Benign Biphasic Tumors of the Mullerian Tract - a Mimic of Phyllodes Tumor. A Clinical-Pathologic Description of 21 Cases

OBJECTIVE

A review of the clinical-pathologic characteristics and outcomes of biphasic polyps occurring in the female genital tract, not meeting the diagnostic criteria of Mullerian Adenosarcoma (MA).

METHODS

An archival database search was run, after IRB approval, between 2001 and 2019, using terminology such as "Mullerian adenofibroma," "atypical Mullerian adenofibroma," "polypoid adenofibroma," and "atypical polyp with increased stromal cellularity." Two pathologists (JW and MRQ) reviewed all the retrieved cases and documented the morphologic features with particular emphasis on the presence of any features of Mullerian adenosarcoma. Follow-up data were also abstracted.

RESULTS

Twenty-one cases, 12 cervical and 9 endometrial lesions, constituted the study cohort. Patients ranged from 26 to 64 years (median 49 years). On review, 20 of 21 of those cases showed Phyllodes-like architectural patterns. However, only one case showed all four features of MA, all of which were focal and inconspicuous. Follow-up (median duration of 5 years) did not document any recurrences in any of the 21 cases after excision.

CONCLUSION

This series adds to the growing body of literature affirming the existence of benign biphasic Mullerian polyps encountered in the endometrium and cervix that fall short of the Mullerian adenosarcoma diagnosis.

Robotic enucleation of a biliary adenofibroma

A 69-year-old man was referred to the hepatobiliary surgeons for mild enlargement of an asymptomatic cystic liver lesion found on routine screening in 2017 that measured 3.7×3.6×4.3 cm. Work-up with MRI revealed a complex multilocular cyst that had enlarged to 6.6×5.5×4.6 cm. Other work-up was unremarkable. He had a Eastern Cooperative Oncology Group score of 1; therefore, a surgical excision was planned due to the possibility for malignancy. A robotic approach with enucleation of the lesion was undertaken, with plans for return for a wider resection if pathological examination revealed malignancy. The lesion was noted to be a biliary adenofibroma, an exceptionally rare lesion that is thought to be benign, but requires excision due to potential malignant degeneration. The patient was discharged home the following day and has had minimal pain in his postoperative course.

AN ELECTRON MICROSCOPE STUDY OF HUMAN BREAST CELLS IN FIBROADENOSIS AND CARCINOMA

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CYTOLOGICAL DIAGNOSIS OF BREAST TUMOURS BY THE IMPRINT METHOD

Tumour imprints were made from 311 breast tumours at the time of frozen section. Rapid and permanent staining methods were employed and the accuracy of diagnosis was compared with that obtained from frozen and paraffin sections. Two false positives (0.65%) and 16 false negatives (5.15%) were found in the imprint group compared with no false positives and five false negatives (1.6%) in the frozen section group. The cytology of breast imprints is described and the false results are analysed. The possible uses of this technique, both alone and in combination with frozen sections, are discussed.

EFFECT OF PREGNANCY AND LACTATION ON GROWTH OF MAMMARY TUMOURS INDUCED BY 7,12-DIMETHLBENZ(A) ANTHRACENE (DMBA)

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Measurement of small-angle photon scattering for some breast tissues and tissue substitute materials

For photon energies encountered in diagnostic radiology the shape of the scattering distributions for low-atomic-number media exhibits peaks in intensity close to the forward direction that are not predicted by conventional theoretical models. The positions and shapes of the peaks depend upon the interatomic and intermolecular configurations of the scatterers. The phenomenon is of particular interest because of its relevance to the understanding and modelling of x-ray imaging processes and the possibility that the peaking may be characteristic of tissue type. In the present study, peaks in the forward scattering distributions have been demonstrated for 19 samples of breast tissue and three tissue substitute materials using a position-sensitive photon detector and a 60 kVp x-ray source. Prominent features were observed for all samples investigated. Large differences were found in the shapes of the distributions between adipose and fibroglandular tissues and only small differences were found between carcinomas and fibroglandular tissues.

Different mitogenic and phenotypic responses of human breast epithelial cells grown in two versus three dimensions

Human breast epithelial cells, derived from fibroadenomas, were cultured under conditions promoting growth in two-dimensions (2D) as monolayers using the collagen-coated dishes and in three-dimensions (3D) inside the collagen gel matrix. Both epidermal growth factor (EGF) and cortisol (F) were required for maximal stimulation in 3D growth, but only cortisol was required for 2D growth. The growth stimulation of exogenously added type IV collagen was no greater than that of type I as a substrate in both the 2D and 3D growth. Immunocytochemical staining, using a polyclonal actin antibody, showed homogeneous staining in all cells in 2D monolayers, whereas more restricted distribution was observed in 3D outgrowths in the collagen gel matrix. The same cells, when cultured in 2D vs 3D, elicit different responses and the original phenotypes may be better maintained in 3D.

[An epidemiological study on the relationship between oral contraceptives and benign breast disease]

The relationship of benign breast disease (BBD) and oral contraceptive (OC) use was analyzed in a case-control study conducted in Milan on 288 women with clinically relevant and histologically confirmed BBD (cases) and 285 age matched controls with a spectrum of acute conditions apparently unrelated to OC use. Compared to women who had never used OCs, the relative risk (RR) for users was 1.0 (95% confidence interval: 0.6-1.5). Likewise, there was no siginficant association with duration of use; however, a significantly lower relative risk emerged in women taking OCs during the year before breast biopsy (RR=0.4; 95% confidence interval: 0.2-0.8). The protection in current users increased with increasing duration of use. In spite of this finding, the overall results of the study do not support the hypothesis that OC use protects against development of histologically confirmed and clinically relevant benign breast disease.

Juvenile (cellular) adenofibromas. A clinicopathologic study

"Juvenile" adenofibromas that presented in 25 patients were reviewed. All of the patients were in the second decade of life. The tumors were solitary in 19 patients and multiple and bilateral in six patients. All were distinguished microscopically by prominent cellularity of both epithelium and stroma. Patients who presented with solitary tumors, regardless of size, microscopic pattern, or manner of excision, had no recurrence. In contrast, all patients who presented with multiple tumors developed additional benign masses, often requiring re-excision. We believe that solitary "juvenile adenofibromas," regardless of size, should be excised so as to preserve as much breast tissue as possible. Those patients with multiple, bilateral tumors may anticipate recurrences, but malignant change is not seen. Tumors with this microscopic pattern also may occur, albeit uncommonly, in adults.

[Steroid hormone receptors in benign breast diseases]

Benign breast diseases generally occur in women with progesterone insufficiency and an unopposed estrogen status. This hormonal imbalance is also a main risk factor for breast cancer in the long run. The presence of estradiol and progesterone receptors in benign breast disease are additional proof of their hormone dependence. The level of receptors is higher when the epithelial cellularity is high and also in more recent lesions, and younger women. The level and subcellular location of the receptors also depend on the endogenous secretion of steroids: their level varies throughout the menstrual cycle, and it is maximal at the end of the follicular phase, due to the high estradiol secretion. The cytosol and nuclear level and location of the receptors are also modified by hormonal therapy: estrogen-progestagens given as a contraceptive, or progestins given as a substitutive and antiestrogen therapy. These modifications constitute a biochemical basis for the hormonal progestagen treatment of benign breast diseases.

Hydrocortisone stimulation of human mammary epithelial cells

Rapid proliferation of mammary epithelial cells derived from biopsy specimens of human fibroadenomas was observed when medium was supplemented with ten percent fetal bovine serum and hydrocortisone (5 microgram per ml-1). Hydrocortisone in combination with FBS also led to a 2.5-fold increase in cell cluster attachment and subsequent colony formation. A similar effect was not observed with human serum. In contrast to fibroblast cell systems, insulin did not significantly alter cell growth. The results show that a mitogenic response to glucocorticoids by mammary epithelium may depend on the presence of factors in sera.

[Radial scars (scarring) and obliterating mastopathy (author's transl)]

The lesion, known under several names, consists of an hyalinized sclerotic center containing abundant elastic and elastoid masses. These radiate into the periphery and enclose lobuli which reveal epithelial proliferation varying from simple hyperplasia with epithelial villi to the rather rare true papillomas. The hyaline and elastic masses in the central parts surround tubuli and correspond to a lesion known as obliterating mastitis (mastopathy) that may lead to total occlusion of the ducts. The entire process ends with a contracting scar that alters the lobuli stemming from the obliterated duct. These may atrophy, dilate, or respond with different forms of hyperplasia. Therefore the designation "radial scars (scarring) possibly with epithelial proliferation" is proposed. As is emphasized the condition may be associated with tubular carcinoma and may resemble pseudoinfiltration in sclerosing adenosis.

Neoplastic and life-span effects of chronic exposure to tritium. I. Effects on adult rats exposed during pregnancy

Female Sprague-Dawley rats were continuously exposed to equilibrium levels of tritiated water (HTO) during pregnancy. The tritium activities were 1, 10, 50, and 100 muCi HTO/ml body water which provided cumulative, whole-body radiation doses of approximately 6.6, 66, 330, and 660 rads. Administration of the radioisotope was terminated at parturition. Throughout their life-spans and at autopsy, the dams showed an increased incidence of mammary fibroadenomas at exposure to 330 and 660 rads. Although the data for the incidence of malignant mammary neoplasms were consistent with a linear dose response, the small numbers of tumors preclude specific definition of the dose-response curve. Postexposure life-spans for dams chronically exposed to 66, 330, and 660 rads during pregnancy were reduced by 14, 24, and 22%, respectively. Accelerated aging was also demonstrated in these rats: The mean age for mammary fibroadenoma onset decreased with an increasing dose of radiation.

Specific Immunogenicity of Human Breast Carcinoma Extracts in Rabbits

Absorbed serum from a rabbit immunized with an extract of a pool of 5 breast carcinomas yielded a single precipitation line when tested on the pooled tumors used to immunize and on single breast carcinomas, whether participating in the immunization or not. No precipitation was seen with control normal mammary tissues from the same patients. Antisera from 5 out of 9 rabbit immunized with different single breast carcinomas gave one precipitin line against the tumor used to immunize and also in cross-reaction against the other 4 mammary carcinomas positive in the direct test. No bands were obtained with normal mammary tissue extracts or with a fibroadenoma extract. A rabbit antiserum against the fibroadenoma was always negative on all the breast carcinoma extracts tested.