title: Independent submacroscopic foci of infiltrating carcinoma in breasts removed for clinical cancer.
abstract: The aim of our study was the detection and the characterization of submacroscopic foci of infiltrating carcinoma in the human female mammary glandular tree collateral to clinical cancer. Accordingly, we analyzed 100 breasts surgically removed by radical mastectomy. Five thin slices per case were analyzed under a dissecting microscope by subgross method of observation. Submacroscopic foci of invasive cancer, well separated and apparently independent of the primary tumor, were found in 19% of the cases and were confirmed by histologic examination. Foci of submacroscopic cancer were either single (79%) or multiple (21%), and were located in slices including or not the main tumor mass (31% and 69% of cases, respectively). Their size ranged from 1 to 4 mm. Four histologic types were represented: 1) invasive ductal NOS with productive fibrosis, scirrhous type (36% of cases); 2) invasive ductal NOS without productive fibrosis, simplex type (32% of cases); 3) invasive ductal with tubular component (16% of cases); 4) medullary (16% of cases). Concordance between histology of clinical and submacroscopic cancers was assessed in 42% of cases. A significant association of the tubular type (invasive ductal carcinoma with a consistent tubular component) of primary tumor was demonstrated (P less than 0.05), as well as with the presence of ductal and lobular proliferative changes in the collateral glandular tree (intraductal papillomas, P less than 0.01; atypical lobules, P less than 0.02). No relationship was found between submacroscopic foci of infiltrating carcinoma and neoplastic familiarity, patients' age by decades, axillary lymph node metastases, size of clinical tumor or profile of the collateral mammary glandular tree. These data support the hypothesis of a multicentric origin of human breast cancer and suggest a systemic nature of the neoplastic mammary disease. Prognostic and therapeutic implications of this concept are discussed.
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000648:ultrastructure*; D000328:Adult; D000368:Aged; D001940:Breast / Q000648:ultrastructure; D001943:Breast Neoplasms / Q000648:ultrastructure*; D002277:Carcinoma / Q000648:ultrastructure*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000648:ultrastructure*; D005260:Female; D006801:Humans; D008875:Middle Aged; D013194:Staining and Labeling