http://www.ezpath.org/home daily 0.75 2016-07-11 http://www.ezpath.org/work daily 0.75 2016-09-22 https://static1.squarespace.com/static/577bf99220099ef80877176d/t/57dafda2e3df28a529ae2e80/1473969576179/ Breast Article Reviews https://static1.squarespace.com/static/577bf99220099ef80877176d/t/57dafd194402434a72b75720/1473969439899/ Breast Article Reviews https://static1.squarespace.com/static/577bf99220099ef80877176d/t/57dafdb959cc685d9e66c01f/1473969599389/ Breast Article Reviews https://static1.squarespace.com/static/577bf99220099ef80877176d/t/57daf54d9f7456bf8bd7d2af/1473967442414/ Breast Article Reviews https://static1.squarespace.com/static/577bf99220099ef80877176d/t/57daf5369f7456bf8bd7d17a/1473967418899/ Breast Article Reviews https://static1.squarespace.com/static/577bf99220099ef80877176d/t/57daf5a3c534a52b4387a545/1473967528534/ Breast Article Reviews https://static1.squarespace.com/static/577bf99220099ef80877176d/t/57d46dcecd0f68a33d3d484b/1473539541724/ Breast Article Reviews https://static1.squarespace.com/static/577bf99220099ef80877176d/t/57d46ee72e69cf71b75c57d5/1473539820036/ Breast Article Reviews https://static1.squarespace.com/static/577bf99220099ef80877176d/t/57d46edabebafba39be2be5d/1473539808278/ Breast Article Reviews https://static1.squarespace.com/static/577bf99220099ef80877176d/t/57d46f1acd0f68a33d3d52e6/1473539872521/ Breast Article Reviews https://static1.squarespace.com/static/577bf99220099ef80877176d/t/57df11f6e6f2e1bd883e881a/1474236923472/ Breast Article Reviews https://static1.squarespace.com/static/577bf99220099ef80877176d/t/57df125415d5dba740c8b2f4/1474237016825/ Breast Article Reviews https://static1.squarespace.com/static/577bf99220099ef80877176d/t/57de01b5d1758eccab1dd59c/1474167225784/ Breast Article Reviews https://static1.squarespace.com/static/577bf99220099ef80877176d/t/57de02c49f7456ee88368e7d/1474167496181/ Breast Article Reviews https://static1.squarespace.com/static/577bf99220099ef80877176d/t/57de01efe3df28c822c1bc3d/1474167286479/ Breast Article Reviews https://static1.squarespace.com/static/577bf99220099ef80877176d/t/57df12402e69cf9a7ae99400/1474236997873/ Breast Article Reviews https://static1.squarespace.com/static/577bf99220099ef80877176d/t/57de01fce3df28c822c1bca7/1474167478455/ Breast Article Reviews https://static1.squarespace.com/static/577bf99220099ef80877176d/t/57de01c0d1758eccab1dd5cb/1474167237623/ Breast Article Reviews https://static1.squarespace.com/static/577bf99220099ef80877176d/t/57df125e2e69cf9a7ae99513/1474237026959/ Breast Article Reviews https://static1.squarespace.com/static/577bf99220099ef80877176d/t/57df124c2e69cf9a7ae9946a/1474237008248/ Breast Article Reviews https://static1.squarespace.com/static/577bf99220099ef80877176d/t/5794f8faebbd1a3518b558cc/1469380873794/ Breast Article Reviews https://static1.squarespace.com/static/577bf99220099ef80877176d/t/5782f69f59cc687a7d6a7ba3/1468200621066/abstract.jpg Breast Article Reviews Introduction •While the standard of care for management of atypical papilloma at core-needle biopsy (CNB) is surgical excision due to numerous studies showing high rates of upgrade to carcinoma, surgical management after CNB diagnosis of intraductal papilloma (IDP) remains controversial •Some studies have recommended excision of all IDPs due to reported high rates of upgrade, and inability of imaging studies to accurately classify the lesion; however, most of these series did not take into account radiologic-pathologic concordance, which may have lead to falsely high upgrade rates •A number of radiologic an histologic features predictive of upgrade rate have been suggested: Size >/= 1.5mm on imaging, the presence of microcalcifications, and older patient age Findings •The study population consistent of 189 women with CNB diagnosis of IDP, and a total number of 196 IDPs. 166 women underwent excision and 24 were followed clinically and radiologically without excision •A residual IDP was present in 107 excision specimens (62.6%) – 39 cases (22.8%) harbored a high-risk lesion (19 cases of atypical ductal hyperplasia, 7 cases of atypical lobular hyperplasia, 4 cases of lobular carcinoma in situ, 1 columnar cell change with atypia, and 8 radial scars) that was not present in the initial CNB sample. •The upgrade rate to carcinoma (2 invasive lobular carcinomas and 2 cases of DCIS) in the EXC specimen was 2.3% (4 of 171 cases). – DCIS involved the residual IDP in 1 case (true upgrade). The other 3 carcinomas were at least 0.8mm from the residual IDP (incidental upgrades •Age was not significantly related to an upgrade, but all patients with carcinoma were >/= 50 years old. All patients with upgrade were asymptomatic •There were no statistically significant differences in the radiologic characteristics of the lesions with and without upgrade •IDP fragmentation was the only histologic parameter associated with an upgrade. All 4 IDPs with an upgrade and 77 of 167 IDPs (46.1%) without an upgrade were fragmented (P=048). Other parameters including histologic size of the IDP, presence of microcalcifications, and complete removal were not predictive of an upgrade Conclusions •In this study, the authors evaluated a large cohort of patients with IDPs diagnosed with radiologic-pathologic concordant CNB. They found a 2.3% upgrade rate (4 of 171 CNBs), confirming that the upgrade rate is low in IDPs with a radiologically-pathologically concordant CNB •Their data suggests that close radiologic follow-up constitutes appropriate management for these patients   http://www.ncbi.nlm.nih.gov/pubmed/27315013   https://static1.squarespace.com/static/577bf99220099ef80877176d/t/5794fa85d2b857dd70a13423/1469381268005/ Breast Article Reviews https://static1.squarespace.com/static/577bf99220099ef80877176d/t/5794fb2b15d5dbb62e93a0c5/1469381430184/ Breast Article Reviews https://static1.squarespace.com/static/577bf99220099ef80877176d/t/57d5b2abb3db2b1e5a162209/1473622704458/ Breast Article Reviews https://static1.squarespace.com/static/577bf99220099ef80877176d/t/578cf1adb8a79bbf14e6cedd/1468854725139/ Breast Article Reviews Introduction •Granulomatous mastitis is a rare inflammatory breast disease that often presents as a breast mass and/or breast pain, and has a wide differential diagnosis including fungal or mycobacterial infection, autoimmune conditions such sarcoidosis , vasculitis, and rheumatoid arthritis, and secondary to infarction or fat necrosis, or in association with occult carcinoma •Despite the wide differential, a large portion of cases remain unexplained, and thus the terminology “idiopathic granulomatous mastitis” is often used •Idiopathic granulomatous mastitis remains a dilemma for clinical management, with response to empiric antibiotics alone generally poor, and surgical or immunomodulatory/steroid treatment with varying success •Studies have documented a striking association of granulomatous lobular mastitis with Corynebacterium species, but an association of granulomatous mastitis with bacterial infection has not gained widespread recognition •This study presents a retrospective single-institution experience of 35 patients with granulomatous mastitis, correlating cases with and without the cystic neutrophilic histologic pattern to gram stain/culture, clinical presentation, and outcome   Findings •A pathology database was searched for breast biopsies showing granulomatous inflammation. Thencorresponding slides were evaluated for the presence or absence ofthe cystic neutrophilic granulomatous (CNGM), defined as a clear space surrounded by a rim of neutrophils, surrounded by granulomatous inflammation •55 breast specimens with granulomatous inflammation from 35 patients were identified, and then divided into CNGM (31 specimens from 19 patients) vs those with granulomatous inflammation but non-CNGM (24 specimens from 16 patients) •Patients with CNGM were more likely to be of Hispanic ethnicity, born outside the US/Canada, of younger age, with shorter interval since last childbirth, and never smokers as compared to non-CNGM •16/19 (84%) of CNGM patients had gram-positive rods seen on histochemical stains, while non of the non-CNGM group had gram-positive rods identified (0/16). •Of the available culture and molecular microbiology results from the CNGM group, one patient had culture positive for Corynebacterium species, one had growth of C minutissimum, one had growth of 1+Proprionobacterium, while another was reported as growth of “2+skin flora.” Molecular study identified C kroppenstedtii in an additional patient •Two CNGM cases were found with >30 IgG4 + plasma cells/hpf, suggesting that the presence of IgG4+ plasma cells is unlikely to be specific for IgG4-related sclerosing disease in the breast •In patients with available followup from both groups, granulomatous breast disease was treated with surgical, (empiric) antimicrobial, and/or immunomodulatory (steroids) modalities, and was often refractory to initial treatment, with over 30% having multiple surgical pathology specimens, and many with additional incision and drainage procedures. Clinical followup data were limited, but where available, patients often experienced a protracted course with eventual resolution (over 6-50 months)   Conclusions •This single-center retrospective series demonstrates a significant association of the CNGM histologic pattern and the presence of Gram-positive rods in granulomatous mastitis, representing the largest study to date. •These results provide increasing evidence of a potential role of Corynebacterium species in a specific subset of patients with granulomatous mastitis (54% of granulomatous mastitis had the CNGM pattern in their study) •Organisms localize to the clear microcystic space in the center of the neutrophilic granulomatous inflammation and are often present in a single focus on the slide, in very small numbers; Thus, pathologists should carefully analyze biopsies showing granulomatous mastitis for fungal, mycobacterial and bacterial organisms, with special attention to the microcystic spaces of CNGM on Gram stain •Further studies are needed to refine treatment http://www.ncbi.nlm.nih.gov/pubmed/27247368 https://static1.squarespace.com/static/577bf99220099ef80877176d/t/57d5b29fd482e9b1b3634249/1473622692175/ Breast Article Reviews https://static1.squarespace.com/static/577bf99220099ef80877176d/t/578cf2e220099e823fe63fd2/1468855016804/ Breast Article Reviews https://static1.squarespace.com/static/577bf99220099ef80877176d/t/57d5b287cd0f68a33d44b5b7/1473622666773/ Breast Article Reviews https://static1.squarespace.com/static/577bf99220099ef80877176d/t/57d5b292b3db2b1e5a16210e/1473622681027/ Breast Article Reviews https://static1.squarespace.com/static/577bf99220099ef80877176d/t/57d5b25ecd0f68a33d44b46f/1473622627697/ Breast Article Reviews https://static1.squarespace.com/static/577bf99220099ef80877176d/t/57d58c895016e199d1dd978d/1473612955733/ Breast Article Reviews https://static1.squarespace.com/static/577bf99220099ef80877176d/t/57d58da946c3c43b07a6ec4b/1473613230015/ Breast Article Reviews 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https://static1.squarespace.com/static/577bf99220099ef80877176d/t/57ddcc388419c2abeeb96135/1474153532642/ Breast Article Reviews https://static1.squarespace.com/static/577bf99220099ef80877176d/t/57ddcc2bb8a79bb3c44bddeb/1474153520358/ Breast Article Reviews https://static1.squarespace.com/static/577bf99220099ef80877176d/t/57ddcbbbe3df28c822c077f6/1474153451841/ Breast Article Reviews https://static1.squarespace.com/static/577bf99220099ef80877176d/t/57dda9e95016e1d6371b142c/1474144749877/ Breast Article Reviews https://static1.squarespace.com/static/577bf99220099ef80877176d/t/5782f441b8a79b369b3b3c81/1468200002331/Papillary+Icon.jpg Breast Article Reviews https://static1.squarespace.com/static/577bf99220099ef80877176d/t/5782f8145016e19ee3d0c7f1/1468200981915/Fibroepithelial+Icon.jpg Breast Article Reviews https://static1.squarespace.com/static/577bf99220099ef80877176d/t/5782f8575016e19ee3d0c9b2/1468201048639/IHC+icon.jpg Breast Article Reviews https://static1.squarespace.com/static/577bf99220099ef80877176d/t/5782f9ab20099e05b58c4cac/1468201389249/Reactive+Icon.jpg Breast Article Reviews https://static1.squarespace.com/static/577bf99220099ef80877176d/t/5782fa5b725e25016e632c5f/1468201564518/Carcinoma+icon.jpg Breast Article Reviews https://static1.squarespace.com/static/577bf99220099ef80877176d/t/5782fafa893fc04f8177e751/1468201722465/Molecular+Icon.jpg Breast Article Reviews https://static1.squarespace.com/static/577bf99220099ef80877176d/t/578307c920099e05b58cb81d/1468205002315/Myofiboblastoma+Icon.jpg Breast Article Reviews https://static1.squarespace.com/static/577bf99220099ef80877176d/t/5783092ecd0f681aa0341358/1468205359096/FEA+Icon.jpg Breast Article Reviews https://static1.squarespace.com/static/577bf99220099ef80877176d/t/57e32b34be65945026aed973/1474505525403/su16030636.1.006.jpg Breast Article Reviews http://www.ezpath.org/test1 daily 0.75 2016-07-11 https://static1.squarespace.com/static/577bf99220099ef80877176d/t/5782e5f4e4fcb5fc319dee55/1468196340291/ test1 https://static1.squarespace.com/static/577bf99220099ef80877176d/5782e5b78419c2419a9934e0/5782e5eae4fcb5fc319dee09/1468196340291/Breast+icon.jpg test1 http://www.ezpath.org/gallery daily 0.75 2020-06-25 https://static1.squarespace.com/static/577bf99220099ef80877176d/t/57e33a67d1758e2877dccc28/1473383362070/ Breast Image Bank - Normal Breast Tissue The adult female breast is composed of a series of branching ducts and ductules that terminate in the acini. This arrangement has been likened to a flowering tree. https://static1.squarespace.com/static/577bf99220099ef80877176d/t/57e33d16893fc0b87d903825/1474510105314/ADH+clubs2.jpg Breast Image Bank https://static1.squarespace.com/static/577bf99220099ef80877176d/t/57e341dabebafb1767ebd6e7/1474510904207/ Breast Image Bank - Columnar Cell Change Columnar cell change is characterized by enlarged TDLUs with variably dilated acini. The acini have irregular contours and some contain secretions. On higher power, the epithelium lining the acinus is characterized by columnar cells. The nuceli are slender, ovoid, and oriented in a regular fashion perpendicular to the basement membrane. These have the appearance of a "picket fence." https://static1.squarespace.com/static/577bf99220099ef80877176d/t/57e358d6d482e91e586a4c6c/1474517597215/Reactive+Icon.jpg Breast Image Bank https://static1.squarespace.com/static/577bf99220099ef80877176d/t/57e35993f7e0abcdf2dab60a/1474517397011/Slide15.JPG Breast Image Bank https://static1.squarespace.com/static/577bf99220099ef80877176d/t/57e359e66a4963bbd2902c54/1474517479958/Slide9.JPG Breast Image Bank https://static1.squarespace.com/static/577bf99220099ef80877176d/t/57e35a0be58c6232570c40d9/1474517516748/Slide2.JPG Breast Image Bank https://static1.squarespace.com/static/577bf99220099ef80877176d/t/57e35b076b8f5b09ba6b8962/1474517768288/111.jpg Breast Image Bank https://static1.squarespace.com/static/577bf99220099ef80877176d/t/57e35b4cff7c50cf343f4128/1474517995503/Slide35.JPG Breast Image Bank https://static1.squarespace.com/static/577bf99220099ef80877176d/t/57e35b8b9de4bb5b97d1b28a/1474517900326/Vascular+Icon.jpg Breast Image Bank https://static1.squarespace.com/static/577bf99220099ef80877176d/t/5ef4cf9642e89335904167ec/1474511479480/ Breast Image Bank - Metaplastic Carcinoma Metaplastic carcinomas are uncommon, representing <1% of all breast cancers. hey represent a heterogeneous group of invasive breast cancers. https://static1.squarespace.com/static/577bf99220099ef80877176d/t/5ef4dd350e809318fdf27cc9/1474417985629/ Breast Image Bank - Lobular Carcinoma In Situ, Type A and Type B Cells Lobular carcinoma in situ is relatively uncommon, being reported in about 0.5-3.6% of breast biopsies in the premammographic era. Classic LCIS and ALH are characterized by a proliferation of small, loosely cohesive, neoplastic epithelial cells within the TDLU. http://www.ezpath.org/nipple-lesions daily 0.75 2016-09-17 https://static1.squarespace.com/static/577bf99220099ef80877176d/t/57dca9a859cc688713e05b55/1473434718702/ Nipple Lesions https://static1.squarespace.com/static/577bf99220099ef80877176d/57d2d3ff9de4bbde8008d4f9/57d2d45ae4fcb5df2720c822/1473434718702/SC16-31471+Nipple+Intraductal+papilloma+w+florid+DH+and+AM2.jpg Nipple Lesions https://static1.squarespace.com/static/577bf99220099ef80877176d/57d2d3ff9de4bbde8008d4f9/57d2d45ee4fcb5df2720c858/1473434722801/SC16-31471+Nipple+Intraductal+papilloma+w+florid+DH+and+AM4.jpg Nipple Lesions https://static1.squarespace.com/static/577bf99220099ef80877176d/57d2d3ff9de4bbde8008d4f9/57d2d463e6f2e1d0d3edb77f/1473434726941/SC16-31471+Nipple+Intraductal+papilloma+w+florid+DH+and+AM3.jpg Nipple Lesions 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