Comedo Carcinoma (or Comedo-Adenoma) of the Female Breast

Abstract

In 1893, forty-one years ago, I assisted Dr. Halsted in exploring a clinically benign tumor of the breast. The patient was sixty-seven years of age and had observed a small tumor for about eleven months. It was our custom then to cut into the tumor and decide on its pathological nature from the naked-eye appearance of the tissues. This tumor was not encapsulated and not cystic, but distinctly circumscribed and buried in a senile breast. The moment we cut into and pressed on it, there exuded from its surface many grayish-white, granular cylinders, which I called at that time comedos. From the gross appearance the tumor was diagnosed as malignant, and the radical operation was performed. The nodes were not involved, the breast was senile, and there was no gross or microscopic evidence of chronic cystic mastitis. This patient lived nineteen years after operation, dying at the age of eighty-six. Since then I have been recording such cases and have divided them into two groups—pure comedo-adenocarcinoma and comedo-adeno-carcinoma with areas of fully developed cancer of the breast. Examples of the latter group, in which areas of pure comedo tumor are present in an otherwise fully developed cancer of the breast, are the more frequent, and for this reason the operator must always bear in mind the possibility of cancer when comedos are present in a tumor. Hence, if the tumor is too large to exclude the presence of malignant areas by frozen sections, a radical mastectomy should be done.