Objetivo: Correlacionar as pacientes com resultado mamográfico BI-RADS 4 ou 5 submetidas a mamotomia e comparar os achados com os encontrados na histopatologia. Método: Foram selecionadas 111 pacientes as quais apresentavam lesões mamárias não palpáveis detectadas na mamografia e que realizaram mamotomia na Clínica de Oncologia e Mastologia de Natal. As amostras foram enviadas para o laboratório Dr. Getulio Sales, após radiografia das peças, e todas as pacientes tiveram de colocar clipe de titânio. Resultados: A faixa etária predominante foi de 41-50 anos (40,5%); cerca de 30,6% possuía histórico familiar de câncer de mama; entre as selecionadas, 97,3% possuíam classificação 4 do BI-RADS e 2,7% tinham classificação 5, predominando, em ambos os casos, as microcalcificações como indicação de mamotomia. A distribuição entre lesões benignas e malignas foi de 70 e 30%, respectivamente. A prevalência de lesões malignas foi de carcinoma ductal in situ (58%). Houve significância estatística com relação à suspeição de malignidade de acordo com o BI-RADS 4 e 5, p=0,018 [IC95%0,28 (0,209-0,383)]. O grau de associação verificado por meio da odds ratio mostra que o grupo BI-RADS 5 tinha 72% menos chance de ser benigno quando comparado ao grupo BI-RADS 4. Não houve relato de complicações nas pacientes submetidas a mamotomia no presente estudo. Conclusão: A mamotomia mostrou-se um método seguro no diagnóstico de lesões suspeitas (BI-RADS 4 e 5), estando dentro do observado na literatura.PALAVRAS-CHAVE: Câncer de mama; diagnóstico precoce; mamografia. RESUMO ABSTRACTObjective: To correlate patients with BI-RADS 4 or 5 mammographic results submitted to mammotomy and compare these findings to histopathological ones. Method: We selected 111 patients with non-palpable breast lesions detected on mammography and who underwent mammotomy at Clínica de Oncologia e Mastologia de Natal. The samples were sent to the laboratory Dr. Getulio Sales, after x-ray of the pieces, and all patients had to use a titanium clip. Results: The prevalent age group was 41-50 years (40.5%); approximately 30.6% had a family history of breast cancer; among the patients selected, 97.3% had a BI-RADS 4 classification and 2.7%, a BI-RADS 5; with microcalcifications being the main reason for mammotomy indication in both cases. The distribution of benign and malignant lesions was 70 and 30%, respectively. The prevalent malignant lesion was ductal carcinoma in situ (58%). Clinical suspicion of malignancy according to BI-RADS 4 and 5 was statistically significant, p=0.018 [95%CI 0.28 (0.209-0.383)]. The degree of association verified through odds ratio showed that the BI-RADS 5 group had 72% less chance of having a benign lesion when compared to the BI-RADS 4 group. There were no reports of complications in patients submitted to mammotomy in the present study. Conclusion: Mammotomy proved to be a safe method to diagnose suspicious lesions (BI-RADS 4 and 5), and its results fit what is observed in the literature.

Introduction: Breast synovial sarcoma is extremely rare, with few cases described. It corresponds to 6–9% of soft tissue sarcomas and is more frequent in extremities (80%), trunk (8%), and abdomen (7%) in young adults. It usually does not affect the breast. Objectives: To report a rare case of monophasic breast synovial sarcoma and provide data for the global literature. Method/Case report: G.S.B., 97 years old, presented a 7 cm nodule in the left breast and negative axillary nodes. Ultrasound (US) revealed a heterogeneous nodule of 6.0 x 5.5 cm, BI-RADS 5. She did not have mammography. Core biopsy showed spindle cell neoplasm. Immunohistochemistry (IHC) indicated mesenchymal lesion, without differentiating stromal components of fibroepithelial tumor from the mesenchymal lesion. Rapid growth with ulceration and tumor bleeding were identified. Urgent mastectomy showed a malignant neoplasm of spindle cell pattern and high grade, with 12 cm, involved lateral margin, and 19 negative axillary lymph nodes. IHC of the surgical specimen indicated monophasic synovial sarcoma. Before the wide excision, she had a rapidly progressive recurrence in the sternum, making it non-resectable. During radiotherapy (RT), local progression was identified. She has been receiving chemotherapy (CT) with ifosfamide and adriamycin. No evidence of distant disease was found after 9 months of diagnosis. Results/Discussion: Synovial sarcoma corresponds to approximately 0.06% of all breast neoplasms, originating from their mesenchymal tissue, with variable epithelial differentiation. The term synovial sarcoma is inadequate, deriving from its frequent juxta-articular location. Its incidence is approximately 1.5 per 1 million individuals, with a mean age of 32 years and a male:female ratio of 1.2:1. The main histological subtypes are: classic biphasic and monophasic. Translocation t(X;18) (p11.2; q11.2) and expression of SYT/SSX gene fusion are present in more than 95% of cases. IHC shows an intense expression of vimentin and CD99, and focal of Bcl2, EMA, CKAE1-AE3, actin, and desmin, as well as negativity for S100, cytokeratins, hormone receptors, myosin, and caldesmon. The differential diagnosis is made with other spindle cell entities, such as fibromatosis, solitary fibrous tumor, myofibroblastoma, metaplastic carcinoma, and other sarcomas. Synovial sarcoma has a moderate response to chemotherapy with anthracyclines. The treatment includes wide surgical resection and RT. Metastases occur in about 50% of cases and are present at diagnosis in 16% to 25%; they are more frequent in the lung (75%), regional lymph nodes (15%), and bones (10%), tending to late recurrence and metastases. The 5-year disease-free survival is 60%. Conclusion: The heterogeneity of the disease and its low incidence hinder prospective studies addressing therapeutic options with better long-term results.

Introduction: Adenoid cystic carcinoma (ACC) is a rare type of breast tumor – less than 0.1% of breast malignancies. Usually, ACC is triple-negative, with lymph node involvement not exceeding 2%, and metastases are uncommon. When localized, the disease is indolent with an excellent prognosis. Objective: To report a case of ACC of the breast and provide data for the medical literature. Method/Case report: J.S.M.S., 44 years old, had a 1 cm nodule in the right breast (RB) and free axillae. Mammography (MMG) showed focal asymmetry in the upper outer quadrant (UOQ) and BI-RADS 0. Ultrasound (US) revealed a solid, circumscribed, periareolar lesion with areas of cystic degeneration, 1.2 cm, BI-RADS 3. Fine-needle aspiration biopsy (FNAB) suggested fibroadenoma. Lesion resection led to the diagnosis of ACC, histological grade 1 (HG1), nuclear grade 1 (NG1), with associated ductal carcinoma in situ (DCIS), and sentinel lymph node with no neoplasia. Immunohistochemistry (IHC) revealed estrogen receptor-negative (ER-), progesterone receptor-negative (PR-), HER2 negative (HER2-), and Ki67 10%. Staging had no evidence of distant disease. The patient did not receive chemotherapy (CT) but underwent 18 sessions of radiotherapy (RT) in the breast with a boost to the tumor bed. She remains disease-free at 8 months of follow-up. Results/Discussion: ACC has low malignant potential with histology similar to that of primary ACC of the salivary gland (which is aggressive); in the breast, it represents 0.058% of all ACC cases. It is more common in Caucasian women aged 60 to 70 years and usually subareolar (approximately 50% of cases). Imaging tests are nonspecific. ACC has lymph node involvement in about 2% of cases. Histology shows epithelial and myoepithelial cells distributed in the classic tubular or cribriform architecture. IHC reveals epithelial cells positive for CD117 and myoepithelial cells positive for smooth muscle actin, calponin, and p63. ACC of the breast expresses proto-oncogene c-KIT and a chromosomal translocation similar to its salivary counterpart: t (6; 9) (q22-23; p23-24). Treatment consists of surgery with free margins. Axillary dissection, CT, and RT have a questionable role due to the indolent course of the disease. Until now, small studies have not suggested a benefit in overall survival when adding adjuvant CT. Although triple-negative, its prognosis is favorable. Local recurrence is approximately 3–18%, and 10-year survival is above 90%. Conclusion: The rarity of these tumors and their favorable course raise questions about the best treatment for ACC. The benefit of axillary dissection, CT, or RT remains unknown because the prognosis seems very favorable with only surgery, despite its triple-negative status. Further studies are necessary to adopt the optimal strategy for these tumors.

Introduction: Encapsulated papillary carcinoma corresponds to approximately 1% of breast tumors. Although rare, it has a good prognosis, slow growth, and a 10-year survival close to 100%. Axillary metastases of non-breast neoplasms are also uncommon, and the coexistence of metastatic non-breast neoplasm in the axilla and another histological type of breast neoplasm is exceedingly rare. Objective: To describe a case of breast neoplasm with axillary metastasis of non-breast disease. Method/Case report: F.R., 95 years old, had a nodule in the left breast (LB) for 1 year, with progressive growth. Examination revealed an irregular nodule in the entire LB with retraction of the papilla, measuring 11x12 cm, and hardened lymphadenopathy of 2 cm in the right axilla. Ultrasound showed a mixed tumor with a multinodular central mass of 18.3x19.7 cm and two enlarged, heterogeneous lymph nodes in the right axilla. Core breast biopsy indicated carcinoma with a papillary growth pattern. She underwent left mastectomy and lymph node excision in the right axilla. Anatomopathological results revealed a 14 cm encapsulated papillary carcinoma with free margins and right axillary lymph node as a high-grade metastatic neuroendocrine carcinoma. She is on exclusive hormone therapy with tamoxifen. When investigating the primary axillary site, abdominal computed tomography (CT) showed an expansive, predominantly cystic, retroperitoneal formation on the left side, in close contact with the tail of the pancreas, adrenal gland, and left renal vein, pending clarification, probably related to the right axillary lesion. Due to clinical conditions, she continues without a diagnosis for the primary site of axillary metastasis. Results/Discussion: Encapsulated papillary carcinoma is characterized by being solitary, unilateral, of slow growth, with papillary proliferation, central malignancy, surrounded by cystic ductal dilatation. It has a good prognosis and is rarely metastatic. Usually, it presents low or intermediate nuclear grade and strong positivity for estrogen receptor. Neuroendocrine tumors are a relatively rare group of neoplasms in any part of the body, occurring in the digestive tract in 62%–82% of cases. They can be asymptomatic or have symptoms associated with the primary tumor or metastasis. They are a heterogeneous group, often found in the retroperitoneum, abdominal lymph nodes, and mediastinum, usually have multiple metastases, and their primary site is hard to identify. Axillary metastases are uncommon, mainly coexisting with breast neoplasm of good prognosis. Conclusion: The rarity of axillary metastasis of neuroendocrine carcinoma associated with the good prognosis of encapsulated papillary carcinomas gives scientific importance to the current case since its axillary approach allowed reaching an unlikely diagnosis of neoplasm with uncommon metastatic site.

Introduction: Schwannoma is a benign tumor originating from Schwann cells present in the myelin sheath of peripheral nerves. Breast presentation is rare, and its clinical manifestation can mimic that of breast carcinoma. Objectives: To report the case of a patient with breast Schwannoma. Method/Case report: T.S.L., 14 years old, presented a nodule in the left breast (LB) with local growth for 2 months. Ultrasound (US) revealed a cystic formation in the lower outer quadrant of 1.8x1.3 cm, BI-RADS 2. Physical examination indicated a nodular skin lesion next to the LB fold, with 2 cm at 5 h, 7 cm from the nipple. After the surgical excision of the nodule, anatomopathological examination showed a spindle cell neoplasm without nodular-pattern atypia or malignancy characteristics. Immunohistochemistry (IHC) confirmed the Schwannoma diagnosis. Considering this scenario, annual control was started, and the patient has no evidence of the disease after 5 years of diagnosis. Results/Discussion: Schwannoma is a typically benign tumor originating from Schwann cells in the myelin sheath of the nerves. It may result from the parasympathetic or sympathetic division of the autonomic nervous system of the organ. It is one of the few truly encapsulated tumors of the human body and almost always solitary. It is usually located in the trunk, flexor surfaces, retroperitoneum, and rarely in the breast, representing approximately 2.6% of Schwannoma cases. It affects individuals aged 30 to 50 years, with equal incidence in both men and women. The skin lesion presents as a sessile, asymptomatic nodule of 1–3 cm and slow growth. Pain and sensitivity may be present when tumor growth causes nerve compression. Mammography (MMG) shows well-circumscribed opacity, with a density similar to that of soft tissue. US usually reveals well-defined, hypoechoic, solid lesions and can include the target sign, posterior acoustic enhancement, and continuity with peripheral nerves. The definitive diagnosis is made histologically, and the differential diagnosis involves other spindle cell neoplasms, such as fibroadenoma, phyllodes tumor, leiomyoma, fibromatosis, and, rarely, metaplastic carcinoma. Fine-needle aspiration biopsy (FNAB) showed palisading fibrillar cells with non-atypical spindle-shaped nuclei forming Verocay bodies. IHC indicates intense and uniform expression of S-100 protein. Malignant transformation occurs in 3–10% of cases, with high cellular proliferation, atypical mitotic activity, cellular and nuclear pleomorphism, and foci of necrosis. The treatment of choice is surgical excision of the lesion. Tumor recurrence is low and associated with the mitotic index. Conclusion: The case reported and publications found bring to light the discussion on diagnosis and treatment of breast Schwannoma, a rare and benign neoplasm in this location.