A clinical and pathologic study of 49 eccrine spiradenomas occurring in 46 patients is presented. The study showed that pain and/or tenderness are not such characteristic clinical features of this tumor as has previously been suggested; either or both were present in only 23% of the 35 patients with well-documented clinical histories. Some pathologic features, not previously documented in this tumor, were seen and included: cylindromatous foci, aggregates of stromal clear cells, clear cells lining ducts and ulceration of the overlying epidermis. Two tumors had undergone malignant transformation, but there were no recurrences in the 35 patients with adequate follow-up.
A clinicopathologic study of 18 eccrine acrospiromas with atypical nuclear changes is presented. The changes included nuclear pleomorphism, prominent nucleoli, chromatin condensation, multinucleate giant cells and increased mitotic activity. Of the 5 neoplasms that occurred, 2 recurred once and were histologically and clinically benign, and the other 2 recurrences were histologically malignant. One neoplasm recurred twice, the first recurrences being histologically benign and the second histologically malignant. It is suggested that such nuclear atypias in otherwise clinically and histologically benign eccrine acrospiromas may be associated with local benign recurrences some of which may undergo malignant change. Search for these nuclear changes and long follow-up of patients in whom they occur are, therefore, recommended.
Fourteen cases of primary malignant lymphomas of the breast were found in the pathology files of the M. D. Anderson Hospital and Tumor Institute from 1944 to 1975. The lymphomas represented only 0.12% of 11,277 primary malignant breast tumors seen during the same period. There were no definite clinical features to distinguish the patients with lymphoma from those with breast carcinoma. All of the lymphomas had a diffuse pattern. Eight cases were classified as undifferentiated lymphoma, five as histiocytic, and one as poorly differentiated lymphocytic, convoluted cell type. Four patients had mastectomies and the remainder biopsies as their sole surgical procedure. Eight patients received post‐surgical radiotherapy and all eventually had chemotherapy. The five‐year survival rate for the 13 patients with follow‐up was 49%. Patients with histiocytic lymphoma appeared to have a more favorable prognosis than those with the undifferentiated type. Six of the latter patients are dead with a median survival of seven months, comparable to the reported survival of patients with American Burkitt's lymphoma. The patient with the convoluted cell type has developed acute blastic leukemia and is currently under therapy.
A retrospective study to determine the effect of extranodal axillary disease on prognosis in invasive carcinoma of the breast was undertaken in a series of 152 cases. It was found that extranodal disease has an unfavorable effect on prognosis in those patients with three or less involved axillary nodes and no effect on prognosis in those patients with four or more involved axillary nodes. Extranodal axillary disease was found to have no influence on the interval between surgery and initial recurrence nor on the anatomic distribution of the recurrence, local or remote.
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