Breast Cancer Pathology

Greg Wolgamot, MD PhD

Jan 16, 2016

Agenda

1. Pathology processing

2. Breast neoplasia 101

3. Pathology report

Agenda

1. Pathology processing2. Breast neoplasia 101

3. Pathology report

Agenda

1. Pathology processing

2. Breast neoplasia 1013. Pathology report

A smorgasboard of pathology!

Normal breast lobule

Normal changes with age

Fibrocystic change (apocrine metaplasia)

Complex sclerosing lesion (radial scar)

Fibroadenoma

Intraductal papilloma

Ductal carcinoma in situ (DCIS)

Invasive carcinoma

Hyperplasia- in situ neoplasia - carcinoma

Progression

Progressive risk of invasive carcinoma

3%

5-7% 13-17% 25-30%

Is DCIS cancer?

Is DCIS cancer?

Semantics. DCIS itself cannot

metastasize, but can progress to invasive

carcinoma, which can metastasize.

From a patient’s perspective, DCIS is

treated like cancer.

Are atypical ductal hyperplasia and DCIS always completely distinct?

Are atypical ductal hyperplasia and DCIS always completely distinct?

Not always. They can form a spectrum, whether analyzed by morphology, genetic techniques, or risk to invasive carcinoma.

Ductal vs. Lobular

Why is it important to distinguish ductal from lobular carcinomas?

Why is it important to distinguish ductal from lobular carcinomas?

Different growth patterns may necessitate

different imaging, surgical, and pathology

approaches. In some cases lobular

carcinomas forms discrete masses, and in

other cases can be deceptively sneaky!

Agenda

1. Pathology processing

2. Breast neoplasia 101

3. Pathology report

Inflammatory breast carcinoma

Inflammatory breast carcinoma

Paget’s Disease (of breast)

Paget’s Disease (of breast)

Paget’s Disease (of breast)

ER

HER-2

What are the most important prognostic indicators?

What are the most important prognostic indicators?

1. Distant metastases

2. Nodal metastases

3. T stage

TNM!

Breast Cancer Pathology

Greg Wolgamot, MD PhD

Jan 16, 2016