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Breast cases

Breast cases. ARC 5, VI PAIRS meeting Hammamet-TUNISIA 27 April 2012. S.Mezghani - boussetta , S.Kechaou *, S.Melliti , M.Gadri , M.Chaabene * Ben Arous , Ariana *, TUNISIA. About breast Stellate images. CASE N°1. CLINICAL FUNDINGS. A 49-year-old woman G3, P2

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Breast cases

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  1. Breastcases ARC 5, VI PAIRS meeting Hammamet-TUNISIA 27 April 2012 S.Mezghani- boussetta ,S.Kechaou*, S.Melliti, M.Gadri, M.Chaabene* Ben Arous , Ariana*, TUNISIA

  2. About breastStellate images

  3. CASE N°1

  4. CLINICAL FUNDINGS • A 49-year-old woman • G3, P2 • no personal or familyriskfactors of breast cancer • a skin retraction of the union of lower quadrant of the right breast • Physical examination: a 5 x 5mm firm nodule in front to the skin retraction was palped (sub-mammary fold) • No other abnormalities were found (neither nipple discharge nor axillaryadenopathy)

  5. mammography Medio-lateralviews

  6. Cranio-caudal views)

  7. Lateralviews

  8. Spot compression focalizedat UQ in CC view of the right breast

  9. ultrasound

  10. Case N°1 A spiculated dense center mass with skin retraction No calcification Hypoechoic mass with long thick spicules

  11. Case N°1 • Classification on the BIRADS OF ACR • ACR4 ? • ACR 5? • Managment? • Surveillance • Cytology • Needlecorebiopsy • Surgical biopsy

  12. Case N°2

  13. Clinicalpresentation • A single 26 year-oldwomanwith no personal or familyriskfactors of brest cancer • Presentedwith a right paraareolar skin retraction • Physicalexaminationshowed no otherabnormalities.

  14. BREAST uLTRASOUND Irregularill-definedhypoechoicpre- pectoral mass

  15. T2 Breastmri A spiculatedtissular mass associated to an architectural distorsion T1 gado T1

  16. BREAST MRI A slow progressive and continuousincreaseenhancement

  17. Case 2 A 26- year-oldwoman A spiculatedtissular mass witharchitectural distorsion of the right breastinfiltrating the pectoral muscle Right Breast: ACR 5, Leftbreast ACR 1 needlecorebiopsyguided by ultra-sound

  18. Case n° 3

  19. Clinicalpresentation Healthy 42-year-old man No history of trauma or prior surgery to the chest wall Presentedwithself detected right breast mass. Physical examination: a 1 cm hard nodule in union of inner quadrants was palped No axillaryadenopathy were found

  20. Mammography and us An ill-defined and spiculatedmargins mass thatwasmarkedlyhypoechoicwith good sonic transmission RB: ACR 5 ,LB: ACR 1 Cytology / needlecorebiopsyguided by ultrasound

  21. Commentaries Patients: woman (2), male (1) Age: 49,26,42 year-old clinicalfindings and imagingfeaturessuspiciousbreastlesions: • firm or hard masses ± skin retraction • stellate masses • no calcification • Architectural distorsion • no adenopathy

  22. Stellate images Malignantstellate images Benignstellate images (3,6%)* False stellate image Post operativescars Inflammatorypseudo-tumors Various types of tumors: Hyalinizedfibroadenomawithfibrosis Fibromatosis Granularcelltumor Fibrocysticdisease: sclerosing changes, sclerosisadenosis, radial scar+++ • Invasive ductalcarcinomawithfibrosis+++ (reactive stroma: fibrosis and elastosis) • Tubularcarcinoma± radial scar what about the 3 cases thatwe are presented ? * 72/1978: 3,6%

  23. PATHOLOGY of micro-biopsy( patient 1/2/3) Pathologyrevealed a fuso-cellular proliferationwithoutnuclearatypia or increasedmitoticactivitysuggesting fibromatosis

  24. Treatement • A wirelocalizationguided by ultrasoundwas made (Patient 2) • A widesurgical excision with wide margins was performed (patients 1/2/3), (excision of the pectoral muscle for patient 2) • Patients (2/3) evolved favorably and respectively 15 and 24 months after with no showed signs of local recurrence Patient 3 : macroscopy of surgical tumoral excision specimen

  25. Histopathologicfindings Immunohistochemistry for smooth muscle actin: Fusocellularproliferationpositive to smooth muscle actin Immunohistochemistry for vimentin Fusocellularproliferationpositive to vimentin

  26. Breastfibromatosis • Breastfibromatosis: desmoidtumorsof the breast • Uncommonbenignbreastlesion; • 0,2% primarybreasttumor; • A proliferation of fibroblastrich in collagenwithoutatypiawithill-definedbordershavingstellate extensions in the fatty tissue • Meanagefor diagnosis: 35 -50,3 (37) years • occurs predominantly in women, it can rarely affect the male breast

  27. Breastfibromatosis • The etiology: unknown • Sporadic cases+++ • the main risk factor: trauma, after surgical procedures (breast implant) • Rarely, breastfibromatosisrelatedwithFAP,gardner syndrome

  28. Breastfibromatosis • A potential for local infiltration and recurrence, so excision must cover a large area, no metastaticpotential • The clinical and radiologicfindingsthink for carcinoma; • A Firm palpable mass suspicious of malignancy • Adherence to the chestwall, dimpling or skin retraction • irregularshape ,highdensity, spiculatedmarginswithout calcifications • A solidmicrolobulated or spiculated mass on ultrasoundhypoechoicwithechogenicrim, irregularmargin, no posterioracousticshadowing, a straightening of the cooper ligament

  29. A table summarizing radio-clinicalfindings for 5 cases referredat RegionalHospital of Ben Arous and Ariana*

  30. Breastfibromatosis • MRI: to determinewithaccuracy the boundaries of the tumor and chestwallinvolvment • Differentialdiagnosis on cytologyexamination: Nodular fasciitis (NF), Scarbiopsy site reaction, Metaplasticcarcinoma, Fibrosarcoma, Low-grade fibromyxoidsarcoma(LGFS), Smooth muscle tumors(SMTs), Benign neural tumors (BNTs). • The treatment of choice: a primarysurgical excision withwideclearmargins (reduce the recurrence rate)

  31. conclusion • The breastfibromatosis: • an extremely rare benigntumor • Must beadded to the differentialdiagnosis of breastlesionwithclinical and radiologicalsigns of malignancy • Can onlybeconfirmed by histologicalstudy • A potential for local infiltration and recurrence, so excision must cover a large area

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