PATHOLOGY OF THE BREAST. Marina Kos
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1 PATHOLOGY OF THE BREAST Marina Kos
2 LOBULES DUCT
3 INFLAMMATIONS Uncommon, except in the peripartal period ACUTE MASTITIS Staphylococci pain and tenderness, warm red skin single or multiple abscesses MAMMARY DUCT ECTASIA nonbacterial obstruction of main ducts by inspissated secretion rupture induration, nipple retraction dilated obstructed ducts (granular debris, macrophages, leukocytes) necrotic epithelium periductal stroma infiltrated with lymphocytes, plasma cells, granulomas (PERIDUCTAL, PLASMA CELL MASTITIS)
4 FAT NECROSIS OF THE BREAST Usually connencted to trauma, irradiation A localized, firm area with scarring that can mimic a breast carcinoma Microscopically irregular steatocytes with no peripheral nuclei and intervening pink amorphous necrotic material and inflammatory cells (including foreign body giant cells)
5 FAT NECROSIS OF THE BREAST STEATOCYTES INFLAMMATORY CELLS, LIPID LADEN MACROPHAGES
6 SILICONE IMPLANTS CONNECTIVE TISSUE CAPSULE
7 SILICONE IMPLANTS CONNECTIVE TISSUE CAPSULE SILICONE FOREIGN BODY GRANULOMATOUS REACTION
8 FIBROCYSTIC CHANGE BLUE DOME CYST MICROCALCIFICATION
9 FIBROCYSTIC CHANGE
10 FIBROCYSTIC CHANGE APOCRINE METAPLASIA
11 FIBROCYSTIC CHANGE epithelial hyperplasia (proliferative FC)
12 FIBROCYSTIC CHANGE atypical epithelial hyperplasia
13 FIBROCYSTIC CHANGE sclerosing adenosis
14 RELATIONSHIP OF FIBROCYSTIC CHANGES TO BREAST CARCINOMA MINIMAL / NO INCREASED RISK Fibrosis, micro/macroscopic macroscopic cystic changes, apocrine metaplasia, mild hyperplasia SLIGHTLY INCREASED ( x) Moderate to florid hyperplasia, ductal papillomatosis, sclerosing adenosis, fibroadenomas, proliferative FC SIGNIFICANTLY (5 x) INCREASED RISK Atypical ductular or lobular hyperplasia A FAMILIY HISTORY OF BREAST CANCER MAY INCREASE THE RISK IN ALL CATEGORIES
15 FIBROADENOMA the most common benign tumor STROMA DUCTLIKE SPACES FIRM, WELL CIRCUMSCRIBED, WHITISH
16 PHYLLODES TUMOR MUCH LES COMMON MAY BECOME VERY LARGE GROSSLY leaflike clefts and slits SOME CAN BECOME MALIGNANT increased stromal cellularity, anaplasia, mitoses
17 INTRADUCTAL PAPILLOMA USUALLY SOLITARY DELICATE BRANCHING GROWTH WITHIN A DILATED DUCT OR A CYST multiple papillae, fibrovascular core + ½ layers of the epithelium
18 GYNECOMASTIA enlargement of the ABSOLUTE OR RELATIVE ESTROGEN EXCESS cirrhosis of the liver, Klinefelter syndrome,, estrogen secreting tumors, estrogen therapy, digitalis therapy, puberty, old age male breast
19 CARCINOMA OF THE BREAST GEOGRAPHIC FACTORS AGE GENETICS & FAMILIY HISTORY PROLONGED EXPOSURE TO ESTROGENS PROLIFERATIVE FC (WITH ATYPIA), LOBULAR CA IN SITU
20 CARCINOMA OF THE BREAST - PATHOGENESIS 1. GENETIC CHANGES 2. HORMONAL INFLUENCES 3. ENVIRONMENTAL FACTORS
21 CARCINOMA OF THE BREAST The left breast affected slightly more often 4% bilateral primary tumors The location Upper outer quadrant 50% Central part 20% Lower outer/upper upper inner/lower inner quadrant 10% each Non-invasive (in situ, DCIS/LCIS) and invasive
22 DUCTAL CARCINOMA IN SITU - DCIS OF THE BREAST CRIBRIFORM SOLID COMEDO
23 LOBULAR CARCINOMA IN SITU LCIS OF THE BREAST
24 PAGET S S DISEASE OF THE NIPPLE EXTENSION OF DCIS TO LACTIFEROUS DUCTS AND CONTIGUOUS SKIN OF THE NIPPLE CRUSTING EXUDATE IN about 50% THERE MIGH BE AN UNDERLYING INVASIVE CARCINOMA
25 PAGET S S DISEASE OF THE NIPPLE PAGET CELLS WITH ABUNDANT CLEAR CYTOPLASM AND PLEOMORPHIC NUCLEI IN THE EPIDERMIS
26 INVASIVE DUCTAL CARCINOMA OF THE BREAST THE CENTER IS FIRM (scirrhous) because of stromal desmoplasia AREAS OF YELLOWISH NECROSIS A HARD, PALPABLE MASS MAY CAUSE DIMPLING OF THE SKIN, RETRACTION OF THE NIPPLE, FIXATION TO THE CHEST WALL
27 INVASIVE DUCTAL CARCINOMA OF THE BREAST FIBROADENOMA
28 INVASIVE (INFILTRATING) CARCINOMA OF THE BREAST DCIS
29 INVASIVE (INFILTRATING) CARCINOMA OF THE BREAST - NOS
30 INVASIVE (INFILTRATING) CARCINOMA OF THE BREAST - NOS
31 INVASIVE (INFILTRATING) CARCINOMA OF THE BREAST INFLAMMATORY CARCINOMA Clinically enlarged, swollen, erythematous breast without a palpable mass because of the lymphatic blockade by tumorous tissue The underlying carcinoma is usually NOS Diffuse invasion of breast parechyma Poor prognosis because of distant metastases
32 INVASIVE (INFILTRATING) CARCINOMA OF THE BREAST INFLAMMATORY CARCINOMA PEAU D ORANGE
33 INVASIVE (INFILTRATING) CARCINOMA OF THE BREAST MEDULLARY CARCINOMA A rare subtype (2%) Sheets of large anaplastic cells with well circumscribed borders Lymphoplasmacytic infiltrate DCIS absent or minimal Increased frequency in women with BRCA-1 mutations
34 INVASIVE (INFILTRATING) CARCINOMA OF THE BREAST MEDULLARY CARCINOMA
35 INVASIVE (INFILTRATING) CARCINOMA OF THE BREAST TUBULAR CARCINOMA Consists of well formed tubules with low grade nuclei Lymph node metastases are rare, prognosis is excellent
36 INVASIVE (INFILTRATING) CARCINOMA OF THE BREAST COLLOID (MUCINOUS) CARCINOMA A rare subtype Tumor cells produce abundant mucin that dissects into surrounding stroma Grossly soft and gelatinous
37 INVASIVE (INFILTRATING) CARCINOMA OF THE BREAST LOBULAR CARCINOMA < 20% 2/3 of the cases are associated with adjacent LCIS The cells invade individually into the stroma ( Indian file ) More frequently bilateral and multicentric Metastasize to CSF, ovary,, uterus, serosal surfaces
38 INVASIVE (INFILTRATING) CARCINOMA OF THE BREAST LOBULAR CARCINOMA
39 FEATURES COMMON TO ALL INVASIVE CANCERS 1. Adhesion to the pectoral muscles or deep fascia of the chest wall FIXATION 2. Adherence to the overlying skin RETRACTION OR DIMPLING OF THE NIPPLE 3. Involvement of the lymphatic channels LYMPHEDEMA ( peau d orange orange peel skin)
40 SPREAD OF BREAST CANCER NODAL METASTASES Outer quadrant, central lesions AXILLARY L.N. Inner quadrants- L.N. ALONG THE INTERNAL MAMMARY ARTERIES SUPRACLAVICULAR L.N. DISTANT DISSEMINATION LUNGS, SKELETON, LIVER, ADRENALS, BRAIN... LUNGS, SKELETON, LIVER, ADRENALS, BRAIN... METASTASES CAN APPEAR MANY YEARS AFTER APPARENT THERAPEUTIC CONTROL OF THE PRIMARY LESION
41 PROGNOSTIC FACTORS THE SIZE OF THE PRIMARY TUMOR (1 cm) LYMPH NODE INVOLVEMENT AND THE NUMBER OF LYMPH NODES INVOLVED BY METASTASES THE GRADE OF THE TUMOR THE HISTOLOGIC TYPE OF THE TUMOR LYMPHOVASCULAR INVASION
42 PROGNOSTIC FACTORS THE PRESENCE OR ABSENCE OF ESTROGEN OR PROGESTERONE RECEPTORS ER PR
43 PROGNOSTIC FACTORS THE PROLIFERATIVE RATE OF THE CANCER Mitotic count Flow cytometry Immunohistochemical markers ANEUPLOIDY
44 PROGNOSTIC FACTORS OVEREXPRESSION OF ERB-B2 B2 amplification of the gene poorer prognosis
45
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