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Hamartomas of the breast are well circumscribed tumour-like lesions composed of fibroadipose and glandular tissue in variable degrees, depending on the patients' age. The nodules have a pseudocapsule and can easily be enucleated surgically. They may be recognised on mammography by their contours and density. Clinically they appear as painless areas of induration most frequently in the fourth and fifth decade of life. Pathogenetically it is assumed that they are an additional sprout of the breast, comparable to an "intra-glandular polymastia".

Fibroadenolipoma is a well recognised but unusual benign tumour of the breast. It is a circumscribed lesion composed of fat and other breast tissues which may be normal or which may show various benign changes. The presence of smooth muscle has been recorded but was not found in our cases. A series of eight cases is described, occurring over a period of 10 years in a series of 20 000 mammograms. Radiological and pathological correlation is made and histological changes are described. Our findings are compared with other reviews in the literature. The lesions are usually diagnosed radiologically.

Fifty-seven biopsy proven breast masses have been examined at our institution by magnetic resonance (MR), mammography, and ultrasound. The three techniques have been evaluated concerning their capability to visualize the lesion and the diagnostic information obtained. Magnetic resonance proved comparable to mammography and superior to sonography in the fatty to medium dysplastic breasts but inferior to the combined examination by mammography and sonography in the dense breasts. In some selected cases, however, special advantages of MR have been found.

Palpable breast masses which have a nondiagnostic appearance on the mammogram often require a biopsy to rule out malignancy. Contact B-scan ultrasonography of such masses were performed in an effort to improve the diagnostic accuracy of mammography and reduce the number of unnecessary biopsies. A total of 200 patients with breast masses of 1-8 cm were examined by both methods. The results of this combined evaluation were compared to those of mammography alone. Of 115 pathologically proven lesions, 44 were fluid-filled cysts. Sonography correctly diagnosed all 44 cysts, while mammography was equivocal in 27 (61%) of them. Of the remaining 71 solid masses, 38 were benign and 33 malignant. Mammography alone correctly diagnosed 31 carcinomas (94%), whereas sonography correctly diagnosed 26 (78.8%). While the infiltrating carcinomas have a typical sonographic appearance, circumscribed carcinomas may have the same sonographic features as fibroadenomas; the value of sonography here was to establish whether the mass was solid. In other solid masses such as those produced by dysplasias, abscesses, and mastitis, sonography was helpful in differentiating between diffuse and discrete lesions. The combined mammographic-sonographic evaluation of breast masses was more accurate than either method alone.

Morphological and mammographic study of small (less than 1 cm) focal mammary gland lesions of 170 women revealed foci of typical epithelium proliferation of the ducts and lobules, fibrosing adenosis, small duct papillomas and fibroadenoma, intraductal and ductal carcinoma in situ, sometimes with small invasion foci, infiltrating carcinoma, infiltrating lobular carcinoma. Peculiarities of small focal lesion morphology determine the mammographic picture. Analysis of nodular shadows on the mammogram gives as a rule a possibility to differentiate between benign conditions (focal proliferation of the epithelium, fibroadenoma), early carcinoma (intraductal and lobular in situ, sometimes with small foci of invasion) and infiltrating carcinoma. Calcareous deposits in both benign lesions and carcinomas do not differ mammographically. Morphogenetic link was revealed between foci of epithelium proliferation (benign displasia), intraductal and lobular carcinoma in situ and infiltrating carcinoma. Among 65 cases of non-palpable carcinoma, 31 (47.7%) were classified as early carcinoma and 34 (52.3%) as infiltrating carcinoma with a relatively low histological degree of malignancy. In both groups a good postoperative survival was observed.

The percutaneous injection of contrast medium was performed into 44 breast fibroadenomas, 13 tumors of fibrocystic disease and 5 cancers. The radiological aspect does not to assure some discrimination between peri- or intracanalicular fibroadenomas, nor between giant fibroadenomas and cystosarcoma phyllodes. The opacification of the intratumoral galactophoric channels is achieved in 34,1% of fibroadenomas. It can be observed in fibrocystic disease but nor in cancer. A pattern of fibrous tissue and/or opacification of large peripheric extratumoral channels will appear in 34,1% of fibroadenomas. They are be observed in fibrocystic diseases and cancers. It is the same thing for spot figure. For diagnosis, the technic is not recommended to be generalized since the accuracy seems to be less serious than the cytological analysis of the puncture.

Using a conventional body CT scanner, computed tomography of the breast was performed on 32 patients known to have or suspected of having breast masses. Xeromammograms were available for comparison in all cases. All mass lesions were histologically proved. Seven patients were examined prone, 25 supine. The prone position yielded pictures that resembled craniocaudal mammograms. Breast asymmetry, skin thickening, stranding from a mass to the chest wall, calcification, and axillary lymphadenopathy could be demonstrated by means of CT. The portion of the breast adjacent to the chest wall was more readily examined by means of CT than by conventional mammography. Internal mammary nodes could not be demonstrated.

Thirty patients with suspected abnormality of the breasts on mammography were evaluated with magnetic resonance imaging (MRI) in a blind fashion. Spin-echo (SE) 250/30 msec scans were used to screen the examined breast. At the location of the suspected abnormality, inversion recovery (IR) 1000/30/300, SE 1000/30, and SE 1000/120 scans were performed. On the basis of these magnetic resonance images and experience with 70 previously studied patients, abnormalities of the breasts were grouped into five patterns. Ten malignant lesions exceeded 1 cm in diameter and were all correctly diagnosed by mammography and MRI. Of the remaining 20 benign conditions, four were suspicious for malignancy on MRI compared to eight with mammography. The shape of the lesion and the change in its signal intensity with different MR radiofrequency pulse sequences allows differentiation between a benign and a malignant process. On the basis of this preliminary experience, it seems MRI may have an adjunctive role to screening mammography. SE 1000/120 scans show higher signal intensity from carcinoma than from normal duct tissue, fibrocystic disease, and fibroadenoma. In this respect, it may allow some tissue specification in the breast.

Normal and neoplastic breast tissues have been characterised in terms of x-ray attenuation. Samples of normal fat and fibrous tissue were obtained from reduction mammoplasty and autopsy, and infiltrating duct carcinoma specimens from mastectomy and lumpectomy. A high-purity germanium spectroscopy system and a beam of 120 kV constant potential x-rays were used to determine the linear attenuation coefficient from 18 to 110 keV. Densities were determined from buoyancy measurements and were used to obtain mass attenuation coefficients. Infiltrating duct carcinomas and fat are well distinguished by x-ray attenuation. For photon energies used for film-screen mammography, infiltrating duct carcinomas are more attenuating than fibrous tissue. Above 31 keV, the ranges of attenuation of the two tissue types overlap. The attenuation coefficients of tissues have been concisely represented by equivalent thicknesses of lucite and aluminium. Analysis based on the average attenuation properties of tissues indicates that dual-energy mammography, using an ideal imaging system, would require 0.06 cGy to provide images in which 1 cm infiltrating duct carcinomas are displayed with a signal to noise ratio of 5 against a background over which the fat/fibrous contrast has been suppressed. This dose is similar to that currently used in conventional film-screen mammography.

Sarcomas of the breast are rare. The radiological and thermographic features of a mixed malignant chondro- and osteoplastic tumour (osteochondrosarcoma) are described. Mammographically, there was rapid growth of nodular, round smooth tumour, with coarse, confluent and bizarre calcification. Thermography revealed the features of malignancy. In the differential diagnosis, a circular focus with coarse calcification, as occurs in a sarcoma, may be difficult to distinguish from a fibro-adenoma. Such lesions should therefore be removed as soon as possible and submitted to careful histological examination.

Demonstration of calciefied fibroadenomas of the breast of a seldom size. Short differential diagnosis between the mostly benign macrocalcifications and the typical microcalcifications in breast cancer.

From 1976 to 1977, 705 patients with a fibroadenoma of the breast, histologically proven by biopsy, were observed at the Istituto Nazionale Tumori of Milan. In 229 cases, the clinical examination was followed by mammography or xeromammography; in 65/229 patients telethermography was also carried out. The aspects of fibroadenoma at x-ray examinations are described together with the difficulties to reach an exact diagnosis: the cases in which a false positive diagnosis of cancer was done are emphasized.

Fine needle biopsy has been used with great accuracy in the diagnosis of breast tumours. There have been few reports on its efficacy as an adjunct to other breast screening techniques like x-ray mammography. Abnormal mammograms in the absence of a palpable breast lump are sometimes detected in the climacteric and these pose a problem of tissue sampling for pathologic diagnosis. We have tried to evaluate the technique of radiologically guided fine needle aspiration in such patients. Our report is of an initial series of 13 cases of non-palpable, mammographically abnormal breast lesions. Eight cases were fibroadenoma, 4 cases mammary dysplasia and 1 a benign breast lesion. Representative cytologic samples were obtained in 11 of our 13 cases. Cytologic diagnosis should be correlated with mammographic findings.

This article reported the result of analysis of 96 cases with heaps of calcifications in the breast all verified by operation. The calcifications, according to the appearances on X-ray film were classified into 4 patterns: club-shaped, fine sandy, fragmented stonelike and coalescent. A comprehensive analysis was made in regard to spatial distribution and amount of calcification and the presence of a mass. The results indicated that club-shaped calcification is highly suggestive of malignancy regardless of the amount of calcification and the presence or absence of a mass. Simple fine sandy calcification in the absence of a mass can not differentiate benign from malignancy because of wide range of overlapping, whereas simple fragmented stone and coalescent types, according to the authors opinion denote benign.

Breast calcifications may be categorized as benign, probably benign, and suggestive of malignancy. The interpretation scheme presented here utilizes a systematic structured approach: identify characteristically benign calcifications, for which no further evaluation is needed; define as suggestive of malignancy those remaining calcifications that present as isolated parenchymal clusters of tiny calcific particles; and (optional) attempt to downgrade some of these suspicious calcifications into the "probably benign" category, so that they can be managed by periodic mammographic follow-up rather than biopsy. The clinical acceptability of this approach will vary with local conditions; success in implementing it will encourage increased use of mammography, and ultimately, improved breast health care.

The synovial sheath obtained in synovectomy in 35 patients with rheumatic- and rheumatic-visceral forms of rheumatoid arthritis was studied histochemically and immunomorphologically. At early stages of exacerbation of the pathological process in the synovial tissue there were revealed predominantly catabolic processes: an increased permeability of vessels; mucoid oedema; fibrinoid changes in the subintimal layer. Further development of the disease was characterized by predominance of anabolic processes with proliferation of synoviocytes, subintimal histiocytes, productive vasculites, massive lymphoid-plasmocytic infiltration, diffuse, or in the form of lymphoid follicles. Using the immunofluorescent technique the authors revealed luminescence of the rheumatoid factor and gamma=globulin in plasmatic cells, extracellularly, and more rarely in macrophages. Pronounced immunological changes in the synovial sheath in the active course of rheumatoid arthritis were accompanied by a high level of metabolic processes and an intensive phagocytic reaction in synoviocytes and subintimal histiocytes. In observations with a low activity of rheumatoid arthritis the synovial tissue was characterized by low levels of enzymes of oxidative metabolism and hydrolysis, emptying of the capillary bed, processes of sclerosis, hyalinosis, amyloidosis.

Three cases of fibroadenolipoma (adenolipoma, hamartoma) of the breast are reported out of sixteen thousand mammographies. Their typical radiological findings are described.

The authors emphasize the value of mammography with a 0.3 millimetres microfocus-tube with a magnification system. This technique is limited to those large lesions increasing "twilight effect". For a better study of all breast's lesions the use of fine microfocus-tubes is suggested, as it results also from the latest literature.

Some of the recent trends in the detection of breast lesions, in particular carcinoma, are reviewed. The value, indications, accuracy and limitations of mammography are outlined. Malignant calcifications and their localisation for surgery, specimen radiography, cysts of the breast, duct discharge and the problem of juvenile breast lumps are discussed. The possible hazards from radiation should not be deterrent in any examination with a specific clinical problem. The position may have to be reviewed if extensive use is made of mannography in screening well women.

The pronounced edge-effect occurring in xeroradiography of intramammary calcifications leads to a change in size of the object, namely, a reduction in the positive and an enlargement in the negative print, to a hard-to-evaluate zone in the border of the object which is in about the same size range for both developing procedures. The extent of edge-enhancement is directly related to the structures in the immediate neighborhood. Form and density of microcalcifications can be better assessed with the positive procedure.

Contrast mammography, with oxygen or positive contrast material, was performed on 88 women with various diseases of the breast. The examination was done after simple mammography had failed to establish a clear diagnosis. In each case, the roentgenologic diagnosis was confirmed by histological examination. In some cases, bicontrast studies of the duct system or of cysts were performed. With contrast mammography, a correct diagnosis was established in 98.7% of malignant tumors and in 97.8% of benign tumors. Bicontrast studies demonstrated intraductal and intracystic malignancies.