Contralateral Carcinoma Research Articles

Subcutaneous mastectomy: surgical indications and pathologico-anatomic findings in the mastectomy specimen

This is a report on the histological findings in subcutaneous mastectomy (scM) specimens of 250 patients, who underwent surgery at the Gynaecological Department of the University Hospital Heidelberg between 1978 and 1987. These operations were indicated either because of diagnostic problems (n = 111), a carcinoma of the contralateral breast (n = 41), a histologically proven mastopathy with epithelial atypia (n = 30), non-invasive lobular carcinoma (n = 28) or non-invasive ductal carcinoma (n = 40). In the group of patients with diagnostic problems, a large number of occult carcinoma and precancerous lesions (36%) could only be found where the glandular tissue could be evaluated neither clinically nor radiologically. In cases with preoperatively diagnosed proliferative mastopathies with epithelial atypia, we found occult carcinoma ipsilaterally in 27%, in cases with a preoperative carcinoma lobulare in situ (Clis) in 28% and with a preoperative diagnosed carcinoma ductale in situ (Cdis) in 57%. The percentage of occult carcinoma in the corresponding contralateral breasts was 6%, 25% and 30% respectively. In women with a previously known contralateral carcinoma, occult invasive or non-invasive carcinoma were diagnosed in 20%. There was a correlation between the incidence rate of carcinoma and genetic risk. On the basis of these results the acceptable indications for a scM are: 1. clinical and radiological diagnostic problems with an additional genetic risk, 2. proliferative mastopathy with epithelial atypia in addition to limited mammographic assessment and familial risk, 3. contralateral carcinoma with radiologic dysplasia or high genetic risk, 4. Clis, when there are radiological diagnostic problems, 5. Cdis less than 2 cm.

Risk of subsequent contralateral breast carcinoma in a population of patients with in situ breast carcinoma

Risk of subsequent contralateral breast carcinoma in a population of patients with in situ breast carcinoma

Risk of subsequent contralateral breast carcinoma in a population of patients with in-situ breast carcinoma.

One hundred ninety-one cases of unilateral noninvasive breast carcinoma were studied with regard to the development of subsequent cancers in the contralateral breast. The majority of patients were treated by mastectomy and have been followed for an average of nine years. Their overall survival did not differ significantly from that of age-specific population survival figures for U. S. women. Among all cases, 13 or 6.8% subsequently developed contralateral carcinoma; 3.1% of these contralateral tumors were invasive. The authors found only one histological type, namely lobular carcinoma in-situ for which the development of subsequent contralateral carcinomas was statistically significant. Seven of the 68 women with this type developed second breast cancers (10.3%; 4.4% of these were invasive). These data suggest that the occurrence of clinically apparent subsequent cancers developing in the opposite breast following the diagnosis of in-situ carcinoma is relatively small.

Lobular carcinomain situ of the breast: Preliminary results of treatment by ipsilateral mastectomy and contralateral breast biopsy

This report describes the follow-up of 108 women who underwent ipsilateral mastectomy for lobular carcinoma in situ (LCIS). Twenty-four women found to have concurrent contralateral carcinoma underwent bilateral mastectomy. The contralateral breast was available for follow-up in the remaining 84 cases, including 33 patients who underwent contralateral biopsy and 51 others who did not have a biopsy of the opposite breast at the time of initial treatment. Five of these 84 patients later developed invasive cancer. Three had had a biopsy that revealed either atypia (two cases) or LCIS (one case). In the two other cases, there had not been a prior biopsy. Two of the 26 patients who had had a benign breast biopsy were found to have LCIS, but none subsequently had intraductal or invasive carcinoma, and none of the 26 women died of breast carcinoma. In this series, 64% of the women retained their contralateral breast; deaths due to contralateral breast carcinoma occurred with half the frequency that had been observed in a prior study of women with LCIS who did not have a contralateral biopsy. These results tend to support our current recommendation to treat LCIS by ipsilateral mastectomy and contralateral biopsy. However, it would be necessary to study these patients for approximately ten more years before results can be considered conclusive. Concurrently, prospective controlled investigations should be pursued to confirm these results, to identify patients most at risk in developing invasive carcinoma, and to determine whether nonsurgical therapy can modify the course of LCIS.

Lobular carcinoma arising in fibroadenoma of the breast.

Lobular carcinoma may arise within the epithelial component of fibroadenoma of the breast, as evidenced by 5 cases reported from the files of the Mayo Clinic and 21 cases cited in the literature. The 5 cases reported here occurred in a series of 4000 cases of fibroadenoma during a 43-year period. Lobular carcinoma is the more frequent type to be seen in fibroadenoma (in 22 of 26 cases); it usually develops in situ. Extra-adenomatous carcinoma of the ipsilateral breast was identified in 11 of 26 cases, and 3 cases of contralateral carcinoma were noted in the entire series. Thus, lobular carcinoma arising within the epithelial component of a fibroadenoma has biological features similar to the behavior of lobular carcinoma of the breast in general. The prognosis has been favorable; lesions are usually encountered early; in only 2 of 26 cases were there axillary metastases.

Infiltrating lobular carcinoma without lobular carcinoma in situ.

Seventeen patients had breast carcinoma with cell populations and histologic growth patterns identical to the infiltrating lobular carcinomas associated with lobular carcinoma in situ (CIS). However, no lobular CIS was demonstrable in the breasts. Nonetheless, seven of the 17 patients have had carcinoma identified in the second breast either synchronously or metachronously. These contralateral carcinomas include infiltrating lobular carcinoma with lobular CIS (two cases), lobular CIS alone (one case), comedocarcinoma and infiltrating ductal carcinoma (one case each). The frequency of lobular CIS in the contralateral breast is similar to that reported when the ipsilateral breast contains lobular CIS alone. This is interpreted as indirect evidence that lobular CIS was probably present in the breast with infiltrating cancer but was destroyed by the neoplasm or missed due to sampling deficiencies. We conclude that the diagnosis of infiltrating lobular carcinoma can be made in the absence of lobular CIS. The clinical importance of recognizing this specific carcinoma lies in the high risk for invasive cancer in the second breast as well as the occurrence of lobular carcinoma in situ.