Subgross physiopathology of the breast associated with clinical cancer

Abstract

Fifty human breasts removed for cancer by radical mastectomy were submitted to subgross analysis of the glandular tree as a whole, stained thin sections (2 mm) under a dissection microscope, followed by histologic study of the lesions found. The glandular tree was more often atrophic (70%) than hyperplastic (30%). The frequencies of physiopathologic changes were as follows: ductal papilloma (4%), ductal hyperplasia (6%), fibroadenoma (16%), sclerosing adenosis (24%), cysts (28%), apocrine cysts (18%), cystic ducts (40%), blind terminal ducts (60%), atrophic lobules (88%), sclerotic lobules (34%), hyperplastic lobules (28%), cystic lobules (52%), persistent lobules in otherwise atrophic breasts (30%), lobules with aporcine metaplasia (30%), atypical lobules with proliferative changes (38%), and independent foci of microscopic cancer (20%). The data indicate: 1) a frequent lack of correlation between ovarian function (menstrual cycles, menopause) and type of mammary glandular tree (hyperplastic, atrophic); 2) a rarity of ductal lesions compared with the frequency of lobular lesions; 3) a ubiquitous distribution of the lesions either near or far from clinical cancer; 4) a significant association of atypical lobules with lobular sclerosis (p < 0.001) and apocrine metaplasia (p < 0.05). The frequency and ubiquity of lobular changes suggest further investigation among them to search for suitable candidates as preneoplastic or predictive lesions.