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Case 1: Core biopsy from a 51 year old woman with an irregular breast massDiagnosis:1-Scar tissue2-spindle cell carcinoma3-phyllodes tumor with stromal overgrowth4-fibromatosis5-stromal fibrosisDiscussion: Fibromatosis is a locally aggressive non-metastasizing lesion that can be primary in the breast or can arise from the chest wall. Microscopically it consists of bland spindle cells arranged in long sweeping fascicles; there is no evidence of atypia or mitotic rate is low. The majority (87%) of the fibromatosis of the breast demonstrate nuclear labeling with beta-catenin. A variety of keratin stains should be performed to rule out metaplastic spindle cell carcinoma.Case 2: Axillary sentinel lymph node biopsy in a 60 year old woman with invasive mammary carcinoma with ductal and lobular features.Diagnosis:1-capsular nevus2-metastatic breast carcinoma 3-metastatic melanoma4-isolated tumor cells5-lymphomaDiscussion: Nevus cells can be seen in axillary lymph nodes from women with breast cancer. They can be mistaken for metastatic breast carcinoma or metastatic melanoma. However the fact that they are confined to the capsule and have bland cytological features in addition of being positive for Melan-A and negative for HMB45 and cytokeratin on immunostain is helpful in the differential diagnosis. Case 3: Core biopsy of the breast performed for a mass on a 55 year old womanDiagnosis:1-granular cell tumor2-invasive apocrine carcinoma3-sclerosing adenosis with prominent myoepithelial cells4-atypical lobular hyperplasia5-extension of ductal carcinoma in situ into lobulesDiscussion:Many benign lesions in the breast, including sclerosing adenosis can mimic malignant entities on mammography as well as morphologically. Myoepithelial markers are usually helpful in making the correct diagnosis in cases of sclerosing adenosis. In this case the lesion has a pattern of sclerosing adenosis with “pink” prominent cells. These cells were positive for S100 (which raised the question of a granular cell tumor) but they also stained for p63 and SMM-HC confirming their myoepithelial nature.Case 4: Core biopsy of the breast performed for microcalcifications in a 64 year old woman Diagnosis:1-invasive tubular carcinoma2-microglandular adenosis3-invasive ductal carcinoma, well differentiated4-tubular adenosis5-atrophic breast tissueDiscussion:Microglandular adenosis (MGA) is a benign breast lesion that is composed of haphazardly arranged rounded tubules displaying an infiltrative pattern in breast tissue and fat. However, the cytology is bland. Myoepithelial cells are absent but PAS positive basement membrane is prominent. The lesion is positive for S100, cam5.2, AE1 and negative for ER, PR, GCDFP, EMA and myoepithelial markers by immunostains. MGA can be associated with breast carcinoma, in some cases of adenoid cystic type.Case 5: excisional biopsy from a 39 year old woman with a breast massDiagnosis:1-sclerosing adenosis2-invasive tubular carcinoma with columnar cell lesion3-papillary sclerosing lesion4-florid usual ductal hyperplasia5-atypical ductal hyperplasiaDiscussion: The lesion is composed of tubules with an infiltrative pattern in a background of columnar cell hyperplasia with atypia. The majority of tubular carcinomas (TC, 93%) arise in a background of columnar cell lesions (CCL). Atypical lobular hyperplasia can also be associated with both lesions, TC and CCL (Rosen’s triad). ................
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