lab - breast pathology (1)

7/23/2019 Lab - Breast Pathology (1)

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Breast pathology

Purulent mastitis (701)

in the beginning of lactation (M.puerperalis)

favor fill of milk and small injury of

nipple

caused by streptococcus andstaphylococcus

It is purulent inflammation and without

antibiotics therapy causing growth anabscess of the breast. Surgical

intervention is needed.

Micro: inflammatory infiltrate. actation

Interlobular septa(typical of lactating

mammary gland)

!lveoli dilated with milk


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Fibrocystic change (4)

the most common benign changes in the

breast

the most common cause of non"

cancerous breast lumps in women # is

not a risk factor for breast cancer

usually related to hormonal fluctuations.

Most fre$uently in premenopausal

women (ages %& to '&)

more than '& of women have

fibrocystic breast symptoms at some

point in their lives.

Signs: lumpiness tenderness cystsareas of thickening fibrosis breast pain

*strogens stimulate proliferation of

connective tissue with the developmentof fibrosis

fibrosis causes obstruction of ductulesthat gradually dilate and become cysticas a result of persistent cyclic epithelial

secretion

grossly the specimen or breast tissuecontains several small randomly

distributed blue"domed or clear cysts.

fibrocystic changes: cysts apocrine

metaplasia (cells resemble apocrinesweat glands) (characteristic for

fibrocystic change) fibrosis adenosis

calcification chronic inflammation

Microscopically:

cystically dilated round to oval spaces

lined by slightly attenuated epithelialand myoepithelial cell layers

stroma between lobules are fre$uently

sclerotic

smaller cysts coalesce form large cysts

lined by attenuated epithelial and

myoepithelial cells

metaplastic aporcrine cells may bepresent

when cysts rupture an inflammatory

response results and subse$uentreparative changes causes additional

fibrosis

Metaplastic apocrine cells (granular

eosinophilic cytoplasm and round nuclei)


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Fibroadenoma (704)

the most common breast tumor in

women under +' years

benign

characteri,ed by proliferation of both

glandular and stromal elements

solid firm smooth movable and usuallypainless or only slightly tender slow

growing

-rossly: less than + cm round or ovoid

elastic nodular smooth surface sharply

demarcated

cut surface homogeneous and firm

grey"white or tan

micro: proliferation forms duct"like

spaces surrounded by fibroblasticstroma. roliferating epithelium appearsnormal

fibroadenomas may be sub"classified

into + types:

intracanalicular show predominant

stromal proliferation that compresses

ducts which are irregular andreduced to slits

pericanalicular : fibrous stromal

proliferation around ductal spacesthat allows the duct spaces remain

round or oval

mi/ed

proliferation of intralobular stroma

distorts the epithelium.


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Phyllodes tumor (705)

phyllodes is -reek for 0leaflike1

very rare breast tumor

arise from intralobular stroma (like

fibroadenoma)

usually age 2&

typically large fast growing. 3orm fromperiductal stromal cells of breast in adult

women

fibroepithelial tumor composed ofepithelial and cellular stromal

component

symptoms: rapid but painless growth of

smooth bulky mass within affected

breast.

If malignant usually the stromalelement. (check for atypia in stroma)

can be benign borderline or malignant.

4igh cellularity


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Paget's disease of the breast (70)

combination of scaly skin changes of

nipple resembling ec,ema andunderlying cancer of the breast. 5ipple

is inflamed because of presence of

aget6s cells

most often in women over '& most women with aget6s disease of the

breast have underlying infiltrating ductalbreast cancer

5ipple and areola are typically red

inflamed and itchy. May be crusting

bleeding or ulceration. 5ipple may beinverted.

Micro: characteristic large cellssurrounded by clear halo"like area

invade the epidermis7 underlying ductalcarcinoma almost always present.

Inflammatory infiltrate underepidermis

aget8s cells


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Breast cancers

second most common type of cancer after lung cancer often in the upper outer $uadrant. eft breast more often affected

9 different classification schemes each based on different criteria and serving different purpose:

pathology # almost always adenocarcinoma most common types are ductal and lobular

grade of tumor # determined by using the loom";ichardson grade system

based on + elements: gland formation polymorphism mitotic figures

rotein < gene status # cancers are tested for e/pression or detectable effect of the estrogen

receptor (*;) progesterone receptor (;) and 4*;%=neu proteins. >he profile of e/pression of

tumor helps predict its prognosis and helps an oncologist choose the most appropriate treatment.

?omedocarcinoma # reinvasive necrotic center surrounded by solid sheets of pleomorphic cells

with high"grade hyperchromatic nuclei Main risk factors:

se/ increasing age family history proliferative breast disease

hormonal factors: early menstruation late menopause late or few pregnancies long term

estrogen therapy (oral contraceptive pill or hormone replacement therapy (4*;>))

high fat diet obesity

others: environment factors # e/posure to radiation

3actors for predictive of outcome:

si,e of tumor and stage

surgical margins

involvement of lymph nodes

sentinel node

hormone receptor status = 4*;% levels

metastasis

>riple test includes:

e/amination of the breast

imaging of the breast through mammography or ultrasound

sampling of the breast tissue with fine needle aspiration (35!) core biopsy or open biopsy

aget8s cells


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!n"asi"e ductal carcinoma (70#)

most common type (@&"A&)

cancer cells resemble the ducts of thebreast

developing in the milk ducts of breast

but breaks out of the duct tubes and

invades or infiltrates surroundingtissues.

0scirrhous1 carcinomas with cells often

arrange in nests or cords or streams in avery desmoplastic stroma

Micro: tumor cells arranged in cordsisland and glands embedded in a dense

fibrosis stroma

Many ducts


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!n"asi"e lobular carcinoma (707)

%ndmost common type of breast cancer

('"B&)

often multifocal within a breast (small

nests) and are often bilateral

micro: strands of small tumor cellse/hibit low cohesion and forms Indian

files. >he strands of tumor cells arearranged concentrically around normal

ducts. >his has been know as targetoid

arrangement

?haracteristic features:

tumor cells are small

polymorphism is slight

intercellular cohesion is reduced

tumor cells arranged in Indian files targetoid arranged of tumor cells

around normal ducts

?ancer cells arranged in lines (Indian file)

lab - breast pathology (1)

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