Search

Objectives: To evaluate the performance of ultrasound-based deep learning (DL) models in distinguishing breast phyllodes tumours (PTs) from fibroadenomas (FAs) and their clinical utility in assisting radiologists with varying diagnostic experiences. Methods: We retrospectively collected 1180 ultrasound images from 539 patients (247 PTs and 292 FAs). Five DL network models with different structures were trained and validated using nodule regions annotated by radiologists on breast ultrasound images. DL models were trained using the methods of transfer learning and 3-fold cross-validation. The model demonstrated the best evaluation index in the 3-fold cross-validation was selected for comparison with radiologists' diagnostic decisions. Two-round reader studies were conducted to investigate the value of DL model in assisting 6 radiologists with different levels of experience. Results: Upon testing, Xception model demonstrated the best diagnostic performance (area under the receiver-operating characteristic curve: 0.87; 95% CI, 0.81-0.92), outperforming all radiologists (all P < .05). Additionally, the DL model enhanced the diagnostic performance of radiologists. Accuracy demonstrated improvements of 4%, 4%, and 3% for senior, intermediate, and junior radiologists, respectively. Conclusions: The DL models showed superior predictive abilities compared to experienced radiologists in distinguishing breast PTs from FAs. Utilizing the model led to improved efficiency and diagnostic performance for radiologists with different levels of experience (6-25 years of work). Advances in knowledge: We developed and validated a DL model based on the largest available dataset to assist in diagnosing PTs. This model has the potential to allow radiologists to discriminate 2 types of breast tumours which are challenging to identify with precision and accuracy, and subsequently to make more informed decisions about surgical plans. [ABSTRACT FROM AUTHOR]

Phyllodes tumors (PTs) are rare breast tumors showing overlapping features with fibroadenomas (FAs). Diagnosis on small biopsies is challenging. New diagnostic markers are needed. Here we evaluated immunohistochemical staining of histone 3 trimethyl‐lysine‐27 (H3K27me3) as a diagnostic and prognostic marker in a series of PTs. Surgically removed PTs at our institution (September 1990 and July 2022) and control FAs. Tissue micro‐arrays (4 cores, 2 mm Ø) stained with H3K27me3, and scored with QuPath‐derived H‐score. Fisher exact test, Mann–Whitney U‐test and chi‐squared test used for group comparison. ROC analysis applied to define cutoffs. Cox proportional hazards models were used for assessing disease‐free survival (DFS), overall survival (OS), and disease‐specific survival (DSS) in PTs. We included 81 patients with PTs and 44 patients with FAs. QuPath‐derived H‐scores of stromal H3K27me3 were statically significantly lower in PTs than in FAs (p < 0.001). We identified exploratory cutoffs to discriminate FAs from benign and malignant PTs (AUC = 0.78 and 0.73, respectively). No associations between DFS, OS, or DSS and H3K27me3 expression were found. H3K27me3 expression differs between FAs and PTs, indicating potential as diagnostic marker, but it is not predictive for DFS, OS or DSS in PTs. Further validation is needed. [ABSTRACT FROM AUTHOR]

Introduction: Ki-67 is a nuclear protein and a marker of cell proliferation. Expression of Ki-67 is detected by immunohistochemistry. Breast fibroadenomas, are benign tumours with a maximum incidence in the second decade of life. Some studies indicate that that fibroadenoma is a risk factor for development of breast carcinoma. The present study aimed primarily at assessing the expression of Ki-67 in normal breast and fibroadenoma. Materials and Methods: The study included a total of 30 cases encompassing, 10 cases of normal breast and 20 cases of fibroadenoma. It was conducted over a period of one year (2022-2023). Grading of Ki-67 was performed based on percentage positivity of cells as low proliferative (< 20%) and high proliferative (>20%). Results: Ki-67 displayed a brown nuclear staining in positive cases which was 100%. There was a significant increase in Ki-67 expression on comparative analysis of normal breast and fibroadenomas (p=0.032). Conclusion: Our study showed an increased level of Ki 67 expression in fibroadenoma breast supporting its proliferative nature. Further studies are needed to understand the behavior of this lesion better. [ABSTRACT FROM AUTHOR]

To compare the quality of life (QOL), cosmesis and cost-utility of open surgery (OS), vacuum-assisted breast biopsy (VABB) and high intensity focused ultrasound (HIFU) for fibroadenoma (FA). A total of 162 patients with 267 FAs were enrolled. Baseline characteristics and treatment information were recorded. Patients were followed up at 3-, 6- and 12-month post-treatment. QOL was evaluated by health survey. Breast cosmesis was evaluated by self-rating survey and Harvard Scale. A decision-analytic model was established and incremental cost was calculated for cost-utility analysis. For QOL evaluation, there was no difference of physical component summary (PCS) score in three groups (P > 0.05), while the mental component summary (MCS) score was significantly higher in HIFU group than the other two groups at 3- and 6-month post-treatment (P < 0.05). The proportion of patients satisfied with breast cosmesis was significantly higher in HIFU group (96.49%) than in VABB group (54.90%) and OS group (49.99%) (P < 0.05). By Harvard Scale, 27.78%, 78.42% and 100.00% of patients were rated as excellent and good in OS group, VABB group and HIFU group, respectively (P < 0.05). To acquire a quality-adjusted life year (QALY), cost of OS, VABB and HIFU was 1034.31 USD, 1776.96 USD and 1277.67 USD, respectively. When compared to OS, incremental cost analysis showed HIFU was cost-effective, while VABB was not. OS, VABB and HIFU were all effective and safe for FA, but among these three treatments, HIFU had the best QOL improvement, breast cosmesis and cost-effectiveness. [ABSTRACT FROM AUTHOR]

Purpose: Surgical excision is often performed to exclude phyllodes tumor (PT) when Core Needle Biopsy (CNB) of the breast returns fibroepithelial lesion—not further characterized (FEL-NFC). If imaging or CNB pathology features can be identified that predict a very low probability of borderline/malignant PT, thousands of women could be spared the expense and morbidity of surgical excisions. Methods: This retrospective cohort study includes 180 FEL-NFC from 164 patients who underwent surgical excisional biopsy. Results: The upgrade rate from FEL-NFC to benign PT was 15%, and to borderline/malignant PT 7%. Imaging features predicting upgrade to borderline/malignant PT included greater size (p = 0.0002) and heterogeneous echo pattern on sonography (p = 0.117). Histologic features of CNB predicting upgrade to borderline/malignant PT included "pathologist favors PT" (p = 0.012), mitoses (p = 0.014), stromal overgrowth (p = 0.006), increased cellularity (p = 0.0001) and leaf-like architecture (p = 0.077). A three-component score including size > 4.5 cm (Size), heterogeneous echo pattern on sonography (Heterogeneity), and stromal overgrowth on CNB (Overgrowth) maximized the product of sensitivity x specificity for the prediction of borderline/malignant PT. When the SHO score was 0 (72% of FEL-NFC) the probability of borderline/malignant PT on excision was only 1%. Conclusion: The combination of size ≤ 4.5 cm, homogeneous echo pattern, and absence of stromal overgrowth is highly predictive of a benign excision potentially sparing most patients diagnosed with FEL-NFC the expense and morbidity of a surgical excision. [ABSTRACT FROM AUTHOR]

Purpose of review: Alternatives to surgical management of breast disease is desired by patients wishing to avoid an operation or those who are not a candidate for surgery. The role of cryoablation for treatment of benign and malignant tumors is reviewed to determine optimal candidacy. Recent findings: Cryoablation is safe, effective, and well tolerated by patients. Cryoablation is being increasingly utilized to treat a subset of patients with primary breast cancer and is most effective when treating small lesions without extensive intraductal component. Combination with immunotherapy can enhance response to treatment. Summary: Further studies are needed to determine if cryoablation is sufficient as de-escalation of other adjuvant treatments continues for patients with early-stage breast cancer. Combination of cryoablation with immunotherapy or treating the primary tumor in the presence of metastatic disease may optimize systemic therapies and patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Fibroadenoma (FA) is documented as the most common benign breast disease typically presenting as a lump. A wide variety of other diseases including breast cancer can similarly present as lumps hence the need for further differentiation. Ultrasonography plays a vital role in the evaluation and treatment of breast lumps with histological analysis as the gold standard. Objective: This study compared the physical and sonographic features of the breast in women with FA and women with breast lumps due to other diseases. Materials and Methods: This is a single-centre comparative study. Clinical and sonographic breast evaluations of the recruited patients with lumps were done and reported using the American College of Radiology Breast Imaging Reporting and Data System score. The lumps were biopsied, and histological diagnosis was documented. Clinical and imaging features of the breasts of women with FA were then compared with those of women with lumps from other breast diseases, and collated data were analysed using SPSS Statistical version 23.0. Results: Data from 118 subjects (59 in each group) were used for this study. There was a significant difference in the physical and sonographic appearance of FA concerning the patient’s age, parity, change in lesion size, perilesional architecture, echogenicity, borders, capsule and background breast density. No FA was found in women with less dense breasts. Conclusion: The sonographic features of breasts showed some differences from the corresponding features of FA and other breast lesions. This has the potential to increase the efficiency of pre-operative diagnosis of FA and could be further applied in developing diagnostic criteria for FA in our environment.

Mammary‐type tissue in the vulva was first described in 1872 but has been rarely reported in the literature. This tissue was previously considered as ectopic breast tissue that occurs as a result of incomplete regression of the milk line. Similar to native breast tissue, ectopic mammary tissue is hormone‐sensitive and can develop benign changes, such as fibroadenoma, as well as malignant changes. A more recent theory suggests that these benign and malignant mammary‐type entities arise from mammary‐like anogenital glands, which constitute normal vulvar components. We report a case of a 41‐year‐old woman who presented with a chronic asymptomatic cyst on the left vulva that eventually became uncomfortable, especially on standing. The cyst was located on the labium minus, measuring 1.0 × 0.5 cm, with no identified erythema or other skin abnormalities. Excision of the lesion and subsequent microscopic examination showed a circumscribed mass with a nodular overgrowth of epithelial and stromal components, resembling a mammary fibroadenoma with pseudoangiomatous stromal hyperplasia. We bring to attention this rare diagnosis and the importance of considering it in the presence of a vulvar lesion. The malignant and recurrence potential of mammary‐type tissue necessitates excision with clear margins and close monitoring of these patients. [ABSTRACT FROM AUTHOR]

Introduction: Endoscopic‐assisted surgery for breast tumors has the advantage of inconspicuous scars, less breast volume loss, and nipple areolar distortion. A novel endoscopic‐assisted technique through inframammary fold for excision of fibroadenomas is presented. Materials and Surgical Technique: Endoscopic‐assisted excision of fibroadenoma(s) through inframammary fold was performed in four patients after informed written consent via three ports (12, 5, and 5 mm). Breast Cancer Treatment Outcome Score‐12 (BCTOS‐12) was used to evaluate patient satisfaction after surgery. Discussion: No intraoperative and wound complication was noted. On median follow‐up of 26.5 months, patients reported satisfactory responses to aesthetic and functional outcomes. No scar related complications were noted. Endoscopic‐assisted excision of fibroadenoma through inframammary fold can be a safe and feasible option with good aesthetic outcomes. [ABSTRACT FROM AUTHOR]

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Benign and malignant breast lesions in children and adolescents are rare compared to adults. Most tumors are benign. Malignant breast lesions are extremely rare. Fibroadenomas are the most common, accounting for 95% of all lesions. Diagnosis is based on history and physical examination of the breast and armpit. Imaging studies include ultrasound, mammography, and magnetic resonance imaging. Ultrasound is the most commonly used imaging test. Other tests are used in cases of diagnostic doubt. Core needle biopsy should be considered for appropriate diagnostic management. Excisional biopsy should be considered for complex clinical conditions and imaging studies. Except in doubtful situations in children and adolescent girls, a conservative approach and observation of the lesions along with periodic ultrasound examination initially every 6–12 months is advisable. Management of malignant breast lesions in children typically involves a multidisciplinary team consisting of pediatric oncologists, surgeons, radiation oncologists, pathologists, and other specialists and depends on the clinical condition of the patient. An important aspect is the experience of the clinician and radiologist in the treatment of breast lesions, as well as increasing patient and family awareness of possible breast lesions and self-examination. This review aims to provide a scoping overview of the available literature on benign and malignant lesions of the breast in pediatric and adolescent populations to assist physicians and surgeons in making decisions regarding the appropriate diagnosis and management of pediatric breast disease.

Introduction: Breast fibroadenoma in the axilla is a rare manifestation that consists of biphasic proliferation of fibromyxoid stroma without atypia or mitosis, with a glandular component consisting of two luminal and myoepithelial layers. In this study, breast fibroadenoma in the left axilla of a 45-year-old woman is presented. Case presentation: The patient was a 45-year-old woman complaining palpation of a mass in the left axilla that underwent a needle biopsy, but in the ultrasound and mammography examination, both breasts were normal and without mass. In the pathology examination of the needle biopsy specimen of the axillary mass, biphasic proliferation of fibromyxoid stroma without atypia or mitosis, along with a glandular component consisting of two layers of luminal and myoepithelial tuberculosis was observed, and after the pathological examination of the surgical specimen, the diagnosis of fibroadenoma was confirmed. During the one year follow-up, the patient was alive with good general condition. Conclusion: A careful examination of any swelling in the axilla area of a woman should be considered, because even though the main breast tissue is normal, it may be caused by benign or even malignant neoplasms from the accessory breast.

IntroductionFemales seeking medical attention at breast clinics commonly present with nonmalignant breast conditions, including nonspecific breast pain or distinct masses like fibroadenomas. Due to its variability, it may be difficult to quantify breast pain. The purpose of the research was to compare centchroman and evening primrose oil to identify a cost-effective, secure, and efficient treatment for benign breast disease. Material and MethodsIn this prospective hospital-based observational study, 100 breast diseases with or without lumpiness for 1 year were included and divided into two groups with 50 cases each, Group-A (Centchroman) and Group-B (Evening primrose oil). ResultsCentchroman exhibited a significantly greater treatment response for alleviating pain-free mastalgia compared to evening primrose oil. Additionally, centchroman showed an excellent response (P < .05). Among participants with mastalgia, centchroman significantly reduced the number of mastalgia patients with tender nodularity post-treatment (P = .035) than evening primrose oil. On the basis of fibroadenoma, partial and complete response was significantly seen in higher number of cases in the centchroman group (P = .007). ConclusionCentchroman therapy demonstrates that the treatment for benign breast disease is safe, effective, and economical.

Fibroadenomas are the most common benign breast tumors in women. Giant juvenile fibroadenomas, which represent about 0.5% to 2% of all fibroadenomas, are a rare variant of these tumors. Giant juvenile fibroadenomas develop between the ages of 11 to 18 years and are usually unilateral and solitary. In the case presented, a 21-year-old woman was found to have multilobular fibroadenomas in both breasts, each with a maximum diameter of over 20 cm. The masses weighed 636 g on the right side and 752 g on the left. The patient underwent nipple-sparing mastectomy and immediate reconstruction with implant insertion in both breasts. This case is notable for the unusual size and shape of the masses, which presented considerable challenges for surgical removal and breast reconstruction. The patient was discharged without postoperative complications and remains under outpatient observation.

Non-malignant breast diseases (NMBD) may increase the risk of developing a malignant neoplasm. Therefore, it seems relevant to search for criteria for cell malignancy in NMBD. Aim of the study was to investigate the relationship between expression of proliferation and epithelial-mesenchymal transition (EMT) markers and histidine-rich glycoprotein (HRG) mRNA in breast diseases. Material and methods. In breast biopsy specimens of 37 patients with invasive carcinoma of a non-specific type (ICNT) and 17 patients with NMBD expression of proliferation markers (Ki-67, cyclin D1 (CCND1)) and EMT markers (E-cadherin (CDH1), type II collagen (CII) and β1-integrin (CD29)) was determined immunohistochemically. HRG mRNA expression was estimated using real time PCR. Results. HRG mRNA expression was detected in 91.9 % cases (34 of 37) in ICNT, 82.4 % (14 of 17) in NMBD and in the latter case was inversely related to the expression of CDH1, CD29 and Ki-67. A direct relationship has been established between the presence of Ki-67 and CCND1, CII, between CCND1 and CD29 in NMBD. In patients with ICNT, a direct correlation was found between the HRG mRNA expression and the presence of CII, and an inverse correlation between the number of cells containing CII and CD29. It was found that in ICNT and NMBD with the presence of HRG mRNA expression, the CDH1 expression is less than in its absence. Conclusions. Indicators of HRG mRNA expression in NMBD, combined with the assessment of proliferation and EMT markers, can be useful in developing criteria for cell malignancy in benign breast diseases.

Fibroadenoma of the breast most often arises during the late teens and early reproductive years. It is the most prevalent tumor in women < 30 years. After the age of 40 to 45, fibroadenomas are rarely observed as new masses in women. Fibroadenomas are made up of both epithelial and stromal components. Fibroadenoma is the most frequent type of breast tumor. It is crucial to diagnose preoperatively, both clinically and pathologically, by using F.N.A.C. Postoperatively, Fibroadenoma is confirmed histopathology. However, malignant transformation is very rare in Fibroadenoma of the breast. Early identification, accurate analysis, and appropriate management are advantageous. The current study's goal is to examine preoperative and postoperative clinicopathological aspects of Fibroadenoma and to assess any differences between preoperative and postoperative diagnosis in patients admitted to Jawaharlal Nehru Medical College, Sawangi (M), Wardha, Maharashtra, India.

Background: We evaluated the effectiveness of Ormeloxifene (Centchroman) on regression of Fibroadenoma in a double‐blind randomized controlled trial. Methods: Patients with biopsy proven Fibroadenoma were enrolled between March 2023 and October 2023 and divided in two arms‐ Ormeloxifene group and Placebo group. Effectiveness of the treatment was evaluated using USG. No residual mass was defined as complete regression and more than 30% decrease in size was considered as partial regression. Results: A total of 130 consecutive patients with Fibroadenoma were randomized to Ormeloxifene group (n = 65) and Placebo Group (n = 65). Complete regression was observed in 9% (6/65) patients in Ormeloxifene group and 10.8% (7/65) in Placebo Group at the end of 12 weeks (p = 0.49). Twenty one patients taking Ormeloxifene reported adverse events as compared to none in the other group. Conclusion: In our study Ormeloxifene was not found to be effective in treatment of fibroadenoma and had concerning side effects. [ABSTRACT FROM AUTHOR]

Vulval fibroadenoma is a rare benign tumor arising from the ectopic breast tissue or mammary-like anal glandular tissue. Although it is a common breast neoplasm, its genital location makes it notable, with less than a hundred cases being reported in the literature so far. It is commonly known to present in the reproductive age group, similar to its breast counterpart, with its histogenesis being a frequent topic of discussion. Despite being benign and largely infrequent, these vulval neoplasms continue to be important reasons for medical consultation. We present one such case of vulval fibroadenoma presenting as an enlarged lymph node in a 37-year-old female. [ABSTRACT FROM AUTHOR]

Introduction: Breast fibroadenoma in the axilla is a rare manifestation that consists of biphasic proliferation of fibromyxoid stroma without atypia or mitosis, with a glandular component consisting of two luminal and myoepithelial layers. In this study, breast fibroadenoma in the left axilla of a 45-year-old woman is presented. Case presentation: The patient was a 45-year-old woman complaining palpation of a mass in the left axilla that underwent a needle biopsy, but in the ultrasound and mammography examination, both breasts were normal and without mass. In the pathology examination of the needle biopsy specimen of the axillary mass, biphasic proliferation of fibromyxoid stroma without atypia or mitosis, along with a glandular component consisting of two layers of luminal and myoepithelial tuberculosis was observed, and after the pathological examination of the surgical specimen, the diagnosis of fibroadenoma was confirmed. During the one year follow-up, the patient was alive with good general condition. Conclusion: A careful examination of any swelling in the axilla area of a woman should be considered, because even though the main breast tissue is normal, it may be caused by benign or even malignant neoplasms from the accessory breast. [ABSTRACT FROM AUTHOR]

Objective Fibroadenomas (FAs) involved by atypia are rare. Consensus guidelines for management of FAs involved by atypia when diagnosed on image-guided biopsy do not exist because of limited data reporting surgical upgrade rates to ductal carcinoma in situ (DCIS) or invasive malignancy. Therefore, these lesions commonly undergo surgical excision. Methods This single-institution retrospective study identified cases of FAs involved by atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), and/or lobular carcinoma in situ (LCIS) diagnosed on image-guided biopsy between January 2014 and April 2023 to determine upgrade rates. Cases with incidental atypia adjacent to but not involving FAs were excluded. Results Among 1736 FAs diagnosed on image-guided biopsy, 32 cases (1.8%) were FAs involved by atypia including 43.8% (14/32) ALH, 28.1% (9/32) ADH, 18.8% (6/32) LCIS, 6.3% (2/32) LCIS + ALH, and 3.1% (1/32) unspecified atypia. The most common imaging finding was a mass. Most cases, 81.3% (26/32), underwent subsequent surgical excisional biopsy. A single case of ADH involving and adjacent to an FA was upgraded to FA involved by low-grade DCIS on excision for an overall surgical upgrade rate of 3.8%. There were no cases upgraded to invasive malignancy. For those omitting surgical excision, there was no subsequent malignancy diagnosis at the FA biopsy site over a mean follow-up of 73 months. Conclusion Cases of radiologic-pathologic concordant FAs involved by atypia have a low upgrade rate of 3.8% and should undergo multidisciplinary review. Larger multi-institutional analysis is needed to determine whether guidelines for excision of atypia should apply to atypia involving FAs. [ABSTRACT FROM AUTHOR]

Background & Objective: p16 has different roles in the nuclear and cytoplasmic locations. The nuclear localization of the p16 protein explains its role in cell cycle regulation. Cytoplasmic expression was considered an artifact in the initial years, but there is evidence to prove that cytoplasmic localization is real and that p16 has different roles in the nuclear and cytoplasmic locations. We aimed to study the immunoexpression of p16 protein in the nuclear and cytoplasmic locations of the epithelial and stromal compartments of fibroadenoma, invasive breast carcinoma, and a select number of phyllodes tumors. Methods: The study included a total of 107 patients, comprising 51 cases of invasive breast carcinoma, 51 cases of fibroadenoma, 4 cases of benign phyllodes tumors, and 1 case of lobular carcinoma in situ (LCIS). The p16 immunohistochemistry was evaluated for nuclear and cytoplasmic localization in the epithelial and stromal compartments of the tumors. Results: Of the 51 fibroadenoma cases, 23 showed strong nuclear p16 epithelial expression, but no case showed cytoplasmic expression. In 19/51 cases, stromal cells also showed strong p16 nuclear expression. Moderate stromal p16 expression was observed in 3 out of 4 cases of benign phyllodes. Out of the 51 cases of invasive carcinoma, 31 showed moderate to strong nuclear p16 immunopositivity, while 27 cases exhibited cytoplasmic p16 expression. We found a statistically significant correlation between moderate to strong nuclear p16 immunoexpression and the molecular subtype of breast carcinoma. Conclusion: The cytoplasmic localization of p16 immunohistochemistry is not seen in epithelial components of fibroadenoma, while it is seen frequently in breast carcinoma. Nuclear p16 expression has a statistically significant correlation with molecular subtypes of breast carcinoma. [ABSTRACT FROM AUTHOR]

Background. Fibroadenoma (FA) and benign phyllodes tumor (PT) of the breast often have similar appearances on imaging. While an exact diagnosis of biopsy specimens is required to choose adequate treatment, including surgical procedures, it is sometimes difficult to pathologically differentiate these 2 tumors due to histological resemblances. To elucidate markers for distinguishing FA from benign PT, we analyzed clinical samples immunohistochemically. Methods. We retrospectively investigated 80 breast fibroepithelial lesions. As a discovery set, 60 surgical excision samples (30 FA and 30 benign PT) were examined. Twenty biopsy samples (10 FA and 10 benign PT) were examined as a validation set. To determine targets for immunohistochemistry, we first tested some proteins based on previous reports. As a result, Ki67 was chosen for differentiating FA and PT; thus further examinations were conducted with this protein. Results. Among the proteins examined, stromal Ki67 was significantly higher in PT than in FA. Benign PT had significantly higher stromal Ki67 expression both at random and at hotspots (p <.001 and <.001, respectively). The receiver operating characteristic curve analysis identified 3.5% and 8.5% (at random spots and hotspots, respectively) as the optimal cutoff values of stromal Ki67 for distinguishing between these 2 tumors. In the validation cohort employing needle biopsy specimens, we confirmed that these 2 cutoff values properly classified these 2 tumors (p =.043 and.029, respectively). Conclusion. We revealed that stromal Ki67 might be a potential marker for distinguishing FA from benign PT. [ABSTRACT FROM AUTHOR]

Introduction: Breast carcinoma is leading cause of cancer death in women. Breast lesions constitute heterogeneous group of diseases with wide variety of etiologies ranging from inflammatory-benign- malignant lesions. There are several reported markers for immunohistochemical detection of myoepithelial cells. Smooth muscle specific proteins, such as smooth muscle actin, smooth muscle myosin heavy chain, calponin and h-caldesmon are used to highlight myoepithelium. p63 antibody is myoepithelial cell marker that selectively stains nuclei. It is negative in stromal, myofibroblastic and adipocytic cells. Aims and Objectives: The aim of this study was to establish role of p63 expression in distinguishing benign breast lesions, premalignant lesions and malignant tumors of breast. Materials and Methods: 30 cases were selected from core biopsy, lumpectomy and mastectomy specimens of breast received at department of Pathology, Chalmeda Anand Rao Institute of Medical Sciences during the period of January 2021 to December 2021 and were studied prospectively. All specimens were processed according to CAP protocol and reported . Immunohistochemistry was performed to determine p63 expression in those specimens. p63expression was evaluated as continuous positive/discontinuous positive/negative. Ethical Approval: This study was reviewed and approved by institute ethics committee, CAIMS, Karimnagar. Results: Among total 30 cases, 18 cases (60%) were benign lesions and all were positive for p63 expression. 3 cases (9.99%) were premalignant and were least positive for p63 expression. All malignant cases 9 cases (29.99%) were negative for p63 expression. Conclusion: The Positive correlation was seen between histomorphological features and p63 scoring in all the lesions, So p63 is good Immunohistochemical marker for evaluating breast lesions. [ABSTRACT FROM AUTHOR]

Copyright of Ginecología y Obstetricia de México is the property of Federacion Mexicana de Ginecologia y Obstetricia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Phyllodes tumours (PTs) are rare fibroepithelial lesions of the breast that are classified as benign, borderline, or malignant. As little is known about the molecular underpinnings of PTs, current diagnosis relies on histological examination. However, accurate classification is often difficult, particularly for distinguishing borderline from malignant PTs. Furthermore, PTs can be misdiagnosed as other tumour types with shared histological features, such as fibroadenoma and metaplastic breast cancers. As DNA methylation is a recognised hallmark of many cancers, we hypothesised that DNA methylation could provide novel biomarkers for diagnosis and tumour stratification in PTs, whilst also allowing insight into the molecular aetiology of this otherwise understudied tumour. We generated whole‐genome methylation data using the Illumina EPIC microarray in a novel PT cohort (n = 33) and curated methylation microarray data from published datasets including PTs and other potentially histopathologically similar tumours (total n = 817 samples). Analyses revealed that PTs have a unique methylome compared to normal breast tissue and to potentially histopathologically similar tumours (metaplastic breast cancer, fibroadenoma and sarcomas), with PT‐specific methylation changes enriched in gene sets involved in KRAS signalling and epithelial‐mesenchymal transition. Next, we identified 53 differentially methylated regions (DMRs) (false discovery rate < 0.05) that specifically delineated malignant from non‐malignant PTs. The top DMR in both discovery and validation cohorts was hypermethylation at the HSD17B8 CpG island promoter. Matched PT single‐cell expression data showed that HSD17B8 had minimal expression in fibroblast (putative tumour) cells. Finally, we created a methylation classifier to distinguish PTs from metaplastic breast cancer samples, where we revealed a likely misdiagnosis for two TCGA metaplastic breast cancer samples. In conclusion, DNA methylation alterations are associated with PT histopathology and hold the potential to improve our understanding of PT molecular aetiology, diagnostics, and risk stratification. © 2024 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland. [ABSTRACT FROM AUTHOR]

Infiltrating epitheliosis (IE) is an uncommon type of complex sclerosing lesion in the breast. This condition is characterized by the infiltration of ducts into a scleroelastotic stroma, along with the presence of cells that display architectural and cytological patterns similar to those observed in usual ductal hyperplasia. We herein report a case of a 24-year-old woman who presented with bilateral breast nodules, which were initially identified as multiple fibroadenomas based on ultrasound findings. The patient underwent Mammotome system and regional mastectomy procedures, and subsequent pathological analysis confirmed the presence of multiple fibroadenomas with atypical ductal hyperplasia and infiltrating epitheliosis. This case discusses the challenges faced in diagnosing malignancy in a patient with multiple fibroadenomas accompanied by atypical ductal hyperplasia and infiltrating epitheliosis. [ABSTRACT FROM AUTHOR]

The axilla is a triangular area situated anatomically beneath the shoulder joint, between the upper arm and thorax. It contains lymph nodes and numerous non lymphatic tissues such as neurovascular structures, muscle, and fat. Axillary swellings can arise from any of these mesenchymal soft tissues. Fine Needle Aspiration Cytology (FNAC) is the first-line investigative technique widely used in evaluating axillary swellings, as it is a simple outpatient procedure that causes minimal complications, unlike core biopsy, which is invasive and carries a high-risk of bleeding. Hereby, the authors present a case series of four unusual cases: bilateral accessory breast tissue (32-year-old female), bilateral galactocele (28-year-old female), unilateral galactocele (24-year-old female), and fibroadenoma (35-year-old female) in the axilla, all of which were cytomorphologically diagnosed with the aid of FNAC. Axillary lumps can present with a variety of unusual lesions and can pose a significant diagnostic challenge to a clinicians. Although histopathology of the biopsy of the lesion remains the gold standard, clinical features along with imaging can aid in the diagnosis with better patient compliance.

Abstract Background Phyllodes tumours (PT) of the breast are rare primary breast neoplasms, mostly seen in fourth to fifth decades of life. These tumours are exceptionally rare in children and young females. The clinico-radiological features often overlap with fibroadenoma. Though imaging plays a pivotal role in providing an initial diagnostic approach, the final confirmation is dispensed on histopathology, which further classifies PT into either benign, low-grade malignant (borderline), or high-grade malignant. On reviewing the literature, only 20 cases have been reported so far in young females, with majority of them being benign and very few numbers of malignant PT. Case presentation Herein, we report the clinical and imaging features of PT in four young females, of benign, borderline and high-grade malignant categories as confirmed on histopathology, thereby adding few more numbers to the already existing cases. Additionally, our fourth case depicts rare presentation of high-grade malignant recurrent PT in adolescent female with nodal and unilateral ovarian metastases. Conclusions In conclusion, a possibility of PT should be considered in differential diagnosis in a large rapidly enlarging breast mass even in young females with characteristic imaging features, as it alters the plan of management.

Phyllodes tumors of the breast are rare fibroepithelial neoplasms that account for less than 1% of all breast tumors. They tend to affect middle-aged women, who present with a rapidly growing, palpable mass. Here we present a case of a 34-year-old female surrogate mother without any reported personal or family history of breast cancer who presented with a rapidly growing left breast mass, pathologically proven to be a phyllodes tumor. The patient was a G7P7 surrogate mother who received estrogen and progesterone injections for her twin surrogate pregnancy starting 4 months before embryo implantation, after which, she discovered a large palpable mass in the left breast at approximately week 7 gestational age. At the initial presentation, the patient was at week 23 gestational age. She underwent C-section delivery of the twins at this time and obtained further work-up of the mass. She had a core needle biopsy which yielded a benign fibroepithelial tumor. Due to the size of her breast mass and atypical morphology, including extension to the nipple, and skin ulceration, the patient subsequently underwent left mastectomy. At the time of mastectomy, which was 8 months after the initial work-up, the mass had grown to measure approximately 12 × 10 cm on physical examination and took up most of her left breast. It was completely resected and was pathologically determined to be a borderline phyllodes tumor. Only a few cases have been reported about the development of phyllodes tumor during pregnancy in the literature, and we believe this is the first case report of phyllodes tumor related to a surrogate pregnancy. Although the relationship between exogenous hormones and fibroepithelial tumors is not well understood, the case poses the clinical question if screening mammograms should be offered to patients undergoing exogenous hormonal therapy, regardless of age to establish a baseline and monitor for the development (if any) or growth of these tumors.

Introduction: Regular ultrasonographic check-ups help in early detection and follow-up of different diseases. Ultrasonography (US) is of the utmost diagnostic importance for mammographically "dense breasts", where glandular tissue is predominant, while in so-called "fat breasts" it is less reliable. It is used to determine the solid or cystic nature of a lesion, often tissue characterization, and the Doppler technique could reveal vascularization characteristics of the mass. Fibroadenomas are the most common benign breast tumors in women of all ages until menopause, with the highest incidence between 15 and 25 years of age. The US detects distinctly circumscribed, rarely round or lobular, hypoechoic masses with smooth and flat contours, uniform echoes with posterior augmentation, and marginal echo fading. Case report: We presented a female patient aged 21, who had multiple lesions in both breasts (25 lesions in total). Ultrasonographic exams were performed multiple times, in the last 5 years, and magnetic resonance (NMR) was done twice. Histopathologic verification diagnosed fibroadenomas. The biggest masses were surgically removed four times in this patient. What are the next steps? Are surgical interventions needed again, and if not how should she be followed up in the future? Is the implant insertion eligible for the sake of esthetic correction? Conclusion: Ultrasonography is a very significant and important method of follow-up of breast lesions. Mammography and magnetic resonance are used as complementary methods. According to a radiologist's expert opinions on breast diseases, ultrasonographic exams every six months and NMR may indicate the need for surgical intervention, especially if new lesions are detected or existing lesions are growing fast.

This case report presents the surgical management of a fibroadenoma in the left breast of a Nineteen-year-old female. The patient was exposed with the complaint of a palpable lump in her left breast, prompting further investigations. Ultrasonography revealed the presence of a lesion consistent with fibroadenoma. Subsequently, the patient underwent surgical excision of the lesion to alleviate discomfort and address diagnostic concerns. The procedure involved a Circumareolar incision followed by meticulous dissection and excision of the fibroadenoma lump. Postoperative evaluation confirmed successful removal of the lesion with resolution of associated symptoms. This case uplifts the importance of prompt diagnosis and appropriate management of benign breast masses in young patients to alleviate anxiety and ensure optimal positive outcomes. [ABSTRACT FROM AUTHOR]

Background: Phyllodes tumours (PT) of the breast are rare primary breast neoplasms, mostly seen in fourth to fifth decades of life. These tumours are exceptionally rare in children and young females. The clinico-radiological features often overlap with fibroadenoma. Though imaging plays a pivotal role in providing an initial diagnostic approach, the final confirmation is dispensed on histopathology, which further classifies PT into either benign, low-grade malignant (borderline), or high-grade malignant. On reviewing the literature, only 20 cases have been reported so far in young females, with majority of them being benign and very few numbers of malignant PT. Case presentation: Herein, we report the clinical and imaging features of PT in four young females, of benign, borderline and high-grade malignant categories as confirmed on histopathology, thereby adding few more numbers to the already existing cases. Additionally, our fourth case depicts rare presentation of high-grade malignant recurrent PT in adolescent female with nodal and unilateral ovarian metastases. Conclusions: In conclusion, a possibility of PT should be considered in differential diagnosis in a large rapidly enlarging breast mass even in young females with characteristic imaging features, as it alters the plan of management. [ABSTRACT FROM AUTHOR]

To investigate the utility of whole-tumor histogram analysis based on multiparametric MRI in distinguishing pure mucinous breast carcinomas (PMBCs) from fibroadenomas (FAs) with strong high-signal intensity on T2-weighted imaging (T2-SHi). The study included 20 patients (mean age, 55.80 ± 15.54 years) with single PBMCs and 29 patients (mean age, 42.31 ± 13.91 years) with single FAs exhibiting T2-SHi. A radiologist performed whole-tumor histogram analysis between PBMC and FA groups with T2-SHi using multiparametric MRI, including T2-weighted imaging (T2WI), diffusion weighted imaging (DWI) with apparent diffusion coefficient (ADC) maps, and the first (DCE_T1) and last (DCE_T4) phases of T1-weighted dynamic contrast-enhanced imaging (DCE) images, to extract 11 whole-tumor histogram parameters. Histogram parameters were compared between the two groups to identify significant variables using univariate analyses, and their diagnostic performance was assessed by receiver operating characteristic (ROC) curve analysis and logistic regression analyses. In addition, 15 breast lesions were randomly selected and histogram analysis was repeated by another radiologist to assess the intraclass correlation coefficient for each histogram feature. Pearson's correlation coefficients were used to analyze the correlations between histogram parameters and Ki-67 expression of PMBCs. For T2WI images, mean, median, maximum, 90th percentile, variance, uniformity, and entropy significantly differed in PBMCs and FAs with T2-SHi (all P < 0.05), yielding a combined area under the curve (AUC) of 0.927. For ADC maps, entropy was significantly lower in FAs with T2-SHi than in PMBCs (P = 0.03). In both DCE_T1 and DCE_T4 sequences, FAs with T2-SHi showed significantly higher minimum values than PBMCs (P = 0.007 and 0.02, respectively). The highest AUC value of 0.956 (sensitivity, 0.862; specificity, 0.944; positive predictive value, 0.962; negative predictive value, 0.810) was obtained when all significant histogram parameters were combined. Whole-tumor histogram analysis using multiparametric MRI is valuable for differentiating PBMCs from FAs with T2-SHi. • In clinical practice, fibroadenomas (FAs) with high-signal intensity on T2WI are easily confused with pure mucinous breast carcinomas (PMBCs). • Whole-tumor histogram parameters derived from T2WI, ADC, and DCE could distinguish PMBCs from FAs with T2-SHi. • Satisfactory diagnostic performance was obtained when all significant histogram parameters derived from multiparametric MRI were combined. [ABSTRACT FROM AUTHOR]

Fibroadenomas are the most common benign breast disorders. The aim of this study was to identify the clinical and therapeutic aspects of fibroadenoma in the obstetric gynecology department and General Surgery of Teaching hospital Gabriel TOURE in Bamako Mali. Patients and Methods: The study was descriptive with retrospective data collection from July 1, 2018 to July 31, 2021. The records of patients treated for fibroadenoma were included in accordance with ethical principles guaranteeing anonymity and confidentiality of data. Results: A total of 112 patients were selected for the study period, representing 15. 9% of all breast pathologies. We recorded 642 cases of breast mass, with fibroadenoma accounting for 16.72% of these breast tumors. Among all 154 benign breast tumors, fibroadenoma accounted for 72%. The mean age was 27 years, with a standard deviation of 14.8 years (13 years and 62 years). The 20-35 age group was the most represented, at 44%. The frequency of fibroadenoma decreased with increasing gestational age and parity. Over 60% of patients were overweight. The main reason for consultation was the presence of breast swelling. Unilateral left breast swelling was predominant in 46% of cases, and location in the upper-outer quadrant accounted for 50%. Surgical excision was the most frequent management modality, accounting for 56,2% of cases. Conclusion: fibroadenoma of the breast are a fairly common benign condition. Diagnosis requires surveillance. Surgical treatment should be discussed according to age, size and the presence of risk factors for malignancy. [ABSTRACT FROM AUTHOR]

Background: Fibroadenoma, a type of fibroma, is the most common benign neoplasm found in the breast. It is predicted that around 10% of females globally may experience the development of fibroadenoma at some stage in their lives. Fibroids seldom become malignancies, about 5% of all cases. Fibroadenoma etiology is uncertain. However, levels of estrogen influence fibroadenomas. Objectives: The objectives of this study were to explore the epidemiological aspects of breast fibroadenoma. Patients and Methods: A cross-sectional study was conducted in the breast examination clinic at Al-Imamaein Al-Kadhimaein Medical City in Baghdad/Iraq. It included 260 female participants aged 15--35 years, diagnosed by specialists with breast fibroadenoma. A modified four-part questionnaire was used to obtain data from participants which includes sociodemographic, breast fibroadenoma risk factors, clinical presentation, and diagnostic intervention. Results: Participants had a mean age of 27.3 ± 6.05 years. It was found that 37.7% of participants were overweight women, 35.8% had a family history of fibroadenoma. The most common presentation was pain presented in 38.1%. Conclusions: The fibroadenomas that developed in the current study sample tended to increase in the second and third decades, notably among nulliparous and nonlactating women. Most participants were overweight with left-sided pain and lumps. [ABSTRACT FROM AUTHOR]

The molecular pathogenesis of breast fibroepithelial tumors continues to be elucidated. Recently, highly recurrent MED12 mutations arising in exon 2 at codon 44 were discovered in fibroadenomas and phyllodes tumors. In addition, a high prevalence of TERT promoter mutations in two hotspots (124 and 126 bp upstream from the translation start site) was discovered in up to 65% of phyllodes tumors. Breast periductal stromal tumors are a potentially distinct category of fibroepithelial lesions that are exceptionally rare with controversial classification and pathogenesis. Herein, we report the first comprehensive molecular genetic workup of a breast periductal stromal tumor that harbored a TERT promoter −124C > T mutation, supporting a relation to phyllodes tumors. [ABSTRACT FROM AUTHOR]