Topic of the day: Microglandular Adenosis, Bull**** or real??

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LADoc00

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Disease of the Day: Microglandular adenosis and its cousin aMGA or atypical microglandular adenosis of the breast. Supposedly in the DDX of tubular carcinoma and both lack a basal cell layer. Tavassoli calls MGA a proliferative breast lesion composed of small round glands and lacking a myoepthelial cell layer. Also has a very collagenous stromal background...

Now how the hell can you reliably tell this from tubular carcinoma? What about case reports of metastasizing MGA?? Is this entity complete BS???

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Do you find the quality of the stroma helpful? I always think that the elastotic/desmoplastic quality of tubular carcinoma stroma is useful. Been fooled though (or at least disagreed with by my seniors, I s'pose who knows?)

Mindy
 
I love all these diseases that are supposed to be "benign" yet metastasize and kill people. It's like thyroidal inclusions in lymph nodes - assuming they are well differentiated some people ignore them in lymph node dissections even if the cancer is an invasive follicular cancer. Or GYN tissue in pelvic lymph nodes.

Like "benign metastasizing leiomyoma." or "Benign metastasizing chondroblastoma." WTF? I mean I guess they don't often kill people but neither do most papillary thyroid cancers yet they are clearly malignant. Pap thyroid CA has clearly defined malignant alterations though, so it's clearly cancer.

In regards to the breast lesions, I guess the best way to solve it is to send it to Tavassoli and make her decide!
 
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yaah said:
I love all these diseases that are supposed to be "benign" yet metastasize and kill people. It's like thyroidal inclusions in lymph nodes - assuming they are well differentiated some people ignore them in lymph node dissections even if the cancer is an invasive follicular cancer. Or GYN tissue in pelvic lymph nodes.

Like "benign metastasizing leiomyoma." or "Benign metastasizing chondroblastoma." WTF? I mean I guess they don't often kill people but neither do most papillary thyroid cancers yet they are clearly malignant. Pap thyroid CA has clearly defined malignant alterations though, so it's clearly cancer.

In regards to the breast lesions, I guess the best way to solve it is to send it to Tavassoli and make her decide!

I dont and never will send anything to Tavassoli. The stromal quality is worthless, the "experts" Ive discussed this with go alot off the angular vs roundness of the glands. Gimmmee a break! That is so weak. I did have a case of benign metastizing leiomyoma this weak tho, so Im fairly certain I buy that.
 
When people throw around terms like "angular" or "round" glands, IMHO they generally already know the diagnosis and are turning the glands into whatever they want to make them so that it supports the diagnosis. At least, that is what I think when I am being pessimistic. Of course I'm probably being naive. It's like when people are convinced something is SCLC on a pleural bx all of a sudden all the cells are molding perfectly. But if they think it's mesothelioma they aren't molding at all.
 
I agree.

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:eek: You do not think invasive carcinomas of the breast carry with them a characteristic desmoplastic stromal reaction?!? I find it to be fairly reliable. Also, angular glands more often remind me of glands getting deformed (squished) by a rubbery, firm, collagenous stroma (i.e. benign) versus glandular proliferation which is characterized by rounded up. plump, reproducing glands and an active elastotic (blue-ish) stroma. It all makes sense to me, but of course in practice you can get deceived.

Mindy
 
Though admittedly my brief literature search described the glands of tubular carcinomas as being more angulated and those of MGA as being more rounded. Characteristics that I do not recall standing out in the examples I have been shown.

Mindy
 
Mindy said:
Though admittedly my brief literature search described the glands of tubular carcinomas as being more angulated and those of MGA as being more rounded. Characteristics that I do not recall standing out in the examples I have been shown.

Mindy

The stromal reaction is similar in both, the gland shape is characteristic the world's "experts" are making the call on. Im continuing to use this term but cautious.
 
LADoc00 said:
The stromal reaction is similar in both, the gland shape is characteristic the world's "experts" are making the call on. Im continuing to use this term but cautious.

Admittedly, Fletcher is not an breast pathologist, but at least it is a quick and easy reference anyone can look at: "[tubular carcinomas] excite a characteristic metachromatic stromal reaction which is not found in microglandular adenosis." I think that in practice, I would be exceedingly hesitant to make the call of MGA in a background of desmoplastic stroma. I don't think that the gland shape gives me the kind-of gut-wrench "this is cancer" feeling, at least in terms of round versus angled. Somehow, I still think that the glands of tubular carcinomas look "plump" and "revved-up" in comparison to the flatter, less active looking MGA glands, despite the fact that they are "angular." In fact that angulation is more like branching (reminiscent, though obviously not as convoluted or dramatic, of hyperplastic endothelium) than the angulation produced in the squished glands of sclerosing adenosis.

I am pretty sure that I will never make an aMGA dx... But we'll see.

BTW, LA, this is much cooler than your usual disgruntled nature :) . (Although I am expecting a biting response of "Yup, he's not a breast pathologist.")

Mindy
 
Mindy said:
Admittedly, Fletcher is not an breast pathologist, but at least it is a quick and easy reference anyone can look at: "[tubular carcinomas] excite a characteristic metachromatic stromal reaction which is not found in microglandular adenosis." I think that in practice, I would be exceedingly hesitant to make the call of MGA in a background of desmoplastic stroma. I don't think that the gland shape gives me the kind-of gut-wrench "this is cancer" feeling, at least in terms of round versus angled. Somehow, I still think that the glands of tubular carcinomas look "plump" and "revved-up" in comparison to the flatter, less active looking MGA glands--at least in the pics I looked at today. Unfortunately I don't have immediately available slides of either to review.

I am pretty sure that I will never make an aMGA dx... But we'll see.

BTW, LA, this is much cooler than your usual disgruntled nature :) . (Although I am expecting a biting response of "Yup, he's not a breast pathologist.")

Mindy

Having sat in with Fletcher, he sees less breast than other soft tissue goodies. Tavassoli, Kempson and Rosen all sing a similar tune from what Ive heard. But there is a group of academics that highly debout these distinctions, Im sitting on the fence at the moment. Ive diagnosed lots of tub CAs and less than 6 MGAs. Those 6 MGAs still haunt me, ill put that way.
 
Wow, you're quick! I edited my post slightly since then...

All academic musing aside, I would be scared senseless to sign out an MGA with my own name on the dotted line.

Mindy
 
Jeez, thanks LA, and I thought it was a virus! (Shame on me)

Mindy
 
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