Rosen's Breast Pathology, 4e

903

Unusual Clinical Presentation of Carcinoma

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

FIG. 33.6.  Fibroadenoma, invasive lobular carcinoma. ILC in a FA with pagetoid LCIS in adjacent ducts.

B

A

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 ).

C