Unusual Clinical Presentation of Carcinoma
903
FIG. 33.6.
Fibroadenoma, invasive lobular carcinoma.
ILC in a FA with pagetoid LCIS in adjacent ducts.
FIG. 33.7.
Phyllodes tumor, benign, with lobular carci-
noma
in situ.
A:
Benign PT with LCIS.
B:
Benign PT with
atypical ductal hyperplasia (bordering on DCIS) and LCIS
(
left
).
C:
LCIS is negative for E-cadherin (
left
), whereas the
ductal lesion is positive for E-cadherin (
right
).
A
B
C
necessitates a mastectomy even when the carcinoma would
be adequately treated by breast conservation.
OCCULT CARCINOMA PRESENTING
WITH ALN METASTASES
Fewer than 1% of patients who have mammary carcinoma
present with an ALN metastasis as the first clinical manifesta
tion of the disease.
129,130
Among 10,014 patients with primary
operable breast carcinoma treated at one institution, 35 (0.35%)
had occult carcinoma presenting with axillary metastases.
Clinical Presentation
This condition occurs throughout the entire age distribu
tion of breast carcinoma,
129–135
with the mean and median
age around 57 years.
136
The right axilla and breast were af
fected slightly more often (54%) than the left in one series,
94
but others have reported left predominance.
137–139
A posi
tive family history of breast carcinoma has been reported in
