TllMOR SJ!MINAR COLLl!CTICSI

SET n.

Breast Seainar1 FhlladelJil1a1 1950, Cl&rk E. Brow

A N H U A L S L I D E S E M J N A R

Philadel~~a Pathological Socio~

• •

,

};~-- 41-h. lf'Fl tv/ "tlNUSU!L '!I.-fOilS OF THE BREAST"

Dr . Cl arl<...£. Srown Md Dr . John Hopkins [, ;,C._,. ___ _ /~t tt; 1~

Lankenau Hospital

3'1,·~· 7fh

?lease enter your diag~os is on the last sheet and mail in enclosed envelope. tour opinion is important,.

Breast Co:U'erence ilo. 1

Donated by E. DeCoursey, :.;,o.

:he patient is a 55 year old, ·•hitc male . "Lump• noticed Eay 15, 1950. Has been increasing in siz-e since then. !low s ize of l'alnut . Appears attached ~o skin without <ili>lpling, but r.ot attached to deep tissues. No axillary ~~volv~~ent . Nipple o. K.

9reast Conference »o. J

~e~ale , Aged )2 7ears. Dcnated by E. L. Heller, ll . D.

~ circunscribcd, !'lOVable, r.on-tendcr mass in t~ breast, present s1nce puberty.

S?t>clr.en conslSted of a piece of breast \.issue attd tu"1or 'lleasuring 7 x 5 x 2 CMS .

In the central portion of the breast tissue "as a fi~ tUMor , well delineated out not <>ncapsulatcd. The cut surface showed a tannish- whi te, smooth, glistening tissue which re~racted in = eas. li~r>terous snail , yello:: arens ~~re scattered throughout. The tu~or cut with a hnrd, gritty sensation.

3reast Conference !lo. 5

Donated by R. L. Breckenridge, .l .D.

I forty year old, white b"O:lM was admitted June 1950 for lobocton~ because of tn extra density seen on roentgen exa"lination in the lert lower· l ll!lil. This was bl:lieved to be> an isolated metastasis or a ~:~aligna.'lt mammary tumor previously treated in 194~ by a loft rndical ~astoctomy. She gives a history of having a •cyst• l"C:loved from tho left breast in 19W. . Two years ago she developed pain along the line of ir.cision. The left lower lobe was r esected wUhout di..ffi­culty. The nntiont recovered uncvcnt.L'ully and has boon well to date . 'The lobe cont«ined a well- circumscribed, rubbery mMs measuring 7 cll!s . in dim~oter. 'l'he cut surfscc buliod out and ;~as l=on-ycllo.w with gr•y- wilite streaking. The "etastntic tumor was s~il21", histologically, to a primary tlllllor of the brcut removed in 191.".

Br east Conference No. 7 -::.s. Donated by E. E. Acgetet·, !! . D.

Aged 58. Firs t seen in April 19116. ? ain in shoulder. Breasts nomal . lloven:bcr 19L 7 - Crncorophobia. Asked for examination. Breasts nor:ncl. . ''cy 19u8 - l'ai!l in upo::r outer qu.?JlrAAt or rir.ht bres:tt. Blood discllnrge frcn nio:>le . June 19h6 - Duct dil:-.tc;d . Old blood expressed. '>eetcmb.-.r 19L8 - :'loplc dischnrge . Oivcn stillbcstcrol. Hov~bcr 191.8 - Lo::cl r esection. llovorobor 1949 - Healed r.nd no si gn of t unor.

3ronst. Come:rcnce Uo. 8

G. S. Donated by Dr. l•!.u-t in

F~al , Aged 15 years . Growth in breast for t..-o years. Loss of ~petit<> for t.1l0 ·•< Irs . F.nlr.rga:'lont of lo.ct. """"""Y gl :md. Right also cnl~.rgad sC<newhat.. i~-ss 1r t'l-. l eft breast was firm and oodulor . Too patient wns M re hirsutE; thM tho u:J.t~t patiant i n thi~ ago group.

,

Bronst Conference No. 9

M.h.K. Donated by T. K. Hepler, :l . D.

Feualu, Aged LO yeArs . 9-)0- h9 patient wcs rui.'littcd to hospital ccmpll!inine of a .n•ss in right breast of five ye:xrs• durr.tion , gredillll.ly becoming lsgcr, bu~ othc•rldsc. symptOtnlc.sa. Rcmova1 of P. ciro>unscri bed, rounded, solid m:.ss 6 x It x h eto>S . witli gross app.:liU'"nco of nn olnatic, cncnnsulnt od, nodular ttt11or .

,reast Con!'erence No . 10

r.,.-,ale. Aged Sl years Donated by F. B. Aegerter, . D.

Discrete lump in the breast with discharge fro.., the nipple !or one year. Lesion :•o>..U.ly removed on November S, l9u2.

~rcast Conference No . 11

fl!>..ue, A;:ed as years . Donated by 'i'. K. !!atl2r.ell, M. D.

This ·•hite i"eoale ome to surgery because of an intensely, firm, paraboloid type of e"l":-p,e:nent of her right breast vhioh had under~;ono a sudden and marked growth :"' six to oi~ht ·weeks prior to surgery.

Breast Oonfer~nce No. 13

C. H. Donated by H. C. Allen, l1 . D.

1hc patil'ltt is a 93 year old, •hite female llho is a known 1\ypertensivo of rather !C"Ortl degree and llho had a cerebr al thrombosis about April 191..9, but recovered en medical therapy and stellat e bl ocks .

Tile patient entered the Deacor.ess Rospit3l, Scpt.enber 6, 19So for a l'C.'lloval ot a t\Jlllor of the r ight upper chost Yall , About Christnas time 191..9 she coughed and felt a lump just below the clavicl e . It slowly gr ew and when seen in Hay 19So ~:as ailout 5 ens. in dia:neter, soft, unattached, and appeared to be a lipoma. Her iali.ly called the surgeon in August 19So and said the lu::p was larger. The exm­ination this tilllc revealed a 16 x 12 x 10 CMS . mass over the right !)ect.oral muscl es and adhe.rent to them but not fixed to the skin or chest well . This has encroached on the breast, but did not nri se in it. There are no palpable lymph r.odes1in the axilla.

X-t·a,v of the chest wo.s esscnticlly clear, except f or tha soft tissue l'I&SS noted clinic~lly.

jnder pcntotbl!l nitrus oxide am cthQI' anesthesia tho nass was rc:;;<>vcd in tote September 6, 1950 with the r isht breast and pcctorl!lis major muscle . 'Ihe. clips :lnd drain were r eDovcd on Soptembar 12, 1950 and the wounil hoalcd by primary int.ent1on. · The patient WIIS discharged on Septenbcr 1$, 19So.

Breast Conforencc No. ll,

Donated by E. L. Heller, M.D.

i:llllp in J:cft breast first noted eight months before ad'llission. 1>'"<-',:1·ess1:ve increase in size of mass with retraction of nipple t-.~:.':ee months' duration.

Gradual e.nd a.'ld discharge of

S~cill'len consisted or~ ;-j, enonnous female bre.est, without- pectoral musculeturc . ~~- llilJplc l<as retr<~Cted with surrounding "pig skin" tlppearancc of the skin. I n ~l:e upper left quadrant ><as e hard, l emon- sized mass , This Has 6 . $ ems. in cii:'nei;er, dull groy in color, ?.nd contained many mi nut e areas of nccz:osis. ~"~" areas of the tu:oor <>ppeared to l:>e liquifit>d, .Further sectioning r ave.aled a ooan-sized nodu.1c j ust <bove the pectoralis fascia . On section, t.his mass ••s hard, yelJ.owish-gr ay in color, and appeared to be tumor. ;/«

' Breast Confer ence No. 1$

Female, Aged 35. Denoted by E . L. Heller, H.D.

' ~iTst noticed a small pApillomatous mass of the nipple one yca;J) prior to admis­sion. Onset related to trnwna of tho br oast. . Slow increase in size.

The specimen com:istod of a tumor mMs weasuring 3 x 2.5 ems. It wns elevated abore t.he skin surface 2 c;ns . Q!ld >res submitted as an ,nlart:ed nipplo of i'emal« bra<cst . The external tumor surface was irregular, tan, and studded 1~th !m.:lll, pinhe.;A, white nodules . 'l'tte cut surface was film, white , fib-rous, and cut ••ith ~ gr itty scnntion. The small , pinhoad-si znd nodules were e·nsily "Mllcd out.

Bre::st Conforanco No . 16

Fen;3lc , Agad J6 Donated by E. L. Huller, M.D.

illis fct .. lllo bad not ed a mess i n bronst f our months before :~dmission.

l'hc specimen consisted of c tumor mnss 2. $ x 2. $ x 2 ems. I t appeared encapsulated ~. on section, a sol id, honogcncous, pila, glistening tissue was noted .

Breast Conference No. 16

LC. , Pgod 79, white, f C!lllll.c . DonatL~ by T. D. Stevenson, H,D,

SL~ months befor e ~ssion the patient noted ~ ~all lunp in the upper portion n! the l eft. breast. ?reduced n painful drawing sensation in the upper breast ' :>! axilln. Exa:lin":tion showed o smill, sl ightly, irr~(;ul<!l', movabl" nrss in the UJliXlr pol-:> o.f the l eft. breast. At opcr .. tion on u-23-46 n n:>Ss 2 ems . in dicmotcr wns removed.

Ott section, thi s was found to contain nW1erous cysts J mrns . in di&.~eter which :<ere filled with gel atinous m:~toM.ol, Frozen sect ion - q'lCSt lonable mucoid c?.roinoono. Because of the d~b111ty of t he p:1ticnt, 3\l])lltntion of the br oest wcs deferred. Fifteen r:1onths follow-up is ncg:ltiv~.

Sre~t Oon.fcr cnco lio. 2l

F. N. Aged 6o, negro, f entcle Donntcd by R. C. Rom, I·: . D.

~his female was admitted t o tbe hospital i n 1950 for tre~tmcnt of carcinoma. ThCi.l patient hpd menorrhagi a in 1939 and op.s r ation was "dviscd for l arge J!l)fO!i'lata. Tho patient r efused rutd di<i not return u!1til 1950 with blood­s tc:inad di scharge . At the t illlc of admission a ~argo, frc~ly movable, cystic mass, 'roplacing upproximatcl y 60% of the right brc~~t t issue, was notod. Clinically t hought to be b<:?nign. Tl\is was excised at t he t i.-nc of D & C.

'l'he •spoc:i:nen was an oval, cyst ic mnss, measuring 8 x 5 x II ems . The wall vaned in thickness fro:n 2 to 10 l'll!IS. The thickest part was <m i r n;gulr"' ro~ss of white, !h"U"d t issue, grossly, ;;md on froaon section - suspicious of ccrcinomn. 11i thin tho cavity war <! loose flecks of firm, white tissue Md a soft, lobular, necrotic m~ss 2 x 1.5 x 1 ems . A nodular mass, 1 em. in dicmeter, projected i nto t he cavity ftbm th~ region of t he hard portion of tbe cyst wttll. T'ne r em3indcr of the lining >raS glistening and pink.

' Breast Conference No . 23

A. D. , Aged 45 years, fem~e. Don.ated by ,J'ul ius- Foldes, <I. D.

A circ,.unseribt·dJ f irm nodule W:!S present i n the """ perf or med. The noduler m2ss ~<.as sectioned. r emaining orvast wer e wi t l'\out D.bnomcl.it.y.

breast. A r adiccl. mPst cctomy P.xillr,ry lymph nodes and t he

Breast &onfcr ence tlo.. 24

R • .R, Donated by Gregory Froio, H. D.

Aged 37, white , singl e , female , A female key puncher >tas admitt'--.a to Doctor •s Ho~,itel on account of a small papilloma on the right breas t .

IVo years ago she noticed c smill tunor on the nippl e . One year ago she wes ox;;minot!. by a -physicbn who s ugges t ed a biopsy ••hich proo<oquro has been put o~f U;'""ltil present ad.fllissi on. _At present, there is ll sc;all papilloma in the r egion of the nippl e of the r ight bre cst.

A .rncst.ectO!lly was performed and no evidence of t u.'!tor within the breast ;ms found .

Br east Conferoncc No . 2$.

c. n~, llged 60 years, whit e , female . Don<:.ted by Gr egor y Froio , !1 ,D.

This femdc wes "-d!nit ted to the hospital J - 27- $0. Physicel axamin.ati om was 'lOa- contributory exoopt f or " m<tss in the r ight breast at :appro:xllnatoly thr co o ' clock. R&dieal resection performed.

Gross eJC,.i nntion r eve aled ,'l right breast, pect or al muscles , and OY.illru-t f at. rn t he bret.'.st ther e was .no.ted a well c-.ircumscri bcd , se1"t mp.ss m~w::ir.g 2. 7 ems. in d lmcter, Lymph node s ware negat ive.

Follot~-up: Tho p11tient is perfectly well >:it h no r ecurr=co up to the pr Qsont ti.Fl~.

Breast Confer ence No . 28

E. B. , Aged 1:2, •tute, fe~alc. Doru!ted by J . !! . Deaver, M. D.

In 7-1-49 tho patient noticed n lump in the laft bro~st. In subsequent wock5 tho lUillp ~;nl'll'gcd. Ex.:l1tlin:~tion showed a bard ;nns s 2 x 3 Cl!IS. slightly fixed ~~ th .. doopor tissues . Tho l ump did not t r:-,nsillll!llinnto . f:n excisi on biopsy wns performed on 2-lh-$0.

Crossly, tho specimen was $. $ ems. in dianeter , I t contained a !'lass of firm, nGdulr.r, portiill7 enc"l'sulatcd tissue monsurtng 4 x 4 x J ems. On section, tlo:: MMS ~ a varigatcd appo::rnnce being morlc up of gray, elastic tissue in 11hich were opoque, yellow, frinblc nodules. S.-.ill hcnorm~c h<'.d occurred into the nnss . In the adjacent brc<1St tissue llllPicrous minute , bluish cyst.s von:: present . Frozen s .:>ction r epor t - ncdullary carci110:1a. A radical =ut.~tion wns performed. The ranai:ning bronst, pcctor al nu~clos , nnd axillary contents ~o-erc grossly normal . Five negative exillary ~ynph nodes were diagnosed, aicroscopicnlly. Six month follow-up - negati ve .

Brcnst Confer ence Ho. 29

V.K. , Aged u6, white, .fenalc. Donated b;r T. D. Stevenson, ~!.D.

In December 19$0 p;,tient noted ~ s:.ill, non- tender l~r.~p in too right brcnst . ':his ws r ll!'lovcd. 'Tho pathologist reported <1n intrnduct:\l popill<XII" but st·t<-d thnt tho pati<:nt shoold h~vo n sir.!pl~ ,~stectomy. This WP.S P"r fomcd 0:1 2-5- $1.

Gross cxamin:1tion of the br.:>nst r e:'lOV!ld by si!'lplo oxciSion showed the old biopsy site filled w:Lth a SMall 8l'IOunt of old bl ood nnd surr ounded by dense, •hitc, brenst tissue. lio m"s s could b<! found io thi'! specimen. Several sections oocro t~cn .?.t r il."lC!oM :>round the bi~sy excision si tc. Slide F )0 -.os cut fror one of these.

Breast Conference No. 32

R. G., Aged 5o, negro, f emnlc. Donated b"f \{, E. Ehrich, M. D.

rn:.;S prti cn-t COfllpl~i nc:d cf c. lmp in tho breast of four mont hs' dtu-~ttion. Thefu --as no po.in nor nipple rctr<>.ct;ion , Peysi cnl e xanination con.fir.ned the presence o~ t:;,e l ump . i~o axill nl"J nodes wore pelpable . The Mass was r emoved four ~•oaths uf~~r it was discovered by the .Patient (2- 15-51) ,

Gress .:xe;nina.ticn: t•iass measured 5 ems . in diarae.tcr and was completely sur .. ro1,1ndcd by fibro- f atty breast tissue . On section, the mass was composed of dGn~a, gray tissua interspersed with smell nodules of softer ta.'l tissua . Sub­squent radical mr.st<.ct0l1T/ shoued normel fibro-clestic breast tissu<J and three nQgativc lymph nodes .

CIAGIIO:lLS 0? IIIW.I.T tlllt:lii:l

t.--"1.. Int.ro.duot.U papilloutoc ils 11'Wl ·~~,.) >· 11bro..ieno-to-iir .~ .-."- •·• Aun;o~ ~

5. Lipo~, met.;i&t.•IJ.<>

v1. ••.llhrJ c rc:!11011, - no • .iCb.lB .t.ct., •lm~c;a<" t.A-;.cJu~•·t.

~. , ibi'O<I..:enou vttb cardl.a•~nou Lw ~]J.. U ll' 1-D) I' It-t M1vvp!thd.ial ,.roll!'u• t!.on 1'1\)~~~tl~ - G<i , Look4 l.U:a • doa t.=or r Jl "~ 0:. PI -

- ,? 9. l.l&nt in'lr can:U10\W.r ~~ (~...!:.· · ~1n~

10. ~ronic C)'lt~ic diaoa .. a (pz"01~:m o! a,oora .. ·~·i~[,uua -

l,5 .

16.

21.

no1. a r.roe oto~)

Cb.:\D4roo)UC:OU. 61l4..edt ;o.-r 1 of ee~~u~ ~~ !~ .!1!1.·

(_ "' ._Lirotare.a::.. ooatch tor lo=Al r wr. a 1 ~.~iR'~~ 1~-J.•Uoo MY ~ hel.-"Ul : \

C&rcltl0111111 ,.o .. ..thly w..rt ,.l.u... orJ..o~·=~~~ro._u, . t.iiii> !.qncateci beC~olul& of 1n~1ltr.t1T .. n. till' oi t~:'"" ~~ I\

w..,._ tti..rn. ruoa. ·~!,~~~~)H)~~ 1•

Inbu~\lctal ~•Ul•ry ~~lrt~ "*-fL!i:'.;,..~<>~. w\h ~~t,\ <:><11 til! a ...U£,1l.lih"t OJi baa~ ot 'a); ...c Uon., . "~ •lo J1 W'

~ - ,..-.., W.re~ \;itb ~'.IA:.IDil.. aat..~ l...C.2 ..n4 belle tora..Uc~ c ve ae'""

tAb before in ,. aolored ., .. u .,nt ol.z;o,. ~\ ~ 1 --c \ 3o-elrl.l.acl ...a.ro.a.. h-..n,.1..u. du~ onu ~ :!.t .,.ron in

bre<.at, I t. L b..nian. \lo.llii .. IOf{tllt(ot.tfo

24. Intra=ct&l h:n>et,lt. 1... llo r1acro l ; not carcinoGA. llo furt.hu t=&UII.m in.11o..t.u . l' ~·~ i-\"tl'lllll~

SUPPW!ENI' TO SE:.JIN:.R PROTOCOL 0!1 UNUSU/.L Ttll'!OrtS OF THE BRE;,ST

This eeajncr on, "Onusucl. TICor s or the Breast" I was made poss:ibJ.e throueh thE. generosi ty of tho contri butors. I \o'Ould like to tl.ke this opportunity to thank them ag~in .

Thora follo~e a tabulation of t.~e vnrious d:iegnosoe submitted . In order to present e cross section or opinion of those individunls presu:n­ebly seeing a g"nt<rous ez~ount of bre£St ~ethology, I heve segrilgnted the opinions of the so-cnll.;-d "Boord" fro!:! tho entire Group . Those consti­tuting the Board wore Drs . Lokor oc.n, Horn, Crnna, lferbut, Heller 1 Aegerter, and myoelf . Drs . Shields loklrrou end R. P _Custer ~ere nlso consulted about many of t he slides and no doubt t.~cir opinions were r eflected in ':Jif ow diLfieoses . It is regrctt.cble thnt I 1.-as unablt. to obtcin long term f ollo,._up stuaies on l:IOSt of t.t.: tunors and tl>.ct. in oany of the::t the finnl diagnosis must r enc.il1 n Lll.tttll' of opinion, Such. is thu ntlture , however 1 of this type of coopc·rutive "ffort,

I would also like to t!w.nk Mr. G. C. Cr .. bC>in of tb.. Bausch and Lccl> Optical Co:.Jpoly fnr supplying end helping to oporat.. the tlicro­projection fncilitios .

Respectfully submitted ,

Clilrk B. Brown , H.D. , Lank~nau Hospi tal

B. C. If 1 . Boord

Benign V.lili.gnnnt !lot designnted

7 0 0

-1-

Benign lJ Malignant 7 !lot designated 0

Diegoosis: GynecOIIIllstie with Lntrnductcl papillomatosis.

C<c::ent: • The consensus of opinion \liiii that this was n benign lesion.

B.C. //)

Benign Kc.lig!Wlt !lot designat ed

7 0 0

Benign 18 ~lignnnt 2 Not designnted 0

Diegnosis : &:l erosing (fibrosin{;) adenosis .

Cement: A mejority indic:ntod thnt this l esion was benign .

B. c. # 5

Benign 0 lhlignant 7

1 F1bro1iposarcamn 1 Cystosarcoma phyl1odes l Fibro:zyxoliposnrcom:t 3 Lipo=C<lOS l M<.tustet:!.c ·sarcoma·

Not desigootaa 0

Diagnosis: Serccz::e. - lletestetic Probably liposnrcoma

13euign 0 !bligoont 20

18 Se.rca:m 2

lbt desicnated o

C=lent: It litl8 c.lmost unnr.imour.J.y agreed thnt this l esion wcs n snrco:na although there wss disagrll..nent as regards the type . Lipossrccx.l& wns nsn:ed &lone or in combinntions in 16 of the 27 returns . Two in the group heliov~d ~~e l esion to be Q :nucoid corcinomn. Scarlet R stain oi' the m!Jtestuste showed about 10% of the tlcor culls to contain lipoid positive vacuole:: , Reviuv of tl.o pri!:ltlry breast ttcor showed snrcotte.tous change in the strO!lll nround rntber splll'se ductnl structuras. Opinion vari es as t o wbother tho primary tumor wns s lipos&reoma or a sarcomatous change in e cysto-sarco:nn phyllodes . If' it .,.,. ro the forms 1 t would fnll into the 8J'OUP OXOillplificd lr.t Case g 28,

B. C. If 7

Benign lohlignnnt Not designated

l 6 0

Die.gncsis: Intraductal corcinooa.

- 2-

Bonign 5 Halignent 15 !lot des~.et.ed 0

OOllllllent : One me111bar o.f the Board f elt thP.t this lesion \lll.ll benign - cystic hyper­plosic with excessive ductal epithelial prolifer~tion possibly due to atilbesterol . Two yeruls l.ctor o !llllas reapper.red under the oparative seer which , on section, proved to be intreductcl end infiltroting ducto.l. carcino:~a . Arlllery matsst.nses vcre pre.sent.

B. C. # 8

Benign J l Fibrotne. l Bonign mixed tumor l Fibroadenol:IO with enrtil­

egenous c otoplcsic - dog tU:lO!' ,

l'.cl.ignant l Carcinoma with =til­ngenous motnpl asi a - dog tumor.

!lot designated ) . l Mixed t1.0or of breast

l J4ixed tucor - canin<: l Cystosarc~ phyllodos .

Benign ~~~ignc.nt Not designated

? 7 6

DJ.~osis: Canine breost tooor - Cll!'cinoM with cartilegenous meteplcsio ,

Comment: Thrae of the llocrd e.nd three in the Group detected that this wos o slide of a dog brtlest twor. The break- dow for tiB Board is shown above ,

This type of brenst ccrcinome. in dOj!s is not uncomon. In this dog tho tumor matastesized \lidaly as o carcinonc. ,

B. C. # 9

Benign 7 l Fib,oe.denOiilll - t'otcl t;rpe . 6 O;,rsbsurc= phyllod .. s ,

~ignant 0 ~lo t deaigocted 0

eunign l) lll'.l!.gno.nt 6 tlot dcsl{;::>eted 1

Diagnosis: Cys';;oso.rc= phyllodes - b~nign ,

-J-

B. C. # 9 (Continued)

~nt: The n:ojori ty opinion ws thet Ws 1llls cystossre~ phyllodes (14) with no designation na to whether or not it wns benign or callgnru1t . It vns nsstt=ed in this instnnoe that ell ioplied thereby a benign l esion.

8 . c. # 10

Boer!!

Bcnign1

Ma:igllWlt Sot deeigD£. ted

7 0 0

Benign 19 Mlllignant 1

/ldenofibrroa Md intraductal corci.!1000. llot designated 0

Diagnosis: Intraductal popillOQQ llith npocrine metaplnsin .

Co:lll:lent: It is known that this l esion did not recur within five yenro. Tho npocrine>­like change in the ductal epithelium is consider~~ by some to bo a degeneration rather then e motnplastic one , It is proocbly not svoct gland epithcliuo. Set> Dawson, E . K. Edinburgh Hediccl JourllE.l. :39:409, 1932.

B. C. #ll

Benign 3 ChondromA

~nant 3 Chondrose.rcotlll

Not designated 1 Torntoid mixed t~or - m~sodermnl

Bunign 10 9 Chondrom,n 1 Benign teratoDn

~hlignnnt 8 Chondrosc.rcOilla

Not doeigoot<:<i :2 1 Teratoid tumor 1 Dercoid

Diagnosis: Chondrosercoce (Dr . Aegertur 's opinion)

COillllant: A rel:!8rkab1y tJven split as r egards benign (chondrO!ll4) or maligm:nt ( ohondrosnrc=) in both Bom-d nnd Group returns . This lesion may well hovo been primary in the rib underlying the branat .

B. C. II 13

~

l3oclgn r.!ignant ~,.,+. desig!lllted

0 7 0

Eanign 0 lftiign~t 19 Not designat~~ 1

1 ltl,l':r.oongioma

Dincnosi.s: Pibrolipo:>yXosnrcaw; (liJ;-<>Z'!l'coma) .

-4-

B. C. # 13 (Continued)

C=ent : As contrasted w1 th the division of opinion in B. C. If ll, 1.e see hera mo:rl!:ed uzmnwty· thet this i s a mt\ligrw-11t lasion, n sarcoma, with diversity of opi nion as r egards type . It is apparently n mixture of fibro1ipomy-,;osarcc;aa ..:. !;h no single elenent obviously predominant. /,bout 25% of the tumor cells gnve " fat positive stain, No cross st riations WGre observed in the tUillor call cyto­pltlsm. The presence of rayofibrils was equivocal .

L . C . # 14

Benign 0 }lallgnc.nt 7

4 br~p1estic carcinoma J Sarcoma

Not, designeted 0

Diagnosis: Anaplastic carcinomn,

Btmign l GranUlcoatous infl~tory

l•!nlignnnt 19 3 Cru:cincoo

16 SarcOtte Not designated 0

Gomment : The breakdown is shaJm ubova with any doubt o1iminn t ed by an additional ~lide of a l eft ~xillery lymph node showing metastntic carcinoma •

.!3 . c. # 15

llenign 6 thlignant 1

C!ircinoaa !lot designated 0

Benign 14 V.nllgnan t 6

3 Tri chaepi·theliorr.a 1 Cercinona 1 Cystic besal cell carcinoma 1 Epiderooid ccrcinome

Not desigoo t ed 0

ili t\gllOSi S :· iluJ.u!rtonc. of t orrunr:l dUCt3 , (iu.tthol' IS opinion)

f1<lllL!Cpt : The terminol ogy i s vnrinblo though i t i s quite unanimously agreed that the l esion is beni&n . The Board submitted Leio!.JYa= of n.i.ppl e (1) , sebaceous cysts (1), syringi<:>mn (1), multiple i nclusion cysts (1 ) , rudimentary accessory oomery gland (1), end ~tama of t orminal ducts (1) . The Group submitted ll similllr diversity of tarminology in the benign clessification wit h inclusion cysts (5) , outnucbering oth~rs.

a brief r~iew of lesions of the nipples is to be fo~~d in Am. Journal of Sw:ger.r 69:155, 1945 J • .J, Cunnir.ghem, S. E. Cohen, end. J . !! . CuruliJ'Ighern.

Two of t he Board believed this t umor to have ll car~enitnl origi n, being repres~nted by en excess of ducts, connective t i ssue , nnd ~1ootbmuscle in the nipplo .

B.C, /116

ll!ml:!!

R~nign 0 lkJignan~ 7

1 Carcinoma with metaplasia 6 Fibrosercooe

lot do<~ignated 0

Diagnosis: Fibrosarcoma.

- 5-

Benign l Adanofibr~ lhlignant 19

3 Cr!.rcinosnrc= 16 SnrcoM

2 J.lyosarca:nn l2 l"ibrosnrcooe

2 Leisarcoot Not dusi&nsted 0

Cor.'llllent : All but ono agreed that this wt~s a mcl.ignnnt lesion . The consensus of opinion was in favor of fibrosercomn,

B. C. 6' 18

Benign J l Cystic hydrndenoon 1 Cystic disease l Intraductal pepillacy grovth with

production of !ll\Ocus, ~igllll.llt 4

J ¥~coid cercinooa 1 Intraduc tal colloid carcinoma

Not designated 0

Benign 11 Malignllllt 9

7 llucoid ccrcinooa 2 Pl:.pillary cystcdonooorcino.:e

Not dcsicnoted o

vr' \<'" "' u-

Diagnosis : Very early :msinous cnrcinooe. , The finding of mucinous tlllteriel end <~ery rare cells in contact with fibrondipose breast tissue is pre­sumptive evidence for invasion.

Com!ant: Almost a spl1 t decision betw~an benign and mlllignnnt , In the benign of the Group mucinous degeneration ins benign l esion wr.s often ontered .

B. c. # 21

Benign 0 ~!'ll i.gnant 6

1 Cys~osnrcoma with squamous cell cercinoca and osteogenic snrcomn ,

J !'..alignant mixed tumor 1 !'.al.ignant celcifying c;pitheli=.

I:Ot designeted 1 Cystosarcomn phyllodes with squecous nnd osseous Q&tnp1nsin ,

Benir,n 5 lhli gnant 10

5 Mnlianant teratoma 2 lhlignnnt chsnges in de-rmoi d J t.fl.scollD.neous

l;ot designated ; 1 i !1xod tu:wr 1 D .. r:.1oid cys~ 1 r;s~osorcoma phyl1odos 2 T·,rc.+.a.l£1

-6-

B. C. H 21 (Continued)

Diegnosis : Cystosurcoon phyllodas with sqU&mous cell ccrcinooa and osteoid (possibly sorcocctoua) stroccl oetnplasia.

G ""lillent: Most f elt that this was ll malignant l esion as will bo seen from tho above . " wick diversi ty of notlGnc.lllture ia apparent . AJ.though theso squemous ductcl ··rcino.':tla era occnsionelly encountered, coses ero only rnrcl.y found in which -.~astasia hes been found in the lynph nodes . (See Pasterru:ck)

=arcino-oatoogenic Sarco~. Budd, J . • · and Brenstin, F . J . LJ:J . Journal Cc.ncer 31:207- 211, 1937 (Seo J.'cl.lory ' s opinion)

J.denoacanthoma Sarcauotodcs . Pasternack, J . G. tn . Journal Pcthol ogy 12 :423, 1936 (Good R;;view article)

A Cccplcx l'.ali&nnnt P=ry Tu:lor . Tudhopc, G. R. !JJ. Pathol ogy and Bacteriology 48:499, 1939

B. C. # 23

Benign 7 , 1 Nourofibroma l Cellular fibromo 5 Sclerosing ~~loon,

Hlitlo!Ulgiap!)ricyt<or., or Homengioendotheliomn

lhlignant 0 Not de.signated 0

Dingnosi~ : Sclerosing hemangioma. ~.

Benign lirnligncnt Not dcsigna ted

r ·""

lJ 6 1 ? no diagnosi s

Ca:ment: In thn Group six felt tho lesion wr.s mnllgnnnt - a tY]Xl of ao.rca:>e . Tha cost frequent diagnosis (16) is entere-d nbov<~ es the fincl. decisi on. Although the l esion docs not contain ell the elc.c&nts described by l.b1boch as charD.ctarizing sc! erosing hemLngiOQQ such ns hemos iderin , giant colls, end foam cells, it is a ''sscule.r t unor of th.. skin nnd i s benign or of low-grc.do wigncucy at most .

B.C. J/24 •

Bo&rd

Benign 4 J Adoncoa 1 Intraductal hyp€rplnsie

11cllignnnt 2 Carcinomn

Hot designnted 1 lntrD.ductol pt.pilloootosis­pre-cencerous .

Benign 10 lhlit;nc.nt 9 tlot dcsigl'Ltod l

Cm·cinoid

B. C. II 24 (Continued)

Diagnosis : J.denome. of tercinol duets. The nuthor disagr<*s with the cajority opinion believinG the lesion to be e low-grade intraductlll eorcincoe. .

Cot:nent: Both Bourd and Group split rather evenly betveen benign end mlignont, 'rile benign diagnoses were predOiililw.ntly "eden=s• and the tlClign£nt dingnosos were sweet gland esrcinoma (3) 1 basal cell =cine!:!& (3) 1 corcinann of breast (3) 1 and iatraductel papillury carcinana (2).

B.C . #25 I

l!enign 2 1 !jGllrulgiol"'l"icyt= 1 Unelnssified benign epithvlial

l esion . l'.nligntlllt 3

2 Undifferentiated carcin~. 1 Hemc.ngioendotbeliome..

!lot d10sigoated 2 2 Plo.amocytooa .,

Benign 1 1 Plaswe cell ~stitis .

Malignant 15 See below

NOt designated 4 3 Pll:tsmoeytoon 1 Neurocystomn

Diegnosis : Undifferentiated eercinocc with pl.nscn c"ll ruJ.ction. (Author's opinion)

Cal::l~:nt: 'Iho brec.la:lo\1!1 as r .,gnrds benign Uld ~ign&nt and classification for each in the Board is shown c.bove. In tho Group th" l:lf'.ligncnt diagnoses predominated as follows:

4 Roticullll:l eell oo.roOJnn, 2 Neurobl aatome. 3 'Snrcomv. - r.ngio. 1 lyr1pho . 1 hnllplustic cercinotll11. 3 Y.alignant tu:nor, lynphome. 1 pkSillll cell oyelooa. 2 He::.aogioendot.b.£>11~ vi th ce.lignant chnnge.

B. C. /i 28

S~nign 3 1 Cystic llyperpl.e.sia 1 Ribrocystie disease with giant

cell r eaction 1 Benign

!cliglll'.nt 2 1 Pibrosarcooe. 1 Cys t osnrooma p.'lyllodes llith

liposarcOJJa !lot designated 2

2 Cystosarcoma phyllodes

Ql:gJm

Benign 5 ltll.igntll1t 10

9 Sercooatous l esion 1 t.denofibro:Ja with scirrhous

cucincna. !lot. designated 5

3 Cystosar= phyllodos 2 Cystoscrcocn

Diognosis: CystosercO!!ln phyllodes ldth liposnrcor.ltltous eht.nge of stromc. Dr. A. P. Stout confir<Jed this diagnosis .

-8-

B. C. # 28 (Continu~~)

Ccoent: :.. rather corked diversity of opinion vith n great de<!l depending upor. thol interprEtation of cystoscrco:m Jlbyllodcs, ns regnrds benign sod orHgnant, vhen not dosigo&t..d specificilly. I believe the st.r= io these tu:JOrs has =lt.iple netnplcst.ic pote.nticlities - in th!s ccso diffcr~nticting tovsrd lipocctcus tissue­lipoSI'..rC<Xlll..

B. C. # '30 (#29 in Dnte. Sheet)

~1:!1

Beni~n 3 ( 2 Pr~-co.nct~rous)

l!.elignc.nt 4 !lot dosignntcd 0

Diagnosis : Intr&ductal e~cino?n?

Bonign llo.lignnnt Not dosignct..d

12 8 0

C=ent : A not too uncot!liiOn proble=ticnl b""nst lesion variously int.;rproted, ns Dbove, es intrnduotel hyperplnsie, intrcductel popillO:JCtosis, intreductel cercill<ICitl, or prc-cano.;rous intre.ductel l esion. Tbnt it cnus~.;s tho pcthologist great diff iculty is evident frao the split r esults te.bulcted above~ Thoso enter ing benign f alt tbnt it ws either intraductal hyperplasia or popillotlll nnd thoso entering malignant -intreducte.l ccrcinotu>. It would a ... -en safest at present to advise at l east simpl e nastecto~ for thorepy .

For soooe discussion on this type of l esion e.,~; - !lerren, S. Surgery 19:32, 1946.

B. C. {/ 32

Board

Benign J 1 Fibroe.cl~>n(lQQtosis vith

squonous call tlC tcplesia. 1 Benign terntama. 1 Squctlous Mteplosi& with cyst

of breast !lcli.gnnnt 2

l EPidormoid cercinowa l Cystoanrcomn phyllodes with

squamous coll cnrcino.•~ · Not dosigmrt.od 2

1 Teratoid mixc~ t~or l Cystoonrcoon phyllodes

B~nign 5 Holigno.nt 9

8 Squ=us cc.ll cnrcinOiiiO l ~hligoont llli.xi!d tumor

tlot dvsit;nnted 5 J Torctoid growth 1 Epidt.rmcl cyst l Epidermal cyst in oystcrphyllodee

Di~gnosis : CystosnrcOIClC. phyllodes with sqWl!lous cell ce.rcinontl . :»< /r.l,

~ . C, # 32 (Continued)

Cor..,ent : A sit uation sioil er t o th!lt in B. C . ~# 21 wit h 1:1 significe.nt di ver s i t y of oyinion between e milignnnt and b~:nign l esion. Th<> groetes t ogr<Je!ilont \lOS t ha t. there 1/l!S. squtm~ous cell cnr oi norw. (11 ) 1.-i th four othars f eeling thnt i t " "'" squamous~ cell :>etapl aai a and not signifying beni gn or mcligrumt .

Se~ r ef erenc&s under # 21 .