Ruth Rosenblatt

Fibromatosis of the Breast: Case Report and Current Concepts in the Management of an Uncommon Lesion

Abstract:u2003 Fibromatosis is an uncommon breast lesion that can mimic breast carcinoma in its clinical presentation. We present a case in which excisional biopsy was necessary to establish a diagnosis of fibromatosis. Clinical, diagnostic imaging, and pathologic features are discussed. Magnetic resonance imaging (MRI) has emerged as a tool for further characterization of breast lesions and as a screening modality in high‐risk patient populations. Ours marks the second case in which dynamic MRI has been correlated with histologically confirmed primary mammary fibromatosis. Unlike the previous report, MRI in this case mimics breast carcinoma in its morphologic and pharmacokinetic features of enhancement. Wide local excision with clear margins remains the treatment of choice. Current data on radiotherapy and pharmacologic therapy for mammary fibromatosis are reviewed.u2002

Focal angiographic changes of cerebral lymphoma with pathologic correlation. A report of two cases.

Direct serial magnification angiography improves vascular detail so that changes which appear to involve the smaller intracerebral vessels will be observed. Two cases of primary intracerebral lymphoma are presented, and the histological perivascular involvement within the lesion is correlated with the angiographic findings. Two patterns of lymphoma involvement may occur: a localized but not encapsulated mass with the gross appearance of a glioma and a diffuse cellular infiltration with cerebral swelling resembling encephalitis.

Arterial Wall Irregularities in Intracranial Neoplasms: The Shaggy Vessel Brought into Focus

Abstract Shaggy vessels were observed in patients with various brain neoplasms, such as glioblastoma multiforme, astrocytoma, medulloblastoma, metastases, and lymphoma. The vascular aberrations are usually confined to a single artery or group of arteries within the mass. Non-contiguous vessels may be involved when the mass is diffuse. Other lesions which primarily produce shaggy vessels are arteritis and meningitis. In these instances the vascular changes are usually diffuse and not within a mass.

Screening Mammography for Women in Their 40s: A Retrospective Study of the Potential Impact of the U.S. Preventive Service Task Force's 2009 Breast Cancer Screening Recommendations

OBJECTIVEnThe objective of our study was to review screening mammography examinations performed at our institution from 2007 through 2010 with the primary endpoint of determining the incidence of breast cancer and associated histologic and prognostic features in women in their 40s.nnnMATERIALS AND METHODSnPatients who presented for screening mammography who ultimately (i.e., after additional imaging, including diagnostic mammographic views and ultrasound) received a BI-RADS assessment of a category 4 or 5 for a suspicious abnormality were followed retrospectively through completion of care and were analyzed with respect to pathology results after biopsy, treatment, and family history.nnnRESULTSnDuring the study period, 43,351 screening mammography examinations were performed; 1227 biopsies were recommended on the basis of those studies and yielded 205 breast cancers (cancer detection rate of 4.7 per 1000 screening examinations). These screening examinations included 14,528 (33.5%) screening examinations of patients in their 40s; 413 biopsies were recommended and yielded 39 breast cancers (39/205 = 19%) (cancer detection rate of 2.7 per 1000 screening examinations). More than 50% (21/39) of the cancers in women in their 40s were invasive. Only 8% (3/39) of the women in their 40s with screening-detected breast cancer had a first-degree relative with breast cancer.nnnCONCLUSIONnFrom 2007 through 2010, patients in their 40s accounted for one third of the population undergoing screening mammography and for nearly 20% of the screening-detected breast cancers--more than half of which were invasive. This information should be a useful contribution to counseling women in this age group when discussing whether or not to pursue regular screening mammography.

Seroma is an Expected Consequence and not a Complication of MammoSite Brachytherapy

Abstract:u2002 Seroma has long been listed as a complication of MammoSite brachytherapy. Palpable abnormalities are clinically apparent months after treatment and a vast majority of patients demonstrate seroma formation in radiologic studies. We embarked on this study to evaluate the actual sonographic incidence and eventual sonographic resolution, possible contributing factors, cosmesis, pain, and local control associated with seroma formation after MammoSite partial breast irradiation (PBI). We investigated 160 patients who underwent MammoSite PBI from 2002 to 2006 of whom 100 patients had serial sonographic information. Clinical and tumor variables, infection, pain, and cosmesis were investigated. Dosimetric data including volume of balloon, dose at balloon surface, and at skin were analyzed. After a median follow‐up of 36u2003months, the incidence of sonographically confirmed post‐radiation seroma was 78% within the first 1u2003year following radiation and steadily decreased with time. The average size of a seroma cavity was 2.3u2003cm (range 0.6–6u2003cm) with a decline to an average of 1.4u2003cm after 1u2003year, with complete resolution in 65% of patients at 2u2003years. No statistically significant correlation was found between patient characteristics, tumor variables, and volumetric or dosimetric data for seroma formation. Excellent/good cosmetic scores were achieved in 94% of women with and 92% without seroma. Local control was equivalent between patients with and without seroma. Consecutive sonographic imaging reveals a high rate of seroma formation after MammoSite PBI, with resolution in 65% of patients by 2u2003years without intervention. Seroma formation does not prevent an excellent cosmetic result or alter local control.

Quantitative assessment of radiation-induced fibrosis of the breast with tissue compliance meter, palpation, and radiological imaging: preliminary results.

Abstract:u2002 Quantification of radiation (RT)‐induced fibrosis (RIF) continues to present a challenge in breast cancer survivors. We compare assessment of RIF by palpation and tissue compliance meter (TCM) to the radiological findings in women treated with RT. Of 300 patients treated with adjuvant RT, 17 women had ≥2‐year follow‐up sufficient to document RIF. Palpation and TCM were employed by three radiation oncologists in a blinded fashion. Palpation grades 1, 2, and 3 denoted mild, moderate, and severe RIF. TCM measured degree of compliance (DC) of RIF in irradiated (RTB) and nonirradiated breasts (NRTB). Architectural distortions (AD) on mammograms, ultrasound (US), and MRI were assessed. Median time of follow up was 3.9u2003years (range 2.1–6.5u2003years). Palpation revealed RIF grades 1, 2, and 3 in four, 10, and three patients, respectively. Mean percent changes (PC) in DC between RTB and NRTB by TCM were 19.5%, 37.1%, and 57.5% for grades 1, 2, and 3 RIF, respectively (pu2003<u20030.0001). There was a strong linear correlation between palpation grade and PC of DC by TCM (spearman‐rank correlation=0.88, pu2003<u20030.0001). Interobserver variability (reliability) was computed using intraclass correlation coefficient (ICC) for TCM and kappa statistic for clinical palpation (ICC=0.99 [pu2003<u20030.0001] and kappa=0.70 [pu2003<u20030.0001], respectively). There was no correlation between average size of the AD as measured by the imaging modalities and RIF as assessed by palpation or TCM. Our preliminary data suggest that quantification of RIF is best with TCM. TCM results correlate better with palpation than with radiological imaging. The study with larger number of patients required to confirm our findings is underway.

Quantifying mammary duct carcinoma in situ: a wild-goose chase?

Duct carcinoma in situ (DCIS) is a malignant neoplasm of the breast that is limited to the glandular component. The introduction of mammographic screening allows for earlier detection of carcinoma, at the stage of DCIS, before it invades the surrounding stroma. Although DCIS has been studied extensively, its quantification remains a dilemma. Several methods for measuring DCIS exist, including clinical measurement, radiographic assessment, and gross pathologic assessment. Other methods have been employedfor this purpose, such as counting the number of tissue sections involved, direct measuring of DCIS from glass slides, and even counting the number of ducts involved. Furthermore, there is no consensus for assessing adequacy of margins. The myriad of techniques for quantifying DCIS has profound implications for treatment and for prognostic evaluation. The inherent difficulties in quantifying DCIS are multifactorial, and the need to establish a standardized approach for reporting the extent of DCIS by correlating radiographic, clinical, gross, and histologic findings is imperative.

A Case of Primary Breast Angiosarcoma

Angiosarcoma of the breast is a rare malignancy that may be easily misdiagnosed. Of the two forms, the more common form presents in patients (typically postmenopausal0 with a history of breast cancer, secondary to irradiation or chronic lymphedema. In contrast, the rarer form, primary angiosarcoma, arises sporadically in premenopausal women who present with palpable masses. Primary angiosarcoma accounts for 1 in 2,500 cases (0.04%) of breast cancer (1). The described patient presented with primary breast angiosarcoma. Ultrasound, mammography, and magnetic resonance imaging findings are presented.