Tonsillar metastasis from carcinoma of the breast with ultrastructural and steroid receptor analyses.

ABSTRACT

PIP: A case report and an ultrastructual study are published together to elucidate an unusual site of metastasis for mammary carcinoma. A 33-year-old American Indian mother presented with a left tonsillar mass; 11 months before she had undergone a right simple mastectomy for an apparently localized carcinoma of the breast. Biopsy material from the tonsillar mass contained carcinoma, and an axillary mass was subsequently excised and noted to contain similar tumor. After oophorectomy, the patient experienced remission of her bone pain and reduction in liver size. 5 figures form the bulk of the ultrastructural study. Histologically the tumor from the original mastectomy represented a medullary variant of infiltrating ductal carcinoma of the breast; the specimen was characterized by sheets of large bizarre, pleomorphic cells with hyperchromatic, pleomorphic nuclei and frequent mitosis. Only slight glandular differentiation of scirrhous reaction was apparent. The tonsillar biopsy contained several nodules of metastatic carcinoma with minimal adenomatous differentiation, bisicular nuclei, and prominent nuclei. Ultrastructurally, both metastatic foci of tumor were similar and characterized as adenocarcinomas with well-developed endoplasmic reticulum, cytoplasmic vacuolization, osmophilic granules, intracellular canaliculi with microvilli, numerous desmosomes, large nuclei with marginated nuclear chromatin, and enlarged nuceoli. Mitotic figures were abundant.