Rosen's Breast Pathology, 4e

913

Unusual Clinical Presentation of Carcinoma

D

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.

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