Australas Radio1 1992: 36: 330-331
Ipsilateral synchronous ductal and colloid breast carcinomas with mammographic correlation C.N.D. GELBER, M.B.B.S., F.R.A.C.R. AND M.R. S C O n , M.B.B.S., F.R.C.R. Radiology Department St. Vincent's Hospital, Victoria Parade, Fitzroy, VIC 3065.
FIGURE 1A - Left breast mammogram demonstratingstellate retroanolarmass (arrow) and =pate well defW mass in upper outer quadrant. B. C C views. C. Oblique view.
FIGURE I S
FIGURE 1C
INTRODUCTION The occurrence of multicentric ipsilateral or contralateral carcinoma is well known. When ipsilateral, this can be difficult to differentiate from intrammary spread, but no problem arises when two clearly separate pathologies are found. We present a case of ipsilateral synchronous ductal and colloid carcinoma with excellent mammographic correlation.
CASE REPORT A seventy year old woman with a family history of breast carcinoma (sister aged 60) presented with a one month history of poorly localised pain in the left breast. She had been receiving oestrogen replacement therapy for several years.
Pathology demonstrated: (i) Colloid carcinoma in the upper
Key w o n k Breast carcinoma Colloid breast carcinoma t carcinoma Ductal h A d d m for camspndence: h.CND Gelber Radiology DeparmKnt St V i n t ' s Hospital Victoria Parade Fitzmy Victoria 3065 Australia
330
An examination demonstrated a 2cm mass in the upper outer quadrant and a diffuse lumpiness medial to the nipple. Both areas were aspirated to reveal atypical cells. Mammography was performed and demonstrated a 34cm. irregular stellate retmaerolar mass lesion and a separate irregular 1.5cm. reasonably well defined lesion in the upper outer quadrant (Figure 1A-C). The patient subsequently underwent frozen section of the upper outer quadrant mass, which proved positive for carcinoma and which was therefore followed by a mastectomy with axillary clearance.
outer quadrant of the left breast described as a well circumscribed mass with nests of regular tumour cells in a sea of mucus, typical of a pure colloid carcinoma (Figure 2). (ii) Invasive ductal carcinoma in central portion of left breast described as a typical infiltrating ductal carcinoma with prominent tubule formation (Figure 3). DISCUSSION The reported incidence of multicentric breast carcinoma varies considerably, examples being 13% ( I ) , 14% (2), 27% (3), 28% ( l ) , and 69% (4). These differences are probably largely due to differences in the histological Submitted for publication on: 25th October. 1991 Accepted for publication on: 17th March, 1992
Australasian Radiology, Vol. 36. No. 4 , November, 1992
IPSILATERAL SYNCHRONOUS DUCTAL AND COLLOID BREAST CARCINOMAS carcinoma is as a well defined lobulated lesion while that of an invasive ductal carcinoma is commonly as a stellate lesion ( 5 ) . While reports of synchronous colloid and ductal carcinoma are not exceptionally rare, we consider the mammographic correlation of our case is quite exemplary.
REFERENCES
FIGURE 2 - Photomicrographdemonstratingfeatures of colloid carcinoma
1. Sloane, IT? Biopsy pathology of the breast Chapman and Hall, 1985; 194-1%. 2. Lesser ML, Rosan PP and Kinne DW. Multicentricity and bilaterality in invasive breast carcinoma. Surgery 1982; 91 : 234-240. 3. Gump FE. Habii DV, Loserf0 P et a/.'Ihe extent and dishibution of cancers in breasts with palpable primary tumours. Annals of surgery 1986,204 :384-388. 4. Egan RL. Multicenuic breast carcinomas; clinical-radiographic-pathologic whole organ studies and 10 year survival. 1982; 49 : 1123-1130. 5. Tabar L. Atlas of Mammography. Georg 'Ihiem, Stuagart 1985.
canca
FIGURE 3 - Photomicrograph demonstrating features of invasive ductal carcinoma Note intraductal calcification (black arrows).
technique used to examine the breast tissue. The tumour may be represented by separate primaries or intra-mammary spread. When tumours of similar pathology are considered, the criteria used for diagnosis of a second primary include distance (greater than Scms) between lesions and the presence of normal ducts between foci of malignancy (4). Most multicentric disease (90%)of similar pathology probably represents examples of intramammary spread (3). Multicentricity is less common with colloid carcinomas ( I , 2).
However, when separate lesions have clearly different pathologies, spread cannot be considered and the lesions can be confidently assumed to be separate primaries. The incidence of separate lesions of different pathologies (our case) has been reported as 16% (4). while that of a single lesion with multiple pathologies has been reported as 8% (4). The combination of colloid and ductal carcinoma as in our case, is uncommon even within these groups. It is well established that a typical marnmographic appearance of colloid
Australasian Radiology, Vol. 36, No. 4. November. 1992
33 1
Ipsilateral synchronous ductal and colloid breast carcinomas with mammographic correlation C.N.D. GELBER, M.B.B.S., F.R.A.C.R. AND M.R. S C O n , M.B.B.S., F.R.C.R. Radiology Department St. Vincent's Hospital, Victoria Parade, Fitzroy, VIC 3065.
FIGURE 1A - Left breast mammogram demonstratingstellate retroanolarmass (arrow) and =pate well defW mass in upper outer quadrant. B. C C views. C. Oblique view.
FIGURE I S
FIGURE 1C
INTRODUCTION The occurrence of multicentric ipsilateral or contralateral carcinoma is well known. When ipsilateral, this can be difficult to differentiate from intrammary spread, but no problem arises when two clearly separate pathologies are found. We present a case of ipsilateral synchronous ductal and colloid carcinoma with excellent mammographic correlation.
CASE REPORT A seventy year old woman with a family history of breast carcinoma (sister aged 60) presented with a one month history of poorly localised pain in the left breast. She had been receiving oestrogen replacement therapy for several years.
Pathology demonstrated: (i) Colloid carcinoma in the upper
Key w o n k Breast carcinoma Colloid breast carcinoma t carcinoma Ductal h A d d m for camspndence: h.CND Gelber Radiology DeparmKnt St V i n t ' s Hospital Victoria Parade Fitzmy Victoria 3065 Australia
330
An examination demonstrated a 2cm mass in the upper outer quadrant and a diffuse lumpiness medial to the nipple. Both areas were aspirated to reveal atypical cells. Mammography was performed and demonstrated a 34cm. irregular stellate retmaerolar mass lesion and a separate irregular 1.5cm. reasonably well defined lesion in the upper outer quadrant (Figure 1A-C). The patient subsequently underwent frozen section of the upper outer quadrant mass, which proved positive for carcinoma and which was therefore followed by a mastectomy with axillary clearance.
outer quadrant of the left breast described as a well circumscribed mass with nests of regular tumour cells in a sea of mucus, typical of a pure colloid carcinoma (Figure 2). (ii) Invasive ductal carcinoma in central portion of left breast described as a typical infiltrating ductal carcinoma with prominent tubule formation (Figure 3). DISCUSSION The reported incidence of multicentric breast carcinoma varies considerably, examples being 13% ( I ) , 14% (2), 27% (3), 28% ( l ) , and 69% (4). These differences are probably largely due to differences in the histological Submitted for publication on: 25th October. 1991 Accepted for publication on: 17th March, 1992
Australasian Radiology, Vol. 36. No. 4 , November, 1992
IPSILATERAL SYNCHRONOUS DUCTAL AND COLLOID BREAST CARCINOMAS carcinoma is as a well defined lobulated lesion while that of an invasive ductal carcinoma is commonly as a stellate lesion ( 5 ) . While reports of synchronous colloid and ductal carcinoma are not exceptionally rare, we consider the mammographic correlation of our case is quite exemplary.
REFERENCES
FIGURE 2 - Photomicrographdemonstratingfeatures of colloid carcinoma
1. Sloane, IT? Biopsy pathology of the breast Chapman and Hall, 1985; 194-1%. 2. Lesser ML, Rosan PP and Kinne DW. Multicentricity and bilaterality in invasive breast carcinoma. Surgery 1982; 91 : 234-240. 3. Gump FE. Habii DV, Loserf0 P et a/.'Ihe extent and dishibution of cancers in breasts with palpable primary tumours. Annals of surgery 1986,204 :384-388. 4. Egan RL. Multicenuic breast carcinomas; clinical-radiographic-pathologic whole organ studies and 10 year survival. 1982; 49 : 1123-1130. 5. Tabar L. Atlas of Mammography. Georg 'Ihiem, Stuagart 1985.
canca
FIGURE 3 - Photomicrograph demonstrating features of invasive ductal carcinoma Note intraductal calcification (black arrows).
technique used to examine the breast tissue. The tumour may be represented by separate primaries or intra-mammary spread. When tumours of similar pathology are considered, the criteria used for diagnosis of a second primary include distance (greater than Scms) between lesions and the presence of normal ducts between foci of malignancy (4). Most multicentric disease (90%)of similar pathology probably represents examples of intramammary spread (3). Multicentricity is less common with colloid carcinomas ( I , 2).
However, when separate lesions have clearly different pathologies, spread cannot be considered and the lesions can be confidently assumed to be separate primaries. The incidence of separate lesions of different pathologies (our case) has been reported as 16% (4). while that of a single lesion with multiple pathologies has been reported as 8% (4). The combination of colloid and ductal carcinoma as in our case, is uncommon even within these groups. It is well established that a typical marnmographic appearance of colloid
Australasian Radiology, Vol. 36, No. 4. November. 1992
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