Histopath Report 9/15/06:
SOURCE: 1) Left inguinal mammary mass. 18 cm skin biopsy
DESCRIPTION: This is an invasive and infiltrative neoplasm of mammary gland
origin. It appears very similar to that from the right inguinal mammary
mass. Similar to that neoplasm, it induces a moderate to marked, sclerosing
stromal response. The neoplastic epithelical cells form prominent lobules,
and multifocally invade lymphatics. Multiple areas of necrosis and inflammation
are seen within the neoplasm. The neoplastic epithelial cells form prominent
nests, sheets, packets, and some acini and ductules. The cells are cuboidal
in shape. Nuclei are round to ovoid, and moderately to markedly pleomorphic.
They have prominent nucleoli. Mitoses average 1/hpf.
MICROSCOPIC FINDINGS: Intermediate grade, sclerosing mammary adenocarcinoma
w/ multiple foci of lymphatic invasion.
Prognosis: Guarded.
COMMENTS: This neoplasm appears quite similar to that from the right
inguinal mammary area. One may be a metastatic extension of the other. This
neoplasm also is completely excised. Presence of lymphatic invasion, documented
histologically in this mass, increases the odds of metastasis prior to
excision.
SOURCE: 2) Right inguinal mammary mass. 4 X 5 cm tissue
DESCRIPTION: This is a multilobulated, invasive, malignant mammary neoplasm.
Focally, it extends directly into and effaces a small portion of the adjacent
hyperplastic lymph node. The neoplasm is composed of lobules of acini and
in some areas, dense sheets of cells with minimal acinar formation. The
neoplastic epithelial cells, often piled up to several layers thick, are
large and cuboidal. They have moderate amounts of basophilic cytoplasm.
Nuclei are round to ovoid, moderately pleomorphic, vesicular, with moderately
stippled chromatin and one to three moderate sized nucleoli. Mitoses average
one per high power field. The neoplastic epithelial cells readily invasive
stroma, often inducing a moderate sclerosing stromal response. There are
some areas of inflammation, mostly composed of plasma cells and lymphocytes
within the fibrous stroma separating the lobules of neoplastic cells. Some
of the neoplastic lobules contain central cystic ducts filled with neutrophils
and necrotic cell debris. Adjacent to the mass are foci of benign mammary
nodular epithelial hyperplasia.
MICROSCOPIC FINDINGS: Intermediate grade, sclerosing, invasive adenocarcinoma,
with foci direct extension into lymph node.
Prognosis: Guarded.
COMMENTS: This is a quite invasive neoplasm, and has spread by direct
extension into a lymph node lying just adjacent to it. The mammary mass and
the affected lymph node are totally excised. However, metastasis to other
regional lymph nodes and distantly is a possibility. The patient should be
monitored for evidence of metastasis. Chest radiographs are warranted to
rule out possible metastasis to the lungs.
Adjacent to the mammary mass, there are foci of moderate, hypertrophy and
hyperplasia of mammary ductular and acinar epithelical cells. Some ducts
are dilated and filled with proteinaceous secretion product, macrophages,
and sloughed epithelial cells. This benign non-neoplastic lesion represents
mammary nodular adenomatous hyperplasia (mammary gland epitheliosis).
Mammary adenomatous hyperplasia is due to chronic hormonal stimulation. Ovariohysterectomy
usually results in regression of these lesions. These lesions can predispose
the patient to mammary neoplsia, and the patient should be followed in the
future for such a possibility.
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