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Summary Histological reports of 1869 consecutive women with invasive breast cancer have been reviewed to determine whether histological features of the tumours were related to the patients' age. The patients, treated between 1983 and 1992, were divided into four groups, based on age. There were 148 aged < 39 years, 355 aged [40][41][42][43][44][45][46][47][48][49] years, 984 aged 50-69 years and 382 aged 70 years or more. The most outstanding finding was the increase in incidence of grade IlIl infiltrating ductal carcinoma in those aged < 39 years (P< 0.0001). Certain tumour types, in particular lobular, were reported more frequently in the oldest age group. Additionally, there was a significant reduction of axillary lymph node metastases, vascular invasion and lymphoplasmacytic stromal reaction with increasing age, all of which were independent of tumour grade. These data suggest that there may be age-related changes in the histology of breast cancer and, in some cases, less aggressive features in the elderly. However, as the life expectancy of women over the age of 70 may be many years, treatment should be based on histological prognostic features of the primary tumour rather than age alone.Keywords: breast cancer; histology; age; tumour grade; axillary nodes There are reports indicating that breast cancer has a relatively unfavourable prognosis in young women (Jacquemier et al, 1985;Rosen et al, 1985;Rochefordiere et al, 1993), but is a disease of good prognosis among the elderly (Rosen et al, 1985). However, others have suggested that age does not influence the behaviour of the disease (Schaefer et al, 1984). Relatively few comparative studies of histological features of breast cancer in the young and old have been conducted. It has been reported that there is a significantly lower mean age for patients with medullary carcinoma, while lobular and mucoid carcinomas are relatively more frequent in the elderly (Rosen et al, 1985). Intracystic papillary carcinoma is also found more frequently in older women (Carter et al, 1983). In addition, it has been suggested that younger women have more aggressive high-grade tumours than the elderly (Jacquemier et al, 1985;Rosen et al, 1985).The aim of the present investigation was to review a large series of patients with invasive breast cancer and to analyse a variety of histopathological findings in relation to age, in order to determine whether there were any indications of less or more aggressive features in different age groups. PATIENTS AND METHODSThe study comprised 1869 women with invasive breast cancer who were treated consecutively at the Breast Unit, Guy's Hospital, in the 10-year period 1983-1992. The patients were divided into four age groups, < 39 years, 40-49 years, 50-69 years and > 70 years. These age groups were selected for the following reasons.The cut-off age for young women has ranged from 30-45 years in previous studies (Jacquemier et al, 1985;Rosen et al, 1985;Lee et al, 1992 Correspondence to: IS Fentiman reasonable size, which was compatible with ...

Mammary hamartomas are macroscopically well-delineated tumours composed of a variable mixture of epithelial elements, fat and fibrous tissue. Such lesions are an under-recognized entity and, as they can be visualized by mammography, may be seen more frequently with the advent of the UK National Breast Screening Programme. The clinical and pathological features of 35 cases of mammary hamartoma seen at the Imperial Cancer Research Fund Clinical Oncology Unit at Guy's Hospital between 1979 and 1990 have been reviewed. Hormone receptor analysis on nine cases gave high progesterone with low oestrogen levels, probably reflecting their premenopausal status. Immunohistochemistry showed that the positive receptor staining was confined to the epithelial elements. In 25 cases pseudo-angiomatous hyperplasia was evident in the stroma of the lesion. The importance of distinguishing the inter-anastomosing stromal spaces seen in the latter condition from low-grade angiosarcoma is emphasized; the relationship between pseudo-angiomatous hyperplasia and mammary hamartoma is discussed; and the possibility that the former represents a permanently dilated form of the lymphatic labyrinth suggested.

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Materials and methodsSurgical specimens of breast tissue containing carcinoma were received fresh in the laboratory 15 min after removal from the patient. After standard pathological assessment and sampling for routine histology and hormone receptor assay, and if sufficient tumour was available, multiple slices, on average measuring 1 cm2, were taken and placed in a variety of fixatives (Table I). Cytosols were prepared from frozen tissue after homogenisation using a microdismembrator (Braun, Melsungen, Germany) according to the instructions in the Abbott enzyme immmunoassay kit (Abbott Laboratories, Maidenhead, Berkshire, UK). The protein concentration of the cytosol extracts was determined by a dye-binding assay (Bradford, 1976 ethanol (six changes), clearing in xylene (three changes) and paraffin wax impregnation (four changes), the entire process taking 11 h. The tissues were then embedded and sectioned for routine histology and immunohistochemistry. Subsequent to the fixation study tissue from 95 consecutive cases of infiltrating mammary carcinoma and 20 cases of pure in situ or predominantly in situ carcinoma with minimal invasion (<2 mm maximum diameter) was fixed in phenol formol saline for evaluation of the different staining patterns seen with the p53 antibody.Tumour typing and grading Infiltrating tumour types were classified according to a modification of the WHO (1982) system. Tumour grading was carried out on all infiltrating ductal carcinomas and tumours of special type. Infiltrating lobular carcinomas were not graded. The histological grading was based on the method of Bloom and Richardson as modified by Elston and Ellis (1991). Cases of in situ ductal carcinoma were classified as comedo when composed of large pleomorphic cells, usually with areas of extensive necrosis, or non-comedo when composed of small or intermediate-sized cells with minimal or no necrosis, usually with a cribriform or micropapillary pattern (Bobrow et al., 1993). ImmunohistochemistrySections of 3 ym were cut and floated onto glass slides coated with poly-L-lysine and allowed to dry overnight. Heat was not used to stick the tissue sections on to the glass as this can