PLATES LV-LIX SARCOMA of the breast is a rare tumour, accounting for less than 1 per cent. of all breast tumours (Jernstrom, Lindberg and Meland, 1963;Fawcett, 1967;Kennedy and Biggart, 1967) and carcinosarcoma is even less common, only one case occurring in the series of 39 breast sarcomas reported by Curran and Dodge (1 962).In view of their rarity and the difficulties in their diagnosis we report two further examples of carcinosarcoma of the breast.
CASE REPORTSCase I An 81-yr-old Negro woman presented with a mass in the left breast which she had noticed 1 mth previously. The mass had been enlarging and was painful. There was no nipple discharge and the only other complaint was of recent weight loss. Her obstetric history is not known.Examination confirmed the presence of a mass situated beneath the nipple of the left breast; it was tethered to the skin but not to the chest wall. Axillary lymph nodes were not palpable. The right breast appeared normal. X-rays of the chest and the skeletal system showed no metastases but there was evidence of extensive Paget's disease of the skull. A simple mastectomy was performed from which the patient made an uneventful recovery. Fourteen months later she was alive and, although no details of her general state of health are known, an X-ray of the chest taken at that time showed no evidence of metastases.
PathologyMacroscopic examination of the mastectomy specimen showed a central oval mass (5 cm diameter) deep to the nipple and areola. The cut surface revealed an extensive multiloculated cystic area, some central haemorrhage and, to one side, firm white tumour tissue ( fig. 1). There were no lymph nodes in the specimen.There were multiple, begular, cysts of varying size; some of these were devoid of epithelium but others were lined by a multilayered epithelium in which the cells were arranged in a disorderly fashion and showed considerable pleomorphism, nuclear hyperchromatism and many mitoses, including atypical forms (fig. 2). The epithelium was sharply demarcated from the underlying stroma with no evidence of invasion; over large areas it had become detached from the stroma in a manner that suggested a natural plane of cleavage between the two components of the tumour. In a few places the malignant epithelium was seen in continuity with a single layer of uniform, flattened or small cuboidal cells. These appearances were interpreted as being those of in-situ intracystic carcinoma, arising in a preexisting simple epithelium.Microscopically the pattern was complex.
Summary
A 63‐year‐old Jamaican negress had an endometrial stromal sarcoma arising in a paramesonephric cyst of the broad ligament. Morphological evidence is presented to show that the tumour arose from an area of endometriosis within the cyst wall. Subsequent metastases responded for a few months to cyclophosphamide therapy and the patient died 14 months after the onset of symptoms.
A case of massive central rupture of the liver in which the patient became jaundiced is described. Autopsy revealed, in addition to the intrahepatic haematoma, large areas of infarction in the liver, some of which had become infected and had given rise to septic embolization to various organs. There was deranged liver function which is ascribed to the structural changes found in the liver. The occurrence of hepatocellular jaundice with this type of liver injury has not, to our knowledge, been previously recorded. It is suggested that immediate investigation and treatment are essential if the patient is to survive.
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