No abstract

A retrospective study was made of recurrent mammary cystosarcoma phyllodes seen at Memorial Sloan-Kettering Cancer Center from 1932 to 1972. C h icopathologic findings, clinical course, treatment, and survival are described. It is apparent that cystosarcomas may recur and several years may elapse between recurrences. We found that 18% of the benign and 8% of the malignant cystosarcomas recurred and malignant "transformation" occurred in two of the 28 recurrent benign cystosarcomas.

Treatment of mammary carcinoma by partial mastectomy rather than by total mastectomy and axillary dissection may diminish the chances of long-term cure by risking incomplete removal of all local carcinoma at the initial operation. This study was undertaken to determine by pathologic examination how often carcinoma might remain in the breast and axilla after partial mastectomy. The operation was simulated in 203 mastectomy specimens after operations for unilateral invasive carcinoma. In so far as could be determined on gross examination, the entire primary lesion was included in the quadrant which was excised in the simulated procedure. Among 100 women with primary lesions less than 2 cm in diameter, 26% had carcinoma in the breast which remained after simulated partial mastectomy. Six percent of them also had axillary node metastases. An additional 30% only had axillary node metastases. When the primary lesion was more than 2 cm in diameter, 38% of patients had carcinoma in the breast after simulated partial mastectomy, of whom 29% also had axillary metastases. After simulated partial mastectomy, carcinoma was found in 80% of breasts from patients with lesions in the subareolar area, in contrast with 25-3570 of patients with a primary carcinoma in one of the four quadrants. None of the 9 patients with medullary and colloid carcinomas that measured under 2 cm had axillary metastases or carcinoma in the breast outside of the primary quadrant. The findings suggested that a familial history of breast carcinoma or a large primary lesion may be associated more often with multifocal disease, but factors such as age at diagnosis, axillary status, and the mammogram report did not have significant predictive value for distinguishing between patients who did or did not have carcinoma in breast tissue after the primary had been removed by a simulated partial mastectomy. NTENSE CONTROVERSY HAS BEEN GENERATED I in the past several years by the proposal that total mastectomy is now an unnecessarily extensive and disfiguring operation for the treatment of primary operable invasive breast carcinoma.* Advocates of conservative surgery contend that radical mastectomy was essential in the past because many more patients presented with advanced disease.' They maintain that today the majority of patients are being treated at an Presented in part at the 27th Annual Meeting of the James Ewing Society. Maui. HI, April 8-13, 1974. The authors express their appreciation for the invaluable assistance of Miss Jane Taylor and Miss Donna Nager in the preparation of this study.Received for publication November 15, 1974. earlier stage and that it is possible to select patients who can be cured by partial rather than total mastectomy.2 Two serious difficulties must be faced in selecting patients for partial mastectomy. First, the operation should remove all carcinoma in the breast if it is to achieve maximum local control. To ensure this requires a reliable method of identifying patients with carcinoma limited to a single quadrant of the brea...

A cohort of 1458 breast cancer patients treated by radical mastectomy in the years 1940–1943 has been followed since that time. There are 184 known alive an average of 30.6 years later. Of the others, 836 have died of either their first or second breast cancers, and 349 have died of other causes. Sixty‐nine seem to have been definitely lost to followup, while followup is active but incomplete for 30 others. The actuarial 30‐year survival rate is 38%, and the cumulative rate of clinical second primary breast cancers is 16.4%.

Three hundred and fifty‐four patients with histologically proven infiltrating lobular carcinoma of the breast were seen at Memorial Hospital, New York City, between 1956 and 1970. This comprised 5.8% of all breast cancers seen during this interval. Infiltrating lobular breast cancer is found less frequently in the Negro female—3.7% vs. 5.8% for all breast cancer. Histologic differentiation from infiltrating duct carcinoma may be difficult. Clinical diagnosis is often complicated by its gross similiarty to “localized mastitis.” Bilaterality is more frequent with infiltrating lobular carcinoma—23% vs. 16% for infiltrating duct carcinoma. Infiltrating lobular carcinoma is lethal in its behavior, 5‐ and 10‐year salvage rates, after similar therapy, being slightly below those for infiltrating breast carcinoma generally. During its in‐situ stage, lobular carcinoma can be cured consistently by total mastectomy. When definitive surgical therapy is delayed until infiltrating breast cancer has developed, the patient is exposed to a greater long‐term risk because of the uncertain prognosis of infiltrating lobular carcinoma.