(Andersen, 1981;Moskowitz, 1981; Tabiar et al., 1985), and from clinically based series of self-selected women (Betsill et al., 1978;Fisher et al., 1986;Moskowitz, 1983;Page et al., 1978;Page et al., 1982). However, as in situ breast carcinoma (in situ BC) is rarely symptomatic and the sensitivity of mammography in detecting malignancy is limited despite improved techniques (Holland et al., 1983), much uncertainty exists concerning these lesions.Histopathologic examination of the breast is a reliable method for detection of clinically and radiologically occult malignant and atypical lesions but extensive sampling is mandatory to detect these small lesions. The few autopsy studies using this technique have been carried out mainly on elderly women (Alpers & Wellings, 1985;Kramer & Rush, 1973;Nielsen et al., 1984).To obtain an estimate of the frequency and characteristics of clinically occult malignant and atypical lesions in younger Danish women, a series of medicolegal cases seemed to be a suitable sample. The results of an extensive histopathologic breast tissue examination and correlative specimen radiography in such a group of women are presented in this paper. Materials and methodsThe study group consisted of a series of 110 consecutive medicolegal autopsies on (Danmarks Statistik, 1985). During the sampling period about 10% of all deaths within the area underwent medicolegal examination and of these about 25% were subjected to autopsy.During the medicolegal autopsy, bilateral total mastectomy with partial axillary dissection (Cady, 1973) was performed in all cases, except for one woman who had undergone previous mastectomy for IBC and consequently only had a contralateral mastectomy.Each fresh breast specimen was weighed and radiographed intact in a single frontal projection in a Faxitron (model 43805N) using Kodak industrial M film. With the nipple as the center point, the specimen was then divided into the four quadrants and cut systematically from the deep fascia to the outer surface in 5 mm-thick slices. Each of these were radiographed and thereafter fixed in formalin. The slices were examined grossly after fixation and the relative proportion of glandular and fatty breast tissue was evaluated in 10% estimates. All tissue including fatty tissue was processed routinely for paraffin embedding. Axillary lymph nodes were also radiographed and processed for microscopic examination.The total number of paraffin blocks was 60,335 with each block containing -1.3 g of breast tissue. The average number of paraffin blocks from each breast specimen was 275 (range 57-683). The average number of lymph nodes from each woman was 21 (range 0-50). Sections for microscopic examination were cut from each paraffin block and stained with hematoxylin and eosin. In cases with suspicion of or with manifest in situ BC and atypical ductal hyperplasia (ADH), additional serial sections were prepared. The PAS-alcian stain was used to support the differentiation between LCIS and DCIS, based on the presence of intracytoplasmic lumi...

Axillary lymph nodes in 184 female autopsy cases were studied using morphological criteria. Special attention was paid to the morphology in 34 women with in situ breast carcinoma (in situ BC) compared to the remaining women without malignant breast lesions, who served as controls. Sinus histiocytosis (SH) and diffuse cortical hyperplasia (DCH) were significantly more frequent among women with in situ BC compared to controls. No significant association was found between unilateral in situ BC and these lymph node patterns on the contralateral side. Germinal center and follicular hyperplasia (GCH/FH), lymphocyte depletion (LD), fibrosis, hyalinization, calcifications and lipomatosis were not associated with in situ BC. The results indicate that in situ BC provokes reactive morphological changes of the regional axillary lymph nodes similar to the changes associated with a good prognosis in women with invasive breast cancer (IBC).

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