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Breast-nonmalignant

Benign tumors

Amyloid tumor

 

Author: Nat Pernick, M.D.

Editor: Hind Nassar, M. D. Johns Hopkins Medical Institute (see Authors page)

Revised: 13 October 2012, last major update - January 2010

Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.

 

Definition

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● Mass composed of amyloid deposits in fat, stroma or vessels

 

Terminology

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● Also called amyloidoma

 

Epidemiology

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● Very rare

● Usually women ages 45-79 years

 

Sites

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● 80% occur in right breast

● Bilateral or unilateral, but only rarely is confined to breast

 

Etiology

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● Predisposing systemic diseases include systemic amyloidosis, rheumatoid arthritis, myeloma, Waldenstrom’s macroglobulinemia

 

Clinical features

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● Painless mass

● May occur late in systemic disease

● Clinical examination needed to differentiate primary and secondary amyloid tumors

 

Case reports

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● 58 year old woman with rheumatoid arthritis (South Med J 2008;101:199)

● 59 year old woman with sclerosing lymphocytic lobulitis / diabetic mastopathy (Breast 2006;15:281)

● 76 year old woman with myeloma (AJR Am J Roentgenol 2000;175:1590)

● 77 year old woman with bilateral masses (Archives 2004;128:e67)

● Sjogren’s syndrome (JBR-BTR 2006;89:313)

 

Treatment

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● Excisional biopsy is successful if amyloid tumor is limited to the breast

 

Gross description (Macroscopy)

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● 5 cm or less, firm, gray-white, opalescent

 

Micro description (Histopathology)

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● Amorphous eosinophilic deposits in fat, stroma or vessels

● May cause ductal atrophy, form rings around individual fat cells, have associated multinucleated giant cell reaction or osseous metaplasia (J Clin Path 2002;55:634)

 

Micro images

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Amyloid occurs in lobule (lower left) and                     Thick wavy bands of amyloid around lobular glands

as separate stromal nodule (upper right, AFIP)         and a nodular deposit that is virtually acellular.

 

 

Diffuse deposits of dense amorphous material

(*) surrounding ductal structures (arrows).

 

 

Object name is 01233.f1.jpg                                                               

Amyloid with osseous metaplasia                                 Hyaline material and chronic inflammation

 

 

                                                               

Amyloidosis (bilateral breast masses)                        Various images (note: slow loading)

Fig 1: 1.7-cm, ill-defined mass containing

coarse calcifications

Fig 2: H&E;  Fig 3: Congo Red

Fig 4: polarized light

 

Cytology description

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● Amorphous acellular material with scattered plasma cells, lymphocytes, stromal cells and epithelial cells

● Rare multinucleated giant cells

● Metachromatic by modified Wright’s stain (Diagn Cytopathol 2003;28:325)

 

Cytology images

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Object name is 01233.f2.jpg

Dense hyaline material and giant cells

 

Positive stains

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● Congo red (red-orange with apple green birefringence under polarized light)

● Metachromatic with crystal violet

 

Electron microscopy descriptions

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● Straight, nonbranching, haphazard amyloid fibrils, 5-10 mm, mixed with collagen fibers (Am J Surg Pathol 1986;10:539)

 

Differential Diagnosis

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Plasmacytoma: immature plasma cells, no amyloid

Stromal fibrosis: may have hyaline material, but it has different histologic features from amyloid; also Congo-Red negative

 

End of Breast-nonmalignant > Benign tumors > Amyloid tumor

 

 

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