Cholesterol granuloma of the breast mimicking carcinoma: report of a case.
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Keywords:
Histopathological examination
Quadrant (abdomen)
Palpation
Breast Cancer Screening
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Historically, physical examinations of the breast, conducted both by the individual (breast self examination, BSE) and the healthcare provider (clinical breast examination, CBE), have been the primary tools for the diagnosis of breast cancer. With the advent of breast imaging (mammography, ultrasound, breast MRI), which is more sensitive than BSE and CBE in breast cancer detection, many of the observations historically described on physical examination are not common in the smaller cancers seen in current practice. Physical examination has become an adjunct to imaging for the early detection of breast cancer. Indeed, BSE does not increase the detection of cancer, and CBE is no longer used to diagnose breast cancer. Rather, it is used as a screening test that can identify areas with breast cancer. While CBE is less sensitive than mammography, it is nonetheless the primary mode of detecting the 15% of breast cancers that are missed by mammography. Signs and symptoms of benign breast conditions include nipple discharge, inflammatory conditions, and breast masses. The key for each of these symptoms is appropriate diagnosis and treatment. The most important consideration is to exclude the presence of cancer. Changes during pregnancy and lactation make evaluation of the breast more difficult, both because of enlargement and the increased ratio of glands to total breast volume. These changes make the breast more nodular and dense. Mammography sensitivity decreases, and for pregnant women, the radiation of mammography should be avoided whenever possible. Pregnancy associated breast cancer is a unique problem because the cancer diagnosis may be delayed due to changes in the breast and risk of radiation to the fetus and also because these tumors appear more biologically aggressive than most breast cancers.
Breast examination
Breast imaging
Breast ultrasound
Breast Cancer Screening
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The purpose of this study was to review the results of mammographic wire-guided biopsies of nonpalpable breast lesions and the features of the lesions in the preoperative examinations. Sixty women, mean age 50.2 years (range 31 to 74), underwent a wire-guided biopsy of the lesion. Twenty-nine patients had preoperative fine needle aspiration of the lesion. The radiographic diagnosis was correct in 33 patients (55%); 25 had breast cancer and 8 patients had a benign lesion. In 9 of the 14 patients with clustered microcalcifications in mammography and in 13 of the 15 patients with a mass noted in mammography, the cytological examination was correct. Nonpalpable mammographic masses with regular borders and normal fine needle aspiration examination do not require biopsy. In malignant mammographic appearances associated with a normal fine needle aspiration examination, biopsy of the lesion should always be done.
Palpation
Histopathological examination
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In a histological study of biopsy and postmortem material from 30 cases of nasal disease in which a clinical diagnosis of 'midline granuloma' or Wegener's granuloma had been given, we selected 10 cases on the basis of the presence of widespread coagulative necrosis and atypical cells. Evidence is provided that such changes represent a malignant neoplasm of histiocytic lymphoma type. Local invasion and spread to cervical and more distant lymph nodes, spleen, liver, and kidney were seen in some of the cases. Erythrophagocytic activity was marked in the spleen in three cases and histiocytic infiltration of the bone marrow in two cases, indicating a more generalised activity of histiocytic cells. Terms such as 'malignant granuloma' should be abandoned. In obstructive and ulcerating conditions of the nose efforts should be concentrated on making an accurate histological diagnosis.
Coagulative necrosis
Infiltration (HVAC)
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The purpose of this article is to describe a method for efficiently and effectively confirming mammographic-sonographic concordance before biopsy.With the increase in mammographic detection of smaller nonpalpable lesions, it is sometimes challenging to confirm that the lesion identified with subsequent sonography for additional lesion characterization is the same lesion. When additional confirmation is necessary, instillation of radiopaque contrast material under sonographic guidance followed by repeat mammography examination can help confirm lesion correlation.
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In this report, we examine a clinical entity called atypical histiocytic granuloma (AHG), which is characterized by ulceroproliferative lesions that clinically simulate a squamous cell carcinoma or specific granulomatous lesions. AHG histologically shows a histiocytic proliferation and is characterized by specific mitotic activity, which has the potential to be confused with malignant processes of a lymphoid origin. There are few cases reported in the literature, and an adequateknowledge of the process is required in order to avoid a misdiagnosis, especially as regards malignant processes. To our knowledge, a case of this type of lesion in the palate has not yet been described. We present a case of an atypical histiocytic granuloma which occurred in the form of an ulcerated pediculated lesion in the palatine mucosa (an uncommon localization that not yet has been researched). This case histologically showed a histiocytic infiltration with an increase in the mitotic index, eosinophils and an accumulation of haemosiderin. The lesion resolved spontaneously after the biopsy, without recurring after a period of five years. This report stresses the important value of immunohistochemistry in diagnosing the lesion and also discusses the similarities and differences between other lesions that may be confused, potentially leading to a misdiagnosis.
Infiltration (HVAC)
Pyogenic granuloma
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Objective:To assess the value of computer stereotactic mammography biopsy in the detection of nonpalpable breast lesion.Methods:One hundred and two cases of clinical nonpalpable breast lesions were detected with computer stereo-tactic mammography biopsy,including stereotactic needle core biopsy(SCNB)and stereotactic mammography needle localized biopsy(SNLB).Results:The diagnostic coincidence rate reached95.1%in61cases with SCNB and87.8%in41cases with SNLB,in which36cases were localized accurately.Conclusions:It suggested that the method of computer stereotatic mam-mography biopsy could localize the lesion accurately,with slight trauma and could be manipulated easily.This method has great value in the diagnosis of early breast cancers,especially plays an important role of localization and qualitative determina-tion in the diagnosis of nonpalpable breast lesions.
Breast biopsy
Stereotactic biopsy
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Analysis of a diagnostic procedure leading to the clinical diagnosis and treatment of nonpalpable lesions in breast was presented in the paper. 668 women with breast lesions were treated in our department between 1995 and 2001. Nonpalpable lesions were detected in 68 women. The following diagnostic-treatment algorithm was used: case history and physical examination, radiological examination, hooked wire localisation under mammography or USG, breast surgical biopsy, intra-operative histological examination, further procedures according to morphological changes found in patients. Mammography was performed in 68 patients. Stereotactic needle biopsy under mammography was done in 61 patients (DXRBL-18-9 needle was used). The lesions were localized under USG in 7 patients. Surgical biopsy and X-Ray examination of the removed specimen was performed in 68 patients. Intra-operative histological examination revealed benign lesions in 54 women whereas malignant lesions were found in 14 women. Post-operative complications were present in 8 patients. Nonpalpable breast lesions require individual, planned diagnostic treatment. Stereotactic needle biopsy not only allows definitive surgical removal of malignant lesions within margins of normal breast tissue but also gives a good cosmetic effect. Complex diagnostics together with standardized procedure ensure the highest rate of correct diagnosis and lower the risk of diagnostic failures.
Stereotactic biopsy
Palpation
Breast biopsy
Histopathological examination
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Abstract Atypical histiocytic granuloma in the oral mucosa has recently been described as a benign non-neoplastic ulcero-proliferative lesion of histiocytic origin with eosinophilia. The disease is confined to the oral mucosa where the lesion is solitary. These lesions, which heal spontaneously, are not associated with systemic disease or dissemination. This report deals with such a case, and it stresses the benign nature of the lesion despite the worrying clinical and microscopic appearance. The morphological diagnosis was substantiated by the use of a series of immunohistochemical reactions.
Oral mucosa
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