Unusual Clinical Presentation of Carcinoma
901
FIG. 33.4.
Fibroadenoma, intraductal carcinoma.
A,B:
The usual epithelium in these two different
sclerotic fibroadenomas has been replaced by high-grade DCIS.
frequent than DCIS (Fig. 33.8). Infiltrating duct carcinomas
(Fig. 33.9) have also been described.
101,102,113–116
An IDC aris
ing in a low-grade malignant PT in a 24-year-old woman
was the source of isolated tumor cells in an ipsilateral
SLN.
117
Korula et al.
118
described a 51-year-old woman who
had DCIS in and around an malignant PT. Lymphatic tumor
emboli were found in the PT, and metastatic carcinoma was
present in two ALNs, but no invasive tumor was detected in
the PT or in the breast. Microinvasive and ILC can also be
found in this setting.
119
A high-grade malignant PT that con
tains carcinoma is a form of
carcinosarcoma
, because these
lesions are, by definition, neoplasms that combine carcino
matous and sarcomatous elements derived from the mam
mary epithelium and stroma. Carcinoma has been found in
the surrounding breast tissue concurrently with, or subse
quent to, excision of a PT that contained carcinoma.
102,120,121
Well-differentiated infiltrating duct carcinoma
122
and
tubular carcinoma
115,123
have been described in PT. The latter
case was unusual in that tubular carcinoma was found in the
second recurrence of a benign PT. The first recurrence con
tained LCIS. In the case reported by Quinlan-Davidson,
115
LCIS and tubular carcinoma coexisted in a low-grade
malignant PT.
Other unusual pathologic presentations have been coex
istent DCIS and LCIS in a benign PT,
124
invasive carcinoma
with ductal, secretory, and squamous components,
125
infil
trating duct carcinoma coincidental with but separate from
benign PT
102
and malignant PT,
126
LCIS in a PT with liposar
comatous stroma,
127
and microinvasive lobular carcinoma in
a benign PT.
119
PT that harbor carcinoma are usually benign
or low-grade malignant tumors, whereas carcinoma is more
often found in breast tissue outside an malignant PT.
114,121
There are rare instances of PT with carcinoma that devel
oped after treatment for another malignant neoplasm. Aziz
et al.
121
described a 43-year-old woman who had carcinoma
in a malignant liposarcomatous PT. Approximately 20 years
earlier she had received chemotherapy for Hodgkin disease
and radiotherapy to the lumbar region. Another woman
who developed a liposarcomatous and chondrosarcomatous
malignant PT associated with carcinoma when 26 years old
had been treated by surgery and chemotherapy without
radiotherapy for tibial osteosarcoma 11 years earlier.
120
Molecular Analysis
Macher-Goeppinger et al.
128
described the results of the mo
lecular analysis of an IDC within an malignant PT. DNA
was isolated from the microdissected epithelial and stromal
components of the PT, and from the high-grade IDC. Using
the multiplex polymerase chain reaction (PCR), compara
tive allelotyping was performed with a panel of 11 microsat
ellite markers. Analysis of the data revealed that the stromal
component of the PT showed loss of heterozygosity (LOH)
at chromosome 16q23, 17q12, 17q25, and 22q13 and that
the epithelial element of the tumor shared the loss of 16q23.
The invasive carcinoma had lost divergent alleles at 16q23,
17q12, and 17q25. These findings were interpreted as dem
onstrating a lack of clonality between the malignant PT and
the invasive carcinoma that arose within it.
Treatment and Prognosis
There have been very few deaths due to carcinoma arising in a
FA, and these have been attributable to IDCs.
101,104
Recurrence
in the breast following excisional biopsy of a FA that harbored
in situ
lobular or intraductal carcinoma has been uncommon
and appears to be less frequent than when the same lesions that
occur outside of FA have been treated only by excisional sur
gery.
99
There are virtually no published data on breast conserva
tion therapy that employed radiation in addition to excisional
surgery to treat intraductal carcinoma in a FA. The low fre
quency of subsequent carcinomas may reflect to some extent the
relatively short follow-up, averaging less than 10 years, in most
series of patients with carcinoma arising in a FA.
There are no systematic data on the treatment and prog
nosis of women who had carcinoma arising in a PT. The
need to ensure adequate excision of the PT in some cases
