Estudo clÃnico-patolÃgico dos papilomas intraductais centrais e perifÃricos da mama

AUTOR(ES)
DATA DE PUBLICAÇÃO

2007

RESUMO

Aiming to detail the clinical-pathologic characteristics of central and peripheral papillomas, diagnosed in breast tissue gotten by setorectomia or excisional biopsy, a retrospective, descriptive study was performed based on the analysis of anatomopathological reports of these materials, archived at Pathology Department of Hospital de Cancer da ParaÃba - NapoleÃo Laureano Foundation, Brazil, from December 2000 to December 2006. Sixty three reports had been located, referring 54 women, with average age of 50,87 Â 11,34 years, which obeyed the characteristics of: diagnosis of papilloma, independent to any classification, in absence of invading carcinoma, firmed on the basis of complete cleavage and total inclusion in paraffin block, by the researcher, by the time of injuryâs anatomopathologic diagnose; register of age, mammary injury topography and result of, at least, one image examination previous to setorectomy, in patientâs report, as well as existence of the paraffin blocks of the respective excisional biopsy materials. Non probabilistic convenience sample consisted on 418 blades of excisional biopsy material and discharge, when present, and 930 histological sections, reevaluated by the researcher and the Professor, by optic microscopy. When necessary, the paraffin blocks were reanalyzed according to routine technique (HE). The variables were: patientsâ age; injury topography and laterality, macroscopic characteristics of: papillary discharge, breast tumor palpability and aspect on image examination, presence of mammary papilla alterations; cancer familial history, previous mammary biopsy or recidivate papilloma; number of biopsy fragments sent to anatomopathological exam, dimensions of surgical part. For classification of cytoarchitectural standard and class of perilesional injuries of papillomas, the categorization was: classic papillar standard, typical epithelial hyperplasia with secondary lumens formation (simple, with typical apocrine metaplasia, standard apocrine simile, atypical apocrine metaplasia) and solid standard; atypical epithelial hyperplasia of solid apocrine simile standard, light epithelial hyperplasia with apocrine metaplasia, epithelial papilllary hyperplasia with apocrine metaplasia (typical or atypical), typical epithelial hyperplasia micropapillary without conjunctive axis, adenose simile areas, mioepithelial hyperplasia and adenomioepitelioma simile. There was predominance of: papilloma in women aging from 50 to 59 years (40% central and 39.3%, peripherals), in right breast (60% central and 64.3%, peripherals), in retroareolar zone (36.5% for central and 25.4% peripherals papillomas). According to clinical consultation reason, 18 (28.6%) cases presented palpable tumor (55.6% central and 44.4%, peripherals papillomas). On non palpable tumors, 23.8% presented only papillar discharge (17.12% with central papilloma and 32.1%, peripheral). Papillar discharge was present in 38.1% of cases, 54.2% in peripheral papilloma, associated to palpable tumor (28.6%). Spontaneous papillar discharge were diagnosed in 36.5% of cases (43.5% central papillomas and 20.6% peripherals), predominating bloody macrocospic aspect (52.2%) (60% central and 46.2% peripherals papillomas). Amongst the 16 cases with mamographic result registered in patientâs report as BI-RADSÂ 4 or 5, concordance index of carcinoma suspicion was equal to 12.5%. Mammary ultra-sound showed that, amongst 53 cases, 15.1% had ductal ectasia with intraductal solid nodule suggestive of papilloma, confirmed by histopathology. Considering predominant architectural standards, those occupying more than 50% of papillomatous lesion as a whole, the classic standard predominated (52% central and 48% peripherals), following mioepithelial hyperplasia (28.6% central and 20% peripherals). In papillomas with carcinoma (12.7%), 33.3% were central, 66.7%, peripherals (of these, 25% perilesional). In one case, there was typical hyperplasia with formation of secondary lumens. Among intraductal carcinoma cases, associated to papilloma, there was predominance of apocrine cribriform papillary (34%) and apocrine papillary standards (26%). There were two cases of intraductal carcinoma of micropapillary standard and apocrine cribriform e intraductal carcinoma of cribriform apocrine sÃmile, in perilesional areas. The results of this research allowed to evidence the involved difficulties in the diagnosis of papillomas and strengthened the idea of the necessity of excision of this injury, having thus prevented the returns and the evolution for malignization

ASSUNTO(S)

diagnÃstico histopatolÃgico carcinoma carcinoma papilloma papiloma breast anatomia patologica e patologia clinica mama histopathological diagnose

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