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Jack Uecker, MD Auditor r. PAUL-RAMSEY HOSPITAL and MEDICAL CENTER ST. PAUL, MINNtSOTA 55101 Anat om i c Patho logy Sem inar Spring Breast- Fest St. Paul-Ramsey Hosp i tal and Med ica l Cen te r Moderator: Jack Uecke r, M.D . Aud i tor i um - 6 :00p.m. - June 4, 1975 Buffet .,; 11 be served CASE /1 1 Thi s 87 year old female presented with a nontender breast nodul e present for about one year. On exam ination the left breast contained a fi rm thick 1 em. tumor. A simpl e mastectomy 1·1as performed and the gross examination of the tumo r shoHed a hard nodu l e of c risp white fi brous tissue flecked with smal l yel l O\~ areas. Subm I tted by: Centra l Reg iona l Pa thology Laborat ~ry St. Paul, Minnesota CAS E #2 Thi s 42 year o ld fema l e presen ted with a fi rm mass of t he ri ght breast. The clinical di agnosis was "fibroma ". At surgery a 10 em. in greatest diameter mass of s oft rubbo fibrous appearing tissue was submitted. Subm itted by: Department of Pathology University of North pako ta Grand Forks, Nor th Da kota CASE /13 Thi s 18 year ol d unmarried 1·1oman presented wi t h a four ~1eek hi story of an enl<!rging breast mass located deep to the nipple and s li ghtly toward the outer quadrant. She also noted some "e nlarged nodes" underneath her a rm but she was otherwise asymptomat A blop$y ~1as performed and a soft poorly defined 2.5 em . mass was removed. Examinat of the ax i l l ary node showed marked hyperplasia but no evi dence of tumor. Subm itted by: Wayn e Schrade r, t~. D. Or 1an do, Florida CASE #4 Thi s 48 year old female p resented with a ri ght breast mass. The mass l<as biopsi ed. Submitted by: Jerry Baldwin, M.D. Hil ler Hosp ita l St. Paul, Minnesota CASE /IS This 36 year o ld ·~as seen because of a protruding n ipple which had previously been inve rted, A biopsy wa s performed with a pre-op diagnos is of "Pogets di sease". Submitted by: Section of Surgical Pathology St. Paul-Ramsey Hospital St. Paul, Minnesota CA SE #6 This 60 year old female presented to her physician with a history of "serous" disch< from her right nipple. A b iopsy was performed and the specimen consisted of a fragr of flbrofatty t i ssue showing a cyst' I ined by a fibrous capsul e . Within the cyst there was a tan-brown solid tumol' measuring up to I em . in diameter. Submitted by: Department of Pathol ogy University of North Dakota Grand Forks , No r t h O~kota CASE //7 This 68 year old femal e present ed wi th mu l t ipl e nodules of the b reast. Ex tens ive biops ies . ,ere per forme d and they cons i sted of fi brofa tty tissue wh ich Included mu l t ip cysts containing intraductal nodul es. In add ition, t he re we re mu l t i p l e areas of st indu ration. Submitted by: Department o f Pathology Mt . Sinai Hosp ita l Mi nneapolis, Minnesota CASE 118 This 65 year o ld l ady had a long hi story of f ibrocys tic disease wi t h mul t ipl e prior breast aspirations and biopsies . Sh e presente d with a palpabl e ma ss ln t he outer quadran t of t he l eft breast. It wa s non tende r and nonfixed but mammag rams we re "suggesti ve" of ma li gnancy. su bm i t ted by: Donn Leaf', M.D . Red Wing, Minne sota CASE #9 This 61 year o l d fema l e p resented with multiple bilatera l sma ll rubbery nodules of t he b reasts. She had mul tip l e p revious b iopsies f or "fib rocyst ic disease". The b rea st~ were large. The current biopsy tissue cons i s ts of a 12 em . mass of rub be ~ , fibrofatty t i ssue >lhi ch contained mult iple cysts measuring up to I em. i n diame ter. One cyst contai ned an intralumi nal pap ill oma a nd throughout the br.east t he t·e •1a s seve ral dilated duc ts filled 1•1i th a creamy ma t e rial, surrounded by firm gri tty nodule• Submitted by: Central Regional Pathol ogy Laboratory St. Paul, Minnesota CA SE /110 Th is middle aged femal e p resented wi th a left breast ma ss. Submitted by: Jerry Baldw"in, M. D. Mi l ler Hospi tal St . Paul , Minnesota CA SE /Il l Thi s 18 year o ld had a small left breast mass for 4· to 5 years . I t ha d been note d by nume rou s examine r s including the pa tien t . An exc lsional biopsy 1•as perfo rme d and the tumor cons Isted o f a we l l circums cribe d I em. no dule of yel l ow ti.., ssue • Submitted by: Se ction of Surgical Patho logy St. Paul-Ramsey Hospita l No s l ide avai l able St. Pau l , Minneso ta . CASE /112 This 32 year o l d patient presented to the surgery cl lnic; with a raised 1 ight tan 8 m. papi l l<•ry lesion of the nipple. This had been present for several months and the pa · had treated the l esion loca l ly wi th hand c ream and a banda id . Exam inat ion of the sub' b reast t i ssue rev('a l ed no abnormal i ties. II biopsy wi t h f rozen sect ion examination lia performed , Submi t t e d by : Section of Surgical Patho l ogy St . Pa ul - Ram sey Hospi tal S l. Pau 1 , Hi nn csote CASE #13 This 45 year .o 1d fema 1e has "s i 1 i eone" i nj ec t ions in to both breasts 1<h i 1 e in ,Japan in· 1966. She had no trouble unti 1 approximately five years later 1<hen she noted firm slightly tender bilateral nodules in both breasts. She consulted a physician who vari fied the presence of "suspic·ious" firm bilateral nodules. Mammagrams v1ere not performed. Bilateral subcutaneous mastectomies were performed. Th ~. specimens consi ste of irregularly lobulated mases of yell'ow fatty ti·ssue admixed with extremely dense, firm to rubbery, fibrous c0nn !!' ctive tissue. Then~. were innumerable cysts. p,.resent in both breasts and the majority of these contained an oily material. In addition there were mul tiple nodules of congealed waxy material. Surrounding this l<axy material there ~1as severe sc.lerosis v1hich ext·ended in to the subjacent skeletal muscle. Submitted by: ·sectron of Surgical Pathology ·st. Paul-Ramsey Hospi tal St. Paul, ~innesota ' 1- ~~ ~~. w Yi~ ~-~...&_ \.MV<L-\r71.,..... .... A.___, , z- uu£~~ <...tii../UA'UJIW.4,. wd4 • . - ~ tz. ... l>l~ ~ 13 - ~ll' CAJ'W. ~ hh·.s - ;T. PAUL-RAMSEY HOSPITAL and MEDICAL CENTER • ST. PAUl.. MINNESOTA SSlOl BREAS T PATHOLOGY SENINAR DIAGNOSES AND DISCUSSION 1. Infiltrating adenocarcinoma with elastosis. This rather ordinary case was included because of the striking elastosis pres ent around islands of tumor and around vessels. It turned out thnt mos t of the pathologists attending· the meeting had not hea·rd of or did not recognize the elastosis. Elastosis is relatively common in breast cancer, both ductal and lobular. One series has elastosis in breast cancer in up to 85% of the cases. See the article by Lund.mar k in CANCER, November, 1972 and the article by Azzopardi in CANCER, January, 1974. 2. Undifferentiated carcinoma with chondroid metaplasia. Dr. l~asdahl , who submitted this case , had originally diagnosed the lesion as an extraskeletal chondrosarcoma but after reflection upon the case and after rather direct instructions by his residents he changed t he diagnosis to undifferentiated carcinoma. This was the concensus diagnosis of the group in attendance at the meeting. See the paper by Smith and Taylor in t he American Journal of Clinical Pathology, May , 1969 and the article by Norris and Taylor in Cancer, July, 1968. 3. Medullary carcinoma. The general subject of breast' cancer in younger patients was discussed. Axillary lymph nodes in this part icular patient were negative. The possibility of reticulum cell sarcoma was suggested by several participants. 4. Angiosarcoma. This case was also presented in the MSCP Sr'minar i n Novem­ ber, 1974 . The general subject of vascular tumors of the breast was discussed and numerous participants stressed the fact that angiosarcomas of the breast often, if not usually, appear harmless, at least in some areas of t he neoplasm. However, tbese are highly malignant tumors, generally of younger women , and the average survival is about two years following diagnosis. We inquired whether or not any of the participants had ever made the diagnosis of heman­ gioma of the breast and Dr. Rosai volunteered the informat ion that he had recently made that.diagnosis as a small incidental finding. 5. Nipple adenoma or subareolar duct adenomatosis. This turned out to be a relatively con·troversial case. The lesion had been called adenocarcinoma on frozen section and a simple mastectomy "as performed.
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