node. She was treated with chlorambucil but the disease ran a protracted course with eventual multiorgan dissemination and required repeated chemotherapy. This time, she presented with bilateral hard, non-tender breast lumps for three months. The clinical diagnosis was lymphoma infiltration versus breast carcinoma. Mammographic examination showed a 2 cm, medium density, well circumscribed mass in the left breast and a 0.5 cm nodule of similar characteristics with macrocalcifications in the right breast. Biopsy from the right breast mass showed amyloid deposits with foreign body giant …

Bilateral breast lumps in a young female--cytological approach to diagnosis.

Abstract: Breast lymphoma is a rare entity, occurring most commonly as a secondary deposit in a known case of lymphoma. Primary breast lymphoma (PBL) is extremely rare, comprising 0.04–0.5% of breast malignancies and less than 1% of all non-Hodgkin’s lymphoma (NHL). Most of these are B-cell NHL, although occasionally T-cell lymphoma and Hodgkin’s disease have also been reported. According to a recent study, there are few case reports of PBL diagnosed on fine needle aspiration cytology (FNAC). We report a case of a young female with bilateral breast lumps, clinically suspicious of phyllodes tumour or carcinoma, but diagnosed on FNAC as PBL, with no evidence of extramammary lymphoma elsewhere at presentation.

Fine needle aspiration cytology of benign breast disease. Markers of apoptosis and proliferation.

Abstract: Aim of the study was to compare the fine needle aspiration cytology findings of benign breast lesions with incidence of proliferation markers and apoptosis. This study included 37 patients with palpable breast lumps, referred for USG guided FNA. FNAC were prospectively classified as C2-benign, C4-suspicious of malignancy, and C5-malignant. The specimens were simultaneously stained for Ki-67, MPM2, Bcl2 and P53. The diagnoses in group-C2 were following: simple cyst, multiple cysts, simple cyst with apocrine metaplasia, inflammatory cyst, benign dysplasia (BD) and benign solid tumors. The final diagnoses, after histopathological verification, in cases of primary classification as C4 and C5 were as follow: proliferative fibroadenoma (FAp) and breas cancer, respectively. Great majority of C2/BD aspirates were negative for proliferative antigens Ki-67 and PCNA. These antigens were detected in part of benign solid tumors, as anticipated in suspicious solid tumor, and in all of cancer aspirates. Bcl-2 immunopositive cells were detected approximately in one quarter of C2/BD, nearly in half of C2 solid tumors and in one C4/FAp. Most of diagnosed specimens were P53-negative. Immunocytodetection of Ki67, MPM2, Bcl2, P53 might be promising, supportive method in the classification of benign breast lesions. FNAC increases the reliability of diagnosis when complemented by immunocytochemical staining. It could be helpful procedure of establishing more accurately the biology of these lesions and possibly serve as an essential factor in clinical follow-up. Nevertheless, further study on larger group of patients comparing cytological and histopathological diagnosis is required to estimate reliability of its predictive value.

A Case Presentation on Bilateral Breast Cancer

Abstract: We present a case of a 56 year old female who presented with a short history of synchronous, bilateral breast lumps. Core biopsies of both lesions revealed different morphological adenocarcinomas in both breasts. The recognised aggressive course and rapid progression of bilateral synchronous tumours was apparent in our patient who subsequently died 6 weeks after initial presentation with multi organ metastasis. This case illustrates the importance of screening for metastatic disease in patients presenting with bilateral breast lumps. INTRODUCTION A 56 year old female patient presented to the breast unit with a short history of bilateral breast lumps. On examination a 1 cm discrete lump was palpated in the upper outer quadrant of her right breast and a 2cm lump in the axillary tail was felt in the left breast. Her past medical history included hysterectomy at the age of 26 for cervical carcinoma-in-situ; chronic back pain managed by the GP and an abnormal mammogram 5 years prior showing microcalcification. She had a significant family history with a sister being diagnosed with breast cancer at the age of 55, and both her mother and maternal aunt being diagnosed with ovarian cancer in their forties. Mammograms of both breasts were carried out urgently due to the high index of suspicion. Figure 1 Mammogram 1: Right breast. Medio-lateral view. Figure 2 Mammogram 2 : Right breast, cranio-caudal view. Figure 3 Mammogram 3: Left breast, medio-lateral view. A Case Presentation on Bilateral Breast Cancer 2 of 3 Figure 4 Mammogram 4: Left breast, cranio-caudal view. Mammogram of the right breast had shown 3 masses, all in the upper outer quadrant. The largest was 2cm. Mammogram of the left breast revealed an irregularly shaped mass in the axillary tail (1.9cm). Core biopsies of the larger lesion in the right breast confirmed it to be a well differentiated adenocarcinoma whereas the smaller one was a moderately differentiated adenocarcinoma with a different morphology to the larger mass. Core biopsy of the left breast lump showed it to be a moderately differentiated carcinoma identical to the morphology of the smaller lesion in the right breast. The patient was reviewed in breast clinic 2 weeks later with a view to perform a bilateral mastectomy. However clinically she had deteriorated rapidly; she was in severe pain and was short of breath with intermittent euphoria. A whole body bone scan confirmed metastatic activity in multiple ribs, throughout the spine, pelvis and the proximal end of the long bones and in the scalp. Metastatic lesions were also noted in the liver and also possibly in the brain. The patient rapidly deteriorated and died within a week of final review.