KSP BREAST PATll9J-OOY SrMINAR, 1976

1. (Vanderbilt School of Medicine, contril:.\lted by Dr . Hartmann, 7 5- 6621).

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This is fran a 62 -year old 1<hitc fc:lalc 1·1ith a 4 em. mass in the right breilSt .

H. S, , NS 74-4789 (Contri":>uted by Dr . !',uhns, Norton-children's Hospitals, Inc . ). This 66- year old, Hhite, married "oma."l noticed a mass in the central area of the right breast approximately t c:n months prior to surgery. H.ammography studies "ere noxmal. No bleeding or discharge fra:1 the nipple t-ras apparent. No familial history of breast cancer ,)as noted. The patic;nt had been on Raudixin (Rauwolfia Serpentine) . In an excisional biopsy, t 1·IO grey-reddish, circunscribed nodules, 0.8 and l.S em. in diameter, '~ere noted .

S.J., 75 -5323 (Contributed by Dr. Black, St . Joseph Infirmary). This 38- year old 1;cman had noted lltnpy ar~as in the upper-outer quadrant of the right breast for approx:bately one year . There had been a recent increase in size. Hamnography 111tS not done. Physical el<omillation shooed numerous, small, firm areas of the upper-outer quadrant . The patimt had not been on medication, and ~:as Gravida 3 , Para 1, AB 2.

G. R.D. ,- SS i5-5443 (Contributed by Dr. Clanton, SUburban Hospital). This 56-year old , Caucasian f emale noted a left breast mass for approximately weeks . No history of discharge, drainage, or hormone therapy ~<as obtained.

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No mammography ,;as done. The spec:lmal consisted of a 9 x 4 x 2 em. portion of fibrous tissue with multiple cysts, up to 1.5 em.

L.K., NS 73-1826 (Contr ibut ed by Dr. Kuhns , Norton-Children's Hospitals, Inc ,). This 47 - year old, Gravida 1, para 1, actively menstruating, married funale had not od a mass, gradually increasing in size 1·7ith some disccmfort, in the right breast for sL'< ocmths prior to surcery. She had noted no nipple dischtn:ge or particular mass . ~·:amL"l.ation by a gyntcologist four l!lonths prior to surgery failed to find an ab>:t:)oality. She ,.,as on hormones for a brief period of time, for t~;o to _ three months, roe year prior to surger;. Examination revealed the right nipple and skin to b: r etracted , associated with a large mass tdth "ell-defined margins taking up most oi the upper-outer quadrant bo..1t not fixed to the under lying structures Gross examina::ioc of t he lesion revealed a 3.8 x 2.5 x 2.2 em. irregular, gritty, brOlm. mass, 3 .8 x 2.5 x 2,2 em., e».-tending 1 em. frCXD the deep pectoral fascia.

R.H., NS 75-3551 (Contributed by Dr. N1hns, Norton-Children's Hospitals, Inc . ) . This 51-year old nether of eight chil<lren (first at age 27) not ed a maso in the right breast approxillately three ~<eeks prior to surgery. Physical examination ShO':(ed a mobile , 2 C:!:. , w.ass in the upper- outer q112drant, and a soft , non-clinically suspicious, 0.7 em. , 101< axillary node . There ,,,as a history of estrogen therapy for her menopausal status. An excisional biopsy ,.)as done.

B.C . , 74 -S-8796, (Contributed by Dr. Ogden, Je.rish Hospital). This 42 - year old, obes e poet . d~~eloped a lesion of the l eft breast at age 25. It ,.:as removed, and the pathologic diag,.loSis ~1as benign. The breast HaS again operated on anc tissue ranoved ~<ith the dillgtloSis of benign lesion. Three years later, B:ld one year before the present specimen .. :as taken, a recurrence ""s e.'l:cised. The final sp'"<:'::~en 1:as a 9 .5 x 7.5 x 6 em. mass of breast and fatty tiasue . Sections showed a 5 x 4 .5 x 4 em. mass in the cmter surrounded by a thick m;mtle of adipose tissue '~ ith a s eparate 1 em. nodule in adjacent adipose tissue, not connected to the main ::tass 6J:Ossly.

Case Histories - 1-

-.---~;:---=-:;-;-;:-;=-;;:;=~----- ~ ~---c-------------8. H. S . , NS 74-5209 (Contributed by Dr. Byrd, Norton-Children 's Hospitals, Inc .).

This 62 - year old, black, ;-:id01·1ed uanan n ot ed seve..'l months prior t:o surgery a distinct sensation of soccthing "craHling on h er breast', and had noted a oass although it had not enlarge d, had not b"en painful, or be en associated t:ith nipple discharge. She had had previous beni gn biopsies of both bre."!Sts roenty years prior to this admission . ~laromography dromnstrated a 1.8 em, lesion in the upper-outer quadrant of the right breast, ~1ell c ircu::nscribed, d e ep . The post:erior margin of thiG l esion ttas poor l y defined. A b i opsy t:as suggest ed by the mammographer .

9. H.L., NS 7 5-1521 (Contribut ed by Dr. Kuhns, Norton-Children's Hospitals, Inc . ).

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This 55- year old , t-~hite female , Gravida 2, Para 2, <135 seen it\ the Breast Cancer Screening Clinic, on January 21, 1975. A mammogram danonstrated a 4 rom. mass on the 1200 radius alOI\g with several nodules. This tvas considered benign. On Harch 7; 197 5, 1!'-'l.!C!l!Ograrn showed an abnonna1 pattern: punctat e calcification, asymmetrical duct pat~ern.

N.B. C., 7 5 - S-7156 (Contri but ed by Dr. Ogden, Je-,.,ish Hospital) . This 47 - y e.'lr old black fenale bad been foll01:ed by her private physician for the past t.:c lve yzars with multiple biopsies. A biopsy of both breasts taken four years before the present spccimtn shO\red intraductal papillcxnatosis t-:ith florid ductal epithelial hypa:rplasia nnd sclerosing adenosis in both biopsic;s , Repeated biopsies of b oth breasts wer e done .

. 11. Y .L., NS 7 4 - 1149 (Contributed by Dr. Kuhns, Norton-Children 1 s Uospitals, Inc . ) . This 65-year ol d oo::cite, ,.,idO\·recl t·IC\lll'ln noticed e lump in the left breast about three months prior to surgery. This ha d gl.'O\·m larger , and had b<!C1l =associated Hith pain . l'o ::"<i?p l e discharge had beC1l present. A previous biopsy of the left breast had b een ci::ne s everal years ago. Exomit-.ation demonstrated a soft, Hell­defined mass o:: tC:e Up!?er-outer quadrant of the left breast . There '~s fixation of the deeper t~sues noted. No o:nlarged ly::~ph nodes t~crc present. l'\•o portions of tissue wer e r .noved. The first ~1as a 3 em. diamet er portion of f atty tissue, the second 1.8 c:::1. diameter, firm, grey-white tissue ''ithout a distinct mass .

12, 75- S- 2311, 75 - S-2396 (Contributed by Dr. Ogda> , Jewish Hospital). This patient t.:as a 69-year old Caucasian fGnale banker t·lho present ed '~ith breast masses . }!=ogJ.e. •. s reveal ed bilat eral breast nodules . The patient is singl e , and a pelvic e>:!!::linat ion ,.ms not performed . There is no history of children, or of pregnancy. J.;o previous biopsies '~ere performed.

,13. H.S. D. , NS 70-807 (Contributed by Dr. Kuhns , }lorton-Children's Hoapitals, Inc,), This 31-year old f e-,J<ll e t·ras found to hAve a lu:np in the upper- out er quadrant of the breast, ' bil o':>l!lar' i 11 nature, 0.75 to 1.5 em. in great est diam eters, 1:hich ,.ras felt t o be 1 fi,brocystic disease'. The patient had been on hormones in the past. A br eas t bi opsy '"as don e .

. il, , A.T . , 7 3- S-4264 , 72 - S- 3641 (Contributed by Dr . Ogden, J eo,;ish Hospita l). This 47 - y!ll!r old '>lac k f emale , ,as firs:: s een in 1972 . She had a four-year his tory of hypcrt Ertsim and a mass in the l eft br east . Biopsy at that time s:\cn<ed ben i gn flor i d i n tradl:ctal papillanatos i.s . The follo.ving y ear she t·:as r cad:titted m1d bccm:s c of the c::aina g e coming ! rom the l e ft nipple, a biops)• of the mass was done .

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DJii<:nosnc LIST

1. l'.ucoid (Co11vid) Carcinoma

2. Poorly Differentiated Papillary Carcino~a

3. Infiltrating and -In Situ lobular Carcino:r.a

4. In Situ lobular Carcinoma

5. Poorly Differentiated Hal!'mary Carcinoma with Lobular ahd Ductal Features

6. Infiltrati ng lobular Carcinoma with S~teat Gland Pattern

7. Cystosarcoma PhYll c~:s

8. Fibromatosis (Reac~ive)·

9. Fibrocystic Disease with Papillor.1atosis and Sclerosing Adenosis

10. fibroadenoma with s~rrounding Atypical Papillomatosis

' . 11. Tubul ar Carc1noma

12. Fil.Jrocys tic Disease :h Papill omatosi s

13. Scl eros ing P.denosis l·,ith Papillo:r.atosis

14. lo•:t Grade Papillary Carcinoma ~tith Focal Invasion

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GENERAL DISCUSSION

As a histologi c er. tfty, brea~t cancer h:; change1 probably not at all since t ime i r.:me;;:orial. The modern era of cl ~ssifi cat ion beg~n uith tha t formu­iated by Stewa_rt at 1'..:?:-orial Hosp"ltal i n Ne:1 York as demonstrated in ·the Breast fascicl e of t he At las of Tumor Pathology, 1st se ri es . (1)

Subsequent classifica t ions , s uch as those of the Pathology Worki ng Group of the Breast Cancer Task Force (2) or that of Acke rmcn and Taylor (3) as utilized in the 1969 Slide Seminar of t he American Socie ty of Clinical Pathologist s , ·• · are but modi f ications. · They are f ormulated to emphasize the many ~ubgroupings of the ductal group of cancers and to be of sreater util ity for prognostic purposes. ·

The Memori al classification divided all breas t car cinomas into three broad groups: t hose of duct al cell , l obul ar cell and unknO'IIn origin. · The concept of or i gin from duct or l obul ar· cell has recently been chall enged by the 5 tud1 es oF We 11 i ngs and Jensen. ( 4) By tota 1 embedding of resected breasts (both surgical and autopsy), they have meticul ously traced origin of all

'breast carcinomas to the lobul ar unit. Further. they have supported t he concept of Gal l ager and others (5) that thes~ carci no~as evolved through a phase of epi thel ia.l hyper pl asia .

This classification of breas · carcinomc has stood the tes t of ti~: . It has b~en reproduc·Jble and does give t: - ~ful prognosti c informat ion . . At l east t hree fcnms of inv<t:; ive breast carcino- · :madull aJ:::, collo~ c! and t ubul ar as ~1ell as the in situ philses of duct and l o.Ju lar car cinoma} enjoy a signi ficantly better· ·prognosi s th lln t he much more common scirrhous form . (3} This has been extended by Gall ager <md 11artin in to the concept of r.;i ni mal .::arc ino:n~, (6) whi ch i s histol ogi cally defined as incl uding t he i n situ fonns of bre~st cancer as ~1ell as those invasive cancers that measure 1ess than 0.5 em. in greatest diameter. This concept wil l have conti nuing and increasing s ignificance because of a decreasing si ze of clinical cancers and bec~~se of the impact of the Breast ~ncer Demonstration Projects of t he National Cancer Institute and the Amer ican Cancer Society by brin9ing to t he pathologist the smallest of lesions.

Inspite of histologic similari ty ove r a long time span, cl in i cal pathologi c cor ral ati v.e s tud·Jes continue to c: made and must be extended by adherence to sound histologic classificat ion in pathoepidemiologi c studi es .

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REFERENCES - GEIIERAL ..

1. Stewart, F.IL Tun:ors of the breast, ,!,tlas of Tumor Pathology, Sec. IX, Fas. 34 , Washir.gton, D.C. - AFIP, 1950. ·

' 2. Pathology ~orking Group, Breast Cancer Task Force , Nation~l Cancer

Institute. Standardized management of breast specirr:ens, Am. J. Cl in .. , · Path. 60:789-793, 1973. •

3. Ackerman, L.V. and Taylor, H. Pnice;:!ings of 35th Slide Semi nar, American Society of Clinical Patholo;ists , Chicago, 19o9.

4. ~lellings, S.R. and Jensen , H.t-1.. On the origin and prog;;osis of ductal carcinoma in the human breast, J. rl~t. Cancer Inst . 50:111-1-1118, 1973 . · - .

5. Gallage·r, H.S. 'and t•lartin, J.E. Early phases in the development of breast cancer, Cancer 24:1170-1178, 1959. ·

6. Gallager, H.S. and 1-lartin , J .E. An orientation to the concept of minimal breast cancer , Ca.~ 28:1 505-1507·, 1971.

7. Da• . .,son, E:K. The genesis ~nd spread of r.::ur.mary cancer, . Ann. R. Col l. Surg. ··. Eng. ?_:241-247, 1948 .

8. !~t Cancer: A Challenging Probl e!>: , Springzr-Verlog, ll e\i Yorl:, 1973.

9. The Trciltr.:ent of Carci nom<t of the Br;;!st , A.S. Jarrett, ed., Excerpta l·ledica; foundation, 1967 .

10. Breast Canc<!r: Early and Late, Year 3ook l-ledica1 Pulll'ishers, 1970 .

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CAS~ l

NODEP.;\TOR'S DJ/,G:iC5~5: l-!uco1d (Colloid) Carcinoma ·'

DISCUSS loti:

This case ser·:es as an introduction to t he study of breast cancer, by illustrating th~ problems of classific~tion. Today's classi f i cations are based on the original one of Stewart and Foote, dividing all breast cancers into those of duct, lobular or u~~ertain origin . The d~ct and lobular division was a concept~al one-~n~t based on anatomical fact. The concept and classification have stood the test of time , for the current classifications are all modifications of the one fror.d!emorial Hospital.

The present case is basically a· circ~~scribed invasive lesion · with mucin production . The growth patte~n is also on~ of papil lary configuration. The. cell s hpve distinct icbular confi9urations.

REFEREiiCES: : .

1. Norris, H.J . and Taylor, H.B. Progncsis of mucinous {gela.tinous) carcinoma of the breast, r.~~ .!§_:B79-8B5; 1955 .

2. Silverberg, S.G., et.al. A~. J. Clin . Path. 55:3:

:~l loid carcinoma of th~ breast, J3 , lg]].

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CAS£ 2

:''J~ERATOR'S OIAG:lCS iS: Poorly Differ.?nt iated Papi1lary Carcino1r.a . . ,:

DISCUSSION:

This is a poorly differentiated papillary carcinoma of the bre~st. It is a circumscribed lesion microscopically, in contradistinction to its appearance on the marr.rr.JJgrams, 1~hich are that of an infiltrating -· · lesion. This is not a medullary carcino:::a, because of i"ts strllctural appearance. It is a histologically hi.gn grade of malignancy .• Treated by a modified radical li".astectoll\Y with no evidence of lymph node rr.-:tas tases. ·

REFERENCES:

1. 11cl<ittrick, J .E., et.al. Intracystic papillary carcinoma of· the breast, Am. Surg. 35 :l95-202, 1959.

2. NcDivitt, R.H., et.al. Prior breast disease in patients treated for papillary carcinorr.a , Arch. Path. ,§i:117-124, ' 1968.

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CASE 3

NODERATOR'S D!AG:;o.>: 3: Infiltrating and In Situ l obular Carcinoma

DISCUSSION :.

This case ill ~ ;:rates the problems of the classification of the small cell infiltra:ing carcinomas of the breast. By definition, 1 accept these as lobular in origin. The criter-ia are those of a \mi­form cel·l type with a linear ~a :tern of. infiltration. lobular carcinoma in situ is reassuring and supportive, but not necessary for the classification of a lesion, such as t his one, as a lobular carcinoma. The' concern for t he other breast is just as meani ngful here, as in the .case of a lobular carcinota in situ. Treated by , radical mastectOmY (one positive node) and biO?SY of the other breast (negative) .

REFERENCES:

1. Fechner, R.E. . Infiltrating lobula r ca.rcir.o;;:a without lobular carcinoma in situ, Cancer 29:1539-1545, 1972. ·

2. Fechner, R.L Ductal carcinoma involving tha lobule of tha breast, Cancer 28:274-zr ·. 1971.

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CAS:: 4

:·lG!JERATOR ' s D!AG:;os:s: In Situ Lobular c~rcir.oma

DiSCUSSION:

This is a classical case of in situ lobular carcinoma . There are rr.any areas of atypical lobular change th:.';; should not be diagnosed, at our present state of knowledge, as a cl ir.ica l cancer. In ger.aral, the ., · cancer dfagnosis is based on a distend~d iobule, a uniform ccll ' type, which sho·..,.s indistinct cytoplasmic borclers and little to no nuc.lear atypia. Na;r;;.ographic stuc(y of the oth§!r ~raast is today, in fl\Y opinion, the Qin imum that should be done for such a patient. Treated by radical w.astecto~ with negative nodes.

REFERENCES:

l. Haagensen·, C. D. ; et.al.· Neoplastic proliferation ·of the epi thelium of the marrmary lobul e , Suro. Clio. ll. A. 52 :497-524, 1972.

z. Harner, tl. · Lobular carcinoma of the !!reast, Cancer 23 :840-845, 1959 . .

3. ~!heeler , J.E.: et.al. Lo!:.:lar carci;::;;:a in ~itu of the breast, Cancer 3!;:554-563, )974 .

4. Anderscr1, J.A. Lobulur c< - inon;a _in s i tu, l'·cta .Path . :iicro. Scand . A82:519-533 , 1974.

CASE 5

NODERATOR' s DIAG,'iGS: 5 : Poorly Differenti~ted 1-larrmary Carci no:;:a , with Lobul ar and Ducta l Features

DISCUSSI ON :

This is a poorl y di fferentlat ed marmary carcinoma Hilich is l obular in t he infiltrat i ve phase a nd intraducta l i n the in s itu phase, as fa r ··• · as our evidence will i l low. Conceptua lly , it i s easi e r to thin~·of such l esions as a ris ing in tl:e lobul ar . imi t , al a J ensen and ~!all ings . and der.:onstrating at least t h'O different gro:'lt h patterns . Of greatest significance is the fact that thi s is a high grade mal ignant tumor . Treated by r adica l mastectomy with 21 out of 27 lymph nodes containing rr.ctastati.c ca rcinoma. Si nce then, she .has had a chest wail r ecurrence, oophorectomy and a bone marrc·11 examinati on which i s n2gative for .tu';r.or. (Course, 3 years .)

REFEREIICE :

1. Wellings, S . R.' and Jensen , H. l1. On t he origin and prognosi s of duct al carc:lnoma in t he hu:r;,n breast , J. Na t. Caocer I nst . 50 : 1111-1 118, 197 3.

Cf1SE 6

f,.JDERI\TOR'S DIAGIIC~fS: Infil trati ng Lobular Carc·1nom~ l'lith S·.~eat Gland Pattern

DISCUSSION:

The mammogra~ contains an area t hat is at least susp1c1ous . The . ~mor is a small cell ~~lignancy , suggesting carcinoid and s~aat gland origi~ . in the differentia l diagnosis. · This is a breast cancer, 1~hich r prefer to think of as a n infiltrating lobular .carc inoma , Sl·/ei!t gland type. This is a tur.:or of 1 o·~ grade r.-.a 1 i gnar.cy . Treated by radica 1 m3stectofl\Y and biopsy of opposite b,r:east. tic residua 1 tu;;:or , no lyr.!ph node metastases and oo disease in other brei!st .

REFERENCES: . '

1. Keasbey , L.E. and Hadley, G.G. Cl ear cell hidrad~noma, Cancer 1.:934-954, 1954.

2. Finck, F.I·L, et .al . Clear cell hidradenoma of t he breast, Cancer 22:125-135, 1958. - .

3. Ahmed, II . The li1:/0epithe1iL' in hu:nan breast carcinoma, J. Path. 113:129-136, 1974.

4. Thackr~y, II.C. and Lucas, R.8. Tu~or of th~ major salivary glands, Atlas of Twr.o r Pathology, 2nd Series, Fas . 10, AFIP, pg . 62, 1974.

XODERATOR'S DIAGIIO:>:o· Cystosarcoma PI'\Yllcdes

OISCUSSION :

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Thi s case ill us~:-~~=s .the continui ng vexing problems that we are faced with under tr.: ~i:gnosis of the strc~al lesions of t he breast . This appears to be c:; :'jl ogically mal i gnant with areas of cellular ., . cro';lding, nuclear aty;:ia, and augmented mitotic rate. For these' reasons, the term to be used is cystosarcc~~ phyllodes , signi fying a F.alignant l esion. '

. REFERENCES :

1. Norris, H.T·. anp Taylor, H.B. Relationship of histologic features to behavior of cystosarcoma phy11 oaes , Cancer 20:2090-2099,.1957 . . . .

2. Curran , R.C. and Dodge, O.G. Sarcoma of breast with particular r eference to its origin f rom fi broadenoma, J. Clin. Path. 15:1-16, 1952 . - ' . ~ .,

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r·;ODERATOR'S DIAG:IOSI5: Fibromatosis (Reactive)

DISCUSSION:

This appears to be a fibroblastic lesion that is not neop)astic, but rather reactive . It .has areas similar to that seen in desmo.id rumors and keloids. The cytology and organization do not sugge~t a tumor; and for th~se reasons, 1 ·prefer '_the term, fibromatosis.

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C.O.S£ 9

f·:OOERATOR'S DIAGNOSIS: Fibrocystic Diseas:: •,lith Papillore3tosis and Scl erasing Ad enos is · '

DISCUSSION:

The mammograms contain m~ltiple lesicr.s, all of which are disturbing. The one biopsied has been verified by spec!men radiography. The process demonstrated is that of a papillomatosis wj th no areas of suspicion .

• REFERENCES:

1. Sanderson , A:T. and Walker, J.C. Disc~ses of th~ adolescent female breast, Brit . J. Surg. 55:443-448 , 1S58. ·

2. Fenoglio, C. and Lattes, R. Sclerosir.g papillary proliferation in the female breast, Cancer 33:69F700, 1974. ·

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CASE 10

I1DD£AATOR' S DIAGti051S: Fi broaden0:::a Hi th Surround i r.g Atypica 1 'Pc:pi 11 omatosi s

DISCUSS I Oil:·

This is a circ~~~cribed lesio~. a fibroadenoma surrounded by a severe proHfera tiva intraductal process. The cellular atypia is ., · severe , but does not justify a cancer diag::osis. Treatment ; in ·a case such as this, should be discussed wi th -the patient and guided bj her wishes .

REFERENCE:

1. Buzancwski - Konakry , K., et.al. Lobular carcino;;.a a ris ing in fibroadenoma of the breast, Cencer 35:450-456,- 1975.

CASE 11

I~O!Jt:.'.ATOR' S DIAGtlOS rs : Tubular. Carcinoma

DISCUSSION:

1. T~ylor, H.B. and tlorris, H.J. Hell differentiate(! carcino:ua of the breast , Cancer 25:687-792, 1970.

2. Carstens, P.H.B:, et.aL Tubular carcinoma of.the breast, ;.~. J. Clin. Path . 58:231-238 , 1972.

3. Erlandson, R.A. and Carstens, P.H.B. Ultrastructure of t ubul ar c~rcinow.a of the breast, Cancer 29: 937-995, 1972. . . -

• 4. Toker, C. Small cell t ubui ,,. carci~o;;:a of the breast:

o~ the 1·o 1 e of 1 oca 1 exci ~ ., as t he treatment of this cancer·, 1-lt. Sinai J. of I· 40:1-6, 1973 .

observations pa-rticular

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CAS!: 12

MODERATOR'S OIAGtiOSlS: Fibrocystic Di seas~ Hith Papillo:.:atosis'

DISCUSS ION:

This rew.a ins c~e of the largest areas of probl~m diagnosis : the differentiai diagnosis of the papillary lesion of. t he breast. The criteria of Kraus an:l 1\eubecker and NcDivitt, Stew:rt and Berg trave stood the test of tk.e, but must be remembered for Hhat they are: guides, not absolutes. This is a beni;~ lesion, preferably called fibrocystic disease with papillo•~tosis.

REFERENCES:

1. folacgillivray, J , B. The probl em of chronic liY.lStitis with epitheliosi s, J. Clin. Path. 22:340-347, 1969.

2. Devitt, J.D. Fibrocysti c ~isease of the breast is not pre-malignant, S .G.O. 134:893-805, 1972.

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3. Ashikari, R., et.al. A clinicopathologic study of atypical l esions of. the breast.. Cancer 33:3: -317, 1971.

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CASE 13

t!OOERATOR 'S OIAG~;OS!S: Sclero!:ing Adenosis with Papillor.kltosis . .

DISCUSSION: ·

Infrequently pr~senting as a mass lesion, it is unusual for a case of sclerosing ~c~nosis to be a problem of differential diagnosi s for today's Pathologist. It is, however, occasionally confused with tubular carcinor.:.a.

REFERENCE:

'1. Urban, J.A. and Adair, R.D. Sclerosing adenosis, Cancer £:625, 1949.

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I•:ODERATOR' S DIAGNOS! S: LO'o'/ Grade Papillary Carcinoma with FO'ca l .tn•:asion

DISCUSS I Oil : '

The uniformity of cells, the non-stro~al containing nature of the papillary fronds, ·and the distortion of th~ glands lead to the con- · clusio.n that .this is a papillary carcinom~. There is but focal evidence of stromal invasion, and the pr::gnosis .is anticipated to be that of an intraductal lesion.

REFERENCE: • 1

1. Silverberg, S.G. a nd Chitale , A.R .. Assessment of si gnificance \>f proporti ons of intraductal and infil t ra ting tumor growth in ductal carcino;;:a of the breast, Cancer 32:830-837, '1973. - .

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