Pathology. Cancer histology. Invasive ductal Invasive lobular Other invasive DCIS. Distribution of Histologic Types of Breast Cancer
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1 Invasive ductal Invasive lobular Other invasive DCIS Distribution of Histologic Types of Breast Cancer Total Cancers Percent In Situ Carcinoma Ductal carcinoma in situ 80 Lobular carcinoma in situ (nb. Not considered a breast 20 ( lesion malignancy, but rather a high-risk Invasive Carcinoma Invasive ductal carcimona 79 Lobular carcinoma 10 Tubular/cribriform carcinoma 6 2 ( carcinoma Mucinous (colloid Medullary carcinoma 2 Papillary carcinoma 1 Metaplastic carcinoma <1 Adapted from Kumar V, Abbas A, Fausto N. Robbins and Cotran: Pathologic Basis of Disease. 7th ed. Philadelphia: Elsevier Inc; Chapter 23, The Breast; p
2 Invasive ductal carcinoma Firm/hard with irregular borders & occasionally calcifications Arises from terminal duct lobular unit ( Society 5 year survival (Am Cancer Overall: 75% Localized: 91% Regional: 69% Distant: <19% ( staging (Based on TNM
3 Invasive ductal carcinoma Marked increase in dense, fibrous desmoplastic stroma Accompanied by varying amounts of DCIS
4 Wide spectrum of appearances: ( grade Well-differentiated tumors (low Tubules lined by minimally atypical cells Typically express hormone receptors Often do not over express HER2/neu ( grade Poorly differentiated tumors (high Anastomosing sheets of pleomorphic cells Less likely to express hormone receptors Most often over express HER2/neu ( grade Majority somewhere in between (intermediate
5 Invasive lobular carcinoma Firm/hard with irregular margins, or occasionally diffuse thickening without a distinct tumor mass Minimal or absent desmoplastic response Hallmark pathology: single infiltrating tumor cells in single file or in loose clusters or sheets Signet-ring cells common Tumor cells frequently arranged in concentric rings surrounding normal ducts
6 Invasive lobular carcinoma Can present as palpable mass or mammographic density; however, 25% have diffuse pattern of invasion presenting as a vaguely thickened area of the breast or subtle architectural changes on mammography Incidence increasing in postmenopausal women Same prognosis as invasive ductal Well-differentiated & moderately differentiated: Usually diploid, express hormone receptors, are assoc. with LCIS; HER2/neu overexpression rare Poorly-differentiated: Usually aneuploid, lack hormone receptors, often overexpress HER2/neu Most show loss of 16q22.1: cluster of cell adhesion genes including e- cadherin & β-catenin Unique pattern of metastasis: Mets to peritoneum & retroperitoneum, leptomeninges, GI tract, ovaries & uterus more frequently observed
7 Other invasive carcinomas Tubular carcinoma Typically detected as irregular mammographic densities Common presentation in late 40 s Well-differentiated by definition Metastasis in <10% of cases Excellent prognosis Morphology: well-formed tubules lined by single layer of cells on background of desmoplastic stroma
8 Medullary carcinoma Typically presents as well-circumscribed mass ( 13% ) Disproportionate representation in BRCA1 carriers High nuclear grade, aneuploidy, absence of hormone receptors, high proliferative rates; yet better prognosis than invasive ductal ( good carcinoma ( looks bad, may act Infrequent lymph node metastasis Typically ER-, PR-, Her2- Morphology: solid syncytium-like sheets of large cells with pleomorphic nuclei, prominent nucleoli, & frequent mitoses Lymphoplasmacytic infiltrate surrounding tumor
9 Other invasive carcinomas Mucinous (colloid) carcinoma ( yrs Older women (>60 May grow slowly over many years ( carcinomas Uncommon (1-6% of breast Typically presents as circumscribed mass May have better prognosis than invasive ductal Distinctive pattern of small islands of tumor cells in sea of mucinous material
10 - Invasive papillary carcinoma Typically presents like invasive ductal carcinoma, but may have better prognosis Papillary architecture ( cancers Rare (<1% of invasive breast - Metaplastic carcinoma Includes wide variety of rare types
11 Ductal carcinoma in situ ( DCIS ) Most frequently presents as mammographic calcifications; often undetectable by palpation/visual inspection Represent 50% of mammographically detected cancers May be multicentric Malignant population of cells limited to ducts & lobules by basement membrane
12 ( DCIS ) Ductal carcinoma in situ Progresses to invasive carcinoma! 25% of patients may develop same breast invasive carcinoma Comedo pattern imparts greater risk Treatment: Mastectomy curative in 95% of cases Breast conservation appropriate for most women with slightly higher risk of recurrence» Risk factors for recurrence: grade, size, margins
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