The importance of pain as a presenting symptom of breast cancer has been assessed in a series of 240 patients with operable breast cancer over four years. From an analysis of the case histories of 36 patients the diagnosis proved difficult in one-quarter of the cancers. This is explained by the high incidence of subclinical and lobular carcinoma in the group. Cancer must be seriously considered as a diagnosis in patients presenting with welllocalised breast pain of recent onset. These patients should be followed for at least one year after the onset of the pain before cancer is confidently excluded.
Aim-To determine interobserver and intra-observer agreement in the assessment of cytological grade and intraduct necrosis in pure duct carcinoma in situ (DCIS) of the breast. Methods-Sixty unselected cases with illustrated diagnostic criteria were circulated to 19 practising histopathologists. Results-Overall agreement was moderate for cytological grade in three categories: 71% agreement; weighted ( w), 0.36; intraduct necrosis in three categories (absent, present, extensive): 76% agreement; w, 0.57; and the Van Nuys classification system: 73% agreement; w, 0.48. Agreement was no better among observers participating in the National External Quality Assurance Programme. Intraobserver agreement for cytological assessment (69.6% agreement; w, 0.52) and intraduct necrosis (68.3% agreement; w, 0.48) was moderate, suggesting that individual variation rather than precision of criteria contributes to the lack of agreement. Conclusions-Moderate agreement on observations can be achieved by nonspecialist pathologists, with better agreement on necrosis than cytological grade. There was evidence of consistent individual bias towards over or under scoring cytological grade, which could be corrected with adequate and prompt feedback. (J Clin Pathol 2000;53:596-602)
A case of ovarian teratoma which produced glial peritoneal deposits is described. Twelve other cases in the literature are tabulated. The age at presentation ranges from 22 months to 22 years (mean age 14·6 years). The primary tumour may be solid or cystic. The prognosis does not appear to be improved by radical surgery as opposed to simple excision but depends mainly on the maturity of the tissues of the primary tumour and the peritoneal deposits. Although the period of follow up is generally short, a survival time up to 26 years is recorded. In the fatal cases, there is rapid recurrence and metastatic spread. The pathogenesis of the glial deposits is discussed.
Fibroadenolipoma is a well recognised but unusual benign tumour of the breast. It is a circumscribed lesion composed of fat and other breast tissues which may be normal or which may show various benign changes. The presence of smooth muscle has been recorded but was not found in our cases. A series of eight cases is described, occurring over a period of 10 years in a series of 20 000 mammograms. Radiological and pathological correlation is made and histological changes are described. Our findings are compared with other reviews in the literature. The lesions are usually diagnosed radiologically.
A consecutive series of 791 women who had attended diagnostic breast clinics during 1967-70 and been found to be free of malignant disease were later traced to determine their subsequent incidence of breast cancer.
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