The impact of malignant nipple discharge cytology (NDc) in surgical management of breast cancer patients

BACKGROUND: The role of nipple discharge cytology (NDc) in the surgical management of breast cancer patients is unclear. We aimed: (i) to evaluate the effect of malignant NDc on the surgical approach to the nipple-areola complex, and (ii) to verify the association between malignant NDc and nipple malignancy. METHODS: We retrospectively analyzed a case series of 139 patients with NDc who underwent breast surgery. The clinical and histological findings, types of surgery with emphasis on nipple-areola complex amputation, immunohistochemical phenotypes of the carcinomas and measurements of the tumor-nipple distance were recorded. Additionally, in patients who showed HER2-positive lesions on definitive surgery, we evaluated the HER2 immunocytochemistry of the NDc smears. RESULTS: Thirty-two malignant and 107 benign/borderline NDc diagnoses were identified. All 32 malignant-NDc cases were histologically confirmed as malignant. Thirty borderline/benign-NDc cases were histologically diagnosed as malignant (sensitivity 58%). The majority of the patients with malignant NDc were treated with nipple-areola complex amputations in both the mastectomy and conservative surgery groups (P<0.001, chi251.77). Nipple involvement was strongly associated with HER2-positive ductal carcinoma in-situ (P<0.001, chi211.98). HER2 immunocytochemistry on the NDc revealed a 100% correlation with the immunocytochemistry performed on the surgical tissues. CONCLUSIONS: Malignant NDc influenced surgical management. The association of malignant NDc with nipple involvement is highly related to ductal carcinoma in-situ with HER2 overexpression. In case of HER2 positive NDc, nipple-areola complex involvement is more likely than in HER2 negative cases

Inflammatory intramammary lymph node - A benign lesion simulating malignancy on breast MRI

Background: Similarities between benign and malignant characteristics of enlarged LN,s are observed on radiological studies. Case report: We present a case of an inflammatory intramammary lymph node, which on dynamic MRI presented enhancement features suspicious of malignancy. A 45-year-old female presented with a painful palpable lump in the upper outer quadrant of the right breast. Physical examination revealed a firm, movable 2 x 1-cm mass in the upper outer quadrant and erythema of the skin of the right breast. The mammogram showed a well circumscribed density, whith incraesed echogenity on ultrasound and increased Doppler signal. Breast, on dynamic MRI presented enhancement features suspicious of malignancy and contrast media was washed out on delayed phase images. Pathological diagnosis was reactive lymphoid hyperplasia of intramammary lymph node

Management of Large Retroperitoneal Lipoma in a 12-Year-Old Patient

Retroperitoneal lipomas are rare tumors. The etiology of their proliferation is uncertain. Metabolic and genetic causes have been reported. We present the case of a 12-year-old patient with a large pelvic lipoma causing dysuria and pelvic pain. Magnetic resonance imaging revealed the existence of a large retroperitoneal fat tumor. Ultrasound-guided fine needle biopsy was performed to exclude malignancy. The biopsy specimen revealed tissue consistent with a benign lipoma tumor. Exploratory laparotomy revealed a solid lipoma of the retroperitoneal space 8 × 6 cm and weighing 300 g. The patient had a good postoperative performance status. Lipomas should be considered in the differential diagnosis of a solid tumor in the retroperitoneal space. © 2009 Elsevier Inc. All rights reserved

Breast capillary hemangioma at the tail of Spencer: A rare entity

A palpable breast lump is a frequent clinical finding and preoperative evaluation varies depending on its localization and characteristics. Vascular tumors are rarely diagnosed especially regarding the tail of Spencer region. In general, they appear oval-shaped with wellcircumscribed margins, but their echostructure varies, and it might be quite difficult for the breast specialist to differentiate it from complex cysts, fibroadenomas or some carcinomas. The authors describe a rare location of breast hemangioma with mammographic characteristics that were suspicious for malignancy. There were no identifiable risk factors, no familial history of breast lumps, and patient did not mention the intake of hormonal therapy. The lump was evaluated by mammography and breast ultrasonography, whereas due to the high vascularity of the nodule, the decision not to perform fine-needle aspiration (FNA) was made and an excisional biopsy was performed. The histological result was &quot;breast capillary hemangioma&quot;

Increased rate of endometriosis and spontaneous abortion in an in vitro fertilization program: No correlation with epidemiological factors

Background. There are conflicting data concerning endometriosis and spontaneous abortion (SAB). The aim of the present study was to evaluate if there was any association between endometriosis and SAB. Moreover, we investigated risk factors in women with endometriosis and SAB. Methods. The medical files of 457 married women with endometriosis and 200 infertile women without endometriosis were studied retrospectively. All cases were diagnosed by laparoscopy. Data concerning demographic variables and menstrual characteristics were recorded from 226 women with endometriosis, which were divided into two groups. Group 1 included 126 cases with endometriosis and SAB, and Group 2 comprised 100 parous women with endometriosis and without SAB. Statistical comparisons between groups were made using the χ2 test and odds ratios (OR) and 95% confidence intervals (CI). Results. The proportion of SAB was significantly higher in women with endometriosis than in infertile women without endometriosis (126/457 (27.6%) vs. 36/200 (18.0%); OR=1.7, 95% CI 1.1=2.6; p=0.01). The frequency of nulligravid women was significantly higher in women with endometriosis than in the control group (OR=1.9, 95% CI 1.4-2.81; p=0.001). Mean age, age at onset of endometriosis, race, height, weight, body mass index, medical history of allergies, and family histories of endometriosis and cancer were similar in women with endometriosis and SAB and in parous women with endometriosis but without SAB. Moreover, the two groups were similar in age at menarche, length of cycle, duration and amount of flow, and the severity of disease. The incidence of infertility was significantly higher in women with SAB (p&lt;0.001). Conclusion. These data suggest but do not prove that the risk of SAB is increased in women with endometriosis. The epidemiological risk factors of endometriosis are not associated with an increase in the abortion rate. © 2008 Informa UK Ltd

Efficiency of GnRH analogues in treating large functional ovarian cysts

Aim: The aim of this study was to determine the potential therapeutic benefit of a single administration of a GnRH analogue in premenopausal women presenting large functional ovarian cysts (FOCs) (diameter &gt; five cm). Materials and Methods: Fifty-one patients (median age 37.4 years) diagnosed with ovarian cysts, presumed benign based on transvaginal and/or transabdominal ultrasound, were divided in three study groups. Patients of group A received no medication whereas patients of groups B and C were treated with a single administration of a GnRH analogue and combined oral contraceptives, respectively. Patients were re-examined after a three-month period. Three of the 51 patients were lost in follow-up or stopped the treatment. Results: Complete resolution of the ovarian cysts was observed in eight (50%), 14 (70%), and eight (67%) patients of groups A, B, and C, respectively. No side effects were observed in either of the three groups. The positive therapeutic effect in group B did not reach statistical significance compared with the two other groups (p &gt; 0.05). Conclusion: A new option of treating large FOCS through a single-dose of a GnRH analogue is proposed and should be carefully considered. Further research is needed in order to evaluate GnRH analogues as an alternative treatment