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Presented by Pedram Argani, M.D. and prepared by Carla Ellis, M.D.
Case 1: A 19-year-old male with a breast mass.
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Question 1 of 1
1. Question
Week 447: Case 1
A 19-year-old male with a breast mass.images/1Alex/08162010case1image1.jpg
images/1Alex/08162010case1image2.jpg
images/1Alex/08162010case1image3.jpgCorrect
Answer: Gynecomastia
Histology: This is an ill-defined lesion which is composed of dense collagenous fibrous tissue, periductal edema, and florid micropapillary hyperplasia involving the ducts. The epithelial hyperplasia demonstrates mitotic activity, but the nuclei are generally uniform and hypochromatic, and the cells have ill-defined cytoplasmic borders. The micropapillae tend to taper as they progress toward the lumen of the duct.
Discussion: Ductal carcinoma in situ would feature monotonous cells forming micropapillae having bulbous extensions into the lumen. The nuclei would be uniform and hyperchromatic and cytoplasmic borders would be sharp. Atypical duct hyperplasia would have some of the features of ductal carcinoma in situ, though not fully developed. Pseudoangiomatous stromal hyperplasia (PASH) may be seen in the stroma of a gynecomastia lesion such as this one; however, the epithelial proliferation and periductal edema are not part of PASH.
Incorrect
Answer: Gynecomastia
Histology: This is an ill-defined lesion which is composed of dense collagenous fibrous tissue, periductal edema, and florid micropapillary hyperplasia involving the ducts. The epithelial hyperplasia demonstrates mitotic activity, but the nuclei are generally uniform and hypochromatic, and the cells have ill-defined cytoplasmic borders. The micropapillae tend to taper as they progress toward the lumen of the duct.
Discussion: Ductal carcinoma in situ would feature monotonous cells forming micropapillae having bulbous extensions into the lumen. The nuclei would be uniform and hyperchromatic and cytoplasmic borders would be sharp. Atypical duct hyperplasia would have some of the features of ductal carcinoma in situ, though not fully developed. Pseudoangiomatous stromal hyperplasia (PASH) may be seen in the stroma of a gynecomastia lesion such as this one; however, the epithelial proliferation and periductal edema are not part of PASH.
