Preoperative and intraoperative diagnosis of low-grade adenosquamous carcinoma of the breast: Potential diagnostic pitfalls
ABSTRACT Low-grade adenosquamous carcinoma (LGAC), a rare variant of metaplastic breast cancer, may mimic benign or other low-grade malignant lesions histologically. Diagnostic difficulty may be encountered when evaluating breast cytology, core needle biopsy or intraoperative frozen section specimens.
Pathology reports, cytology aspirates and histological slides of LGAC diagnosed at the Department of Pathology, Singapore General Hospital, were reviewed. Four cases of LGAC were analysed. Cytology from the first case showed atypical cells and the subsequent surgical excision specimen showed a complex sclerosing lesion with LGAC. The second and third cases were investigated by core needle biopsies: the preoperative histological features were suggestive of but not diagnostic of LGAC, until further excision biopsies were performed. The fourth case entailed a frozen section specimen, for which definitive diagnosis was deferred to paraffins. The patients remained well with no evidence of recurrent disease to date.
When limited material, in the form of needle aspirates, core biopsy specimens or frozen sections, is submitted for histology, making a diagnosis of LGAC is not only challenging, but may be impossible. In difficult cases, careful pathological assessment, clinicopathological correlation and follow-up or complete excision biopsy may prove invaluable in establishing a definitive diagnosis.
- SourceAvailable from: Adriano Oliveira Torres de Carrasco
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- "Apesar da alta incidência de tumores de mama em mulheres , o tipo histológico de carcinoma adenoescamoso é raro. O carcinoma adenoescamoso de mama em geral é caracterizado por ser bem circunscrito, integrante do grupo dos carcinomas metaplásicos, associados à mutação do antioncogene BRCA1 e ao bom prognóstico (Ho et al 2006, Geyer et al. 2010, Noël et al. 2010). Independente do tipo histológico, tanto em mulheres como em outros animais como cadelas, gatas e possivelmente em primatas não humanos , o tratamento para as neoplasias malignas de mama deve ser realizado de forma precoce para a obtenção de melhor prognóstico (Gomes 1997, Lana et al. 2007, Morris & Dobson 2007). "
ABSTRACT: Mammary tumors in non-human primates are rare. The aim of this paper is to report the occurrence and treatment outcomes of a female Cebus sp. (fam. Cebidae) with high-grade mammary carcinoma received at the Serviço de Atendimento de Animais Selvagens (SAAS), Universidade Estadual do Centro-Oeste. A right mammary gland nodule was identified and at radiographic examination a point of radiopacity due to gun projectile entrapped within the mammary mass was seen. After the patient stabilization, the mass was excised and submitted to histopathological examination. The diagnosis was of high-grade carcinoma, compatible with adenosquamous carcinoma. The monkey was transported to Wild Animals Treat and Receiving Center (CETAS) and introduced into a colony. More than 20 months after surgery no evidence of relapse was seen and the patient is living with the group. That suggests that the adopted therapy was effective, achieving quality of life and increased survival.Pesquisa Veterinária Brasileira 01/2013; 33(1):99-104. DOI:10.1590/S0100-736X2013000100018 · 0.44 Impact Factor
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- "However, due to the inherent limitations of the core biopsy, diagnostic excision was recommended by the histopathologist. Ho et al  have demonstrated in their small series of four cases that limited material in fine needle aspiration/core biopsy does not yield enough material for confirmatory histopathological diagnosis. "
ABSTRACT: Adenosquamous carcinoma of the breast is a rare form of metaplastic breast carcinoma. We report such a case in a 19 years old female. Case notes and histopathology were reviewed. Adenosquamous carcinoma was diagnosed on wide local excision and patient underwent skin-sparing mastectomy with Latissimus dorsi flap reconstruction. Adenosquamous carcinoma of the breast is a rare form of metaplastic breast carcinoma. Data on correct management, follow-up and prognosis are very limited but given the high potential for local recurrence, aggressive surgery may be the only option.World Journal of Surgical Oncology 05/2010; 8(1):44. DOI:10.1186/1477-7819-8-44 · 1.20 Impact Factor
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ABSTRACT: The widespread use of mammographic breast screening and the introduction of even more sensitive radiological techniques have placed increasing demands upon the pathologist for the accurate diagnosis and histological categorisation of screen-detected lesions. Subsequent management algorithms rely on correct pathological classification. Needle core biopsy (NCB) has become the mainstay of non-operative diagnosis in many Breast Units. However, despite good specificity and sensitivity, there remain lesions that are particularly challenging on NCB. This may be because they can mimic invasive carcinoma or because there is a risk of associated carcinoma. Particular areas of difficulty arise as a result of the focal nature of sampling inherent with biopsy specimens. Troublesome lesions include atypical epithelial proliferations, sclerosing lesions and radial scars, papillary, columnar cell and apocrine lesions and lobular in situ neoplasia. Immunohistochemistry can be helpful in clarifying the nature of some of these lesions in NCB material but subsequent management nevertheless often remains controversial. Finally, special type invasive carcinomas such as lobular and metaplastic cancers and non-primary malignancies such as lymphoma and metastasis can be misdiagnosed in the limited material of a NCB, particularly if not considered in the differential diagnosis. Good communication between clinician, radiologist and pathologist is especially important in the breast screening setting, in order to avoid misdiagnosis, ensure correct categorisation of NCB samples and to ensure optimum patient care.Pathology 02/2009; 41(1):3-17. DOI:10.1080/00313020802563478 · 2.62 Impact Factor