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Purpose: To analyze the histologic appearance of mammographically detected lesions suspected of being radial scars., Materials and Methods: Mammographic and pathologic findings in 40 patients with a preoperative diagnosis of radial scar were reviewed retrospectively., Results: Pathologic examination revealed 20 pure radial scars, 12 pure carcinomas, and eight malignant lesions (seven tubular carcinomas and one infiltrating ductal carcinoma) associated with a radial scar. At mammography, no difference was noted between benign and malignant lesions according to size and shape of the spicule, size of the central core, and the presence of calcifications., Conclusion: Because of the association of radial scars with borderline and malignant lesions, a spiculated lesion suggestive of a radial scar found at mammography must always be surgically removed. The surgeon and pathologist must be aware of the mammographic aspects of radial scar, however, to avert excessive surgery, because all cancers in this study had a good prognosis.

As breast cancer screening programmes gain momentum, there is a parallel increase in histological problems mainly related to the identification of an increasing number of "borderline" breast lesions. The results of recent studies are often inconsistent, and bear witness to the lack of a consensus regarding the interpretation of both ductal and lobular epithelial hyperplasia. The authors insist on the need for an adequate number of samples and an irreproachable histologic technique which is indispensible if the morphologic subtleties, currently the only valid factors permitting the diagnosis, are to be appraised. The role of the pathologist is therefore crucial in the management of specimens which are entrusted to him and in helping the clinician to tailor treatment to fit each individual patient.

Pathologists have associated calcium oxalate dihydrate (weddellite) in breast biopsy specimens with benign or borderline lesions and rarely with malignancy. These microcalcifications may have a polyhedral shape in histologic specimens owing to their crystalline structure. A retrospective radiologic-histologic correlation study was performed on 300 clusters of microcalcifications to determine if microcalcifications with a polyhedral shape could be found at mammography. In 19 cases (6.3%), polyhedral microcalcifications (PMs) were detected by two radiologists. In 12 of these 19 cases, weddellite crystals were found in the histologic specimen under polarized light; in seven cases, no calcification was found. Although rare, PMs can be found at mammography by radiologists aware of their existence. They are due to weddellite crystals and in this series were associated with benign disease in 89% of cases. Prospective studies are required to determine the frequency of PMs on screening mammograms and to evaluate their negative predictive value.

Background: Immediate breast reconstruction (IBR) after mastectomy represents a clear improvement in the quality of life of patients with breast cancer, but prosthesis removal is relatively frequent. Therefore, it is important to identify risk factors related to this removal., Methods: A series of 142 patients treated with mastectomy and IBR at the Institut Gustave-Roussy between January 1976 and December 1988 were studied. Forty-seven had an in situ carcinoma, 93 an infiltrating carcinoma, and 2 a fibrosarcoma. IBR failures were defined as removal of the prosthesis, and early failures as removal during the first 7 weeks after IBR., Results: The early failure rate was significantly higher in patients with invasive carcinomas or fibrosarcomas than patients with in situ carcinomas (12% versus 0%, P = 0.04). The risk of late IBR failure was significantly higher in patients who had received postoperative radiation therapy than patients who did not (P = 0.0002). However, this increased risk applied only to women in whom the chest wall was exposed to radiation because of a high risk of recurrence., Conclusion: It might be preferable to postpone breast reconstruction for patients with infiltrating breast carcinoma because early complications are not infrequent and could delay adjuvant chemotherapy. Late complications associated with chest wall irradiation could be avoided with the use of alternative techniques such as the transverse rectus abdominis myocutaneous (TRAM) flap procedure.

Breast tissue samples were taken during surgery in premenopausal women with various benign breast diseases. Surgery was scheduled between day 11 to 13 of their menstrual cycle, before presumed ovulation and endogenous production of progesterone. Each patient was treated 11 to 13 days before surgery by daily percutaneous topical application on breast of either a placebo gel, a gel containing progesterone or a gel containing estradiol. Treatments were assigned at random and the study conducted double-blind. The mean estradiol concentration in breast tissue was significantly higher (3,409 pg/g) in the estrogen-treated group than in the placebo (365 pg/g) and the progesterone (523 pg/g) treated groups. The mean progesterone concentration in breast tissue was significantly higher (69.1 ng/g) in the progesterone treated group than in the placebo (1.95 ng/g) and the estradiol (3 ng/g) treated groups. Mitotic activity was calculated by counting with light microscopy mitoses in epithelial cells of normal lobular area. Mean mitotic activity was significantly lower in progesterone treated group (0.04/1,000 cells) than in placebo (0.10/1,000 cells) or in estradiol (0.22/1,000 cells) treated groups. High concentration of progesterone sustained in human breast tissue in vivo during 11 to 13 days does not increase, but actually decreases mitotic activity in normal lobular epithelial cells.

The authors are dealing with the problem of pre-cancerous lesions from data contained in the pathological archives of the Institut Gustave-Roussy. One series consists of 320 cases operated upon for benign lesions or tumors of the breast (Fibroadenomas appearing at a relatively advanced age) of which 4 developed cancers. The past histories of another series of 730 patients having had mastectomies for cancer are examined; 24 of these had been operated upon previously for benign tumours or lesions of the breast. Attention is drawn to a number of histological signs the presence of which in an "a priori" benign lesion should evoke caution: multilayered epithelium of the galactophores glands with an "en flammèche" appearance, tubular adenomatous hyperplasia, irregular lobular hyperplasia, microcalcifications... Despite careful examination of multiple sections, the pathologists decision between benign and malignant lesion continue to be difficult.

At the conclusion of this study based on 327 cases of breast cancer T1, T2 T3 (less than 7 cm) No, N1, Mo Pev O, treated by mastectomy and axillary dissection without previous treatment, it appears that the microscopic dissemination to the nipple has a pejorative prognosis value. The 5 years is 84 p. 100 when there is no nipple dissemination, 74 p. 100 when there is an intraductal nipple dissemination, and 57 p. 100 when there is lymphatic or interstitial nipple dissemination. These differences have a statistical value. This value does not seem connected with other pathological prognosis factors: tumors size, Bloom histopronostic grading, and the number of nodes invaded. The intra-mammary spread without nipple involvment has no prognostical value.

We report 7 cases of unusual fibroadenomas of the breast. They are characterized by an exuberant cellular proliferation within the ductal lumens. They appear in young women from 20 to 40 years old. These lesions are histologically identical to those described by Azzopardi (1979) under the name of "Argyrophilic cells in fibroadenomas" and by Eusebi and Azzopardi (1980) and by Govoni (1981) and called "Lobular endocrine neoplasia in fibroadenoma of the Breast". An immunohistochemical study reveals a major positivity of these cells, in all cases, with Antikeratin Antibody (anti Kl1) and with Epithelial Membrane Antigen (anti EMA) proving the epithelial origin of these cells. There cells cannot yet be regarded as belonging to the neuro-endocrine group, because of the negativity, in all cases of Grimelius and Bodian stains, and of the very heterogeneous positivity observed with Neuron-Specific Enolase antibody (anti NSE) and with anti Human Natural Killer antibody (anti HNK). These cellular proliferations seem to us, on the microscopical point of view related to the atypical epithelial hyperplasias of the breast, and different from the in situ lobular carcinoma. Thus we propose to call these lesions "variant of the breast fibroadenoma" characterized by an atypical epithelial clear cell hyperplasia. The treatment of these lesions merely consists of a lumpectomy. Only one case is associated with an eleven years free of disease follow-up: a follow-up comprised between on to fifteen months is observed in the others cases. The knowledge of these benign lesions appears to us very important, to avoid improper treatment caused by an erroneous diagnosis of carcinoma developing in a breast fibroadenoma.