Unusual Clinical Presentation of Carcinoma
913
FIG. 33.20.
Occult carcinoma.
A:
The entire occult carci-
noma represented in this section consists of two nodular
foci of intraductal carcinoma with lymphocytic reaction
(
arrows
) and in intervening zone of fibrosis.
B:
Focus of
intraductal carcinoma in the
right-hand
nodule.
C:
Dense
collagenous tissue in the center of the lesion could be the
site of “healed” invasive carcinoma.
D:
Nearly the entire
“occult” microinvasive and intraductal carcinoma in this
case is represented in this figure. The patient presented
with an enlarged lymph node. The metastatic poorly dif-
ferentiated carcinoma therein was ER (−) and HER2 (
+
).
More than 200 sections were prepared from the mastec-
tomy specimen before this focus was detected. The DCIS
partially involved one duct.
E:
The invasive and
in situ
car-
cinoma cells exhibit 3
+
positivity for HER2.
D
E
When a localized lesion has been detected and excised
from the breast, the patient may be a candidate for breast
conservation coupled with axillary dissection and breast ir
radiation.
129,144,148,176
Radiation may be given to the breast
and axilla after the diagnosis of carcinoma was established
by excisional or needle biopsy of an enlarged ALN if a pri
mary lesion is not detected in the breast.
132,144,170
The 5-year
DFS reported with the latter approach varied from 66% to
