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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: 24 January 2010, 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).
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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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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