Histopathological Classification of Benign Lesions
The majority of benign mammary lesions have their atypical or malignant variant. On certain occasions, the differentiation by the pathologist is difficult, as the histopathological analysis must follow strict diagnostic criteria. The unprecise benign characterization of mammary lesions may lead to inadequate clinical-surgical follow-up and consequently the progression of locoregional disease, causing definitive sequels for patients. The differential diagnosis between benign lesions from malignant neoplasms is fundamental to the appropriate clinical-surgical indication.
- 1.Lakhani SR, Ellis IO, Schnitt SJ, Tan PH, van de Vijver MJ, editors. WHO classification of tumours of the breast. Lyon: IARC; 2012. Pathological, clinical and radiological findings related to the prognosis of the different types of lesions in mammary pathology, according to the most recent classification of the World Health Organization (WHO)Google Scholar
- 2.Lewis JT, Hartmann LC, Vierkant RA, Maloney SD, Shane Pankratz V, Allers TM, Frost MH, Visscher DW. An analysis of breast cancer risk in women with single, multiple and atypical papilloma. Am J Surg Pathol. 2006;30:665–72. Cohort study in patients diagnosed with fibrocystic mammary alteration. The RR for breast carcinoma in single papillomas (RR 2.04) was greater when compared to the non-proliferative mammary alteration (RR 1.28), but similar to the proliferative mammary alteration without atypia (RR 1.90). The RR for single papilloma carcinoma with atypia (RR 5.11) was not substantially different from atypical ductal hyperplasia/atypical lobular hyperplasia (RR 4.17). Patients with multiple papillomas present RR for carcinoma of 3.01, which is increased compared to the proliferative alteration without atypia or to the unique papillomas, and even greater in multiple papillomas with atypia (RR of 7.01). Therefore, multiple papillomas represent a proliferative mammary alteration with unique biological and clinical behaviorCrossRefGoogle Scholar
- 3.Nakhlis F, Lester S, Denison C, Wong SM, Mongiu A, Golshan M. Complex sclerosing lesions and radial sclerosing lesions on core needle biopsy: Low risk of carcinoma on excision in cases with clinical and imaging concordance. Breast J. 2017. Radiant sclerosing lesions (RSL) and complex lesions (CEL) are found to be unusual in biopsies, associated to divergent diagnoses obtained by surgical specimens, ranging between 0% and 23%, presenting, therefore, controversial management. In this study, it was sought to determine the risk of malignancy ratio between RSL/CEL, diagnosed in biopsies, aiming the evaluating the risk of future cancer when performed solely by clinical follow-ups of these lesions, without surgical excision. Retrospectively, 118 cases of RSL/CEL in biopsies between 2005 and 2014 were analyzed. Among the 98 patients evaluated, in 34 cases (35%) surgical excisions were performed and in 64 (65%) clinical follow-up was performed. A malignancy rate of 9% was observed in surgical specimens of BIRADS lesions > 4c characterized as RSL/CEL in biopsies. In patients with concordant biopsies and BIRADS 4a, or in lesions weakly suspicioned, subjected to observation, a low subsequent rate of ipsilateral carcinoma was found. Despite this data, further studies are needed to confirm that clinical accompaniment may be a reasonable alternative to surgical excision whenever facing a RSL/CEL diagnosis in concordant biopsies, in BIRADS 4a or in non-palpable lesions less likely to be suspicioned.Google Scholar
- 4.Page DL, Salhany KE, Jensen RA, Dupont WD. Subsequent breast carcinoma risk after biopsy with atypia in a breast papilloma. Cancer. 1996;78(2):258–66. Study demonstrates that the relative risk of atypical and non-atypical papillary lesions to develop invasive carcinoma is proportional to the lesions observed in the adjacent breast parenchyma. The carcinoma RR in women with papillomas, with atypical hyperplasia in adjacent parenchyma was 4 times higher than that observed in papillomas without atypia, being the risk particularly increased in the sites where the original papilloma was excised.CrossRefGoogle Scholar
- 5.Spruill L. Benign mimickers of malignant breast lesions. Semin Diagn Pathol. 2016;33(1):2–12. Revision article in which some of the most common benign lesions (usual ductal hyperplasia, sclerosing, and radiation) are described and the malignant lesions that may simulate those benign diagnosis. The histopathological aspects are emphasized, aiming to identify characteristics that will lead to their correct diagnosis, either by biopsy, with partial representation of the lesion, or by the obtaining surgical specimens, representing the lesions. entiretyCrossRefGoogle Scholar