Breast hamartoma with invasive ductal carcinoma. Report of two cases and review of the literature.

Two cases of well-defined masses also containing clinical and radiographical abnormalities suggestive of malignancy, subsequently found to be invasive ductal carcinomas in breast hamartomas are described. The patients were 53 and 78 years old. Both presented with a generally soft palpable breast lump, containing a firm area which in one case invaded and ulcerated the skin. Mammography demonstrated two typical hamartomas: one containing a spiculated opacity, the other irregular opacities with suspicious calcifications, suggesting the presence of carcinomas in these benign lesions. The cut surface of these well-circumscribed masses measured 5 cm and 7 cm. The microscopic appearance was characteristic of breast hamartoma (sharp circumscribed "pseudocapsule" surrounding breast fibrocystic changes with variable amounts of adipose tissue) with the firm area in each case corresponding to invasive ductal carcinoma. In one case the invasive ductal carcinoma was confined to the hamartoma, whereas in the other malignant tumor, cells extended beyond the surrounding breast tissue and infiltrated the skin. These findings raise the question of secondary involvement of a hamartoma by invasive carcinoma. Breast hamartomas are probably underrecognized lesions. In our view, these findings do not justify a more aggressive approach towards the management of breast hamartomas.

Bronchial granular-cell tumor. Report of a case with preoperative cytologic diagnosis on bronchial brushings and immunohistochemical studies.

A 42-year-old man presented with a polypoid endobronchial mass of the right apical segmental bronchus. Bronchial brushing smears contained clusters of cells exhibiting abundant diffusely granular cytoplasm with indistinct borders. A cytologic diagnosis of granular-cell tumor was rendered. Histologic examination of the upper right lobectomy specimen provided confirmation. Immunohistochemically, the granular cells strongly reacted with the S-100 protein antibody. This case demonstrates that the cytologic diagnosis of bronchial granular-cell tumor is possible if this lesion is considered in the differential diagnosis of lung tumors.

An extensive morphological and comparative study of clinically early and obvious squamous cell carcinoma of the esophagus.

Squamous cell carcinoma of the esophagus appears mainly as an isolated tumor, frequently diagnosed in its latest stage. However, current advances in endoscopy, systematically used for high risk subjects, allow the detection of very early lesions such as epithelial dysplasia or in situ carcinoma. Twenty-eight squamous cell carcinomas were extensively studied: Group A contained 15 clinically "early cancers"; Group B 12 clinically obvious carcinomas and group C one clinically obvious bifocal carcinoma. All 15 "early cancers" were multicentric and composed of large fields of invasive, microinvasive or in situ carcinoma around which were found epithelial dysplasias of various degrees. Lymph node metastases at surgery were found in 26% of these cases. Obvious squamous cell carcinomas were contiguous with dysplastic areas in 16.6% and with in situ carcinomas in 33% of these cases. Half (50%) had lymph node metastases at surgery. There was no dysplasia or in situ carcinoma around the two main tumors of group C. A comparison between the different morphological features of the three groups leads us to question whether the solitary tumor of the esophagus really represents the final evolution of an early multifocal carcinoma.

Unusual intestinal talcosis.

A case of intestinal talcosis in a 46-year-old man is reported. At the age of 27, the patient was treated for pulmonary tuberculosis with tablets containing talc (183 g talc per 2,670 g total drug intake) over a period of 28 months. Eighteen years later, the patient was hospitalized for abdominal pain that remained refractory to antacids; he subsequently underwent a right hemicolectomy. Light-microscopic examination revealed a prominent fibrosis of the intestinal wall in which birefringent particles were demonstrated by polarized light. Using energy-dispersive spectroscopy, an analysis of these particles showed that they were predominantly composed of silicon and magnesium as well as small amounts of phosphorus, sulphur, calcium, and iron--the spectrum typically associated with talc. We believe that the source of this talc is the tablets ingested by the patient during prior antituberculosis therapy.