BREAST

FIBROCYSTIC CHANGES
NON PROLIFERATIVE
Cysts and fibrosis

PROLIFERATIVE
Innocuous/atypical ductular epithelial cell hyperplasia
Sclerosing adenosis

CYSTS AND FIBROSIS

Dilation of ducts + formation of cysts + increase in fibrous stroma
Morphology
Ill defined 1-5 cm diameter
Discrete nodularity
Microcalcification
Lining columnar, cuboidal cells
Apocrine metaplasia polygonal eosinophilic cells with granular cytoplasm
Stroma fibrous
Inflammatory infiltrate may be present

EPITHELIAL HYPERPLASIA
Mild and orderly
Ducts filled by orderly cuboidal cells and small glandular pattern within
Ductal papillomatosis
Atypical lobular hyperplasia
Monomorph8ic cells with complex architectural patterns
Dosent often produce discrete breast mass. But produce microcalcifications

SCLEROSING ADENOSIS
Gross
Hard rubbery similar to ca breast
Microscopy
Proliferation of lining epithelial cells and myoepithelial cells in small ducts
Glandular pattern within fibrous stroma
Stromal fibrosis
Can resemble invasive scirrhous ca breast

TUMORS
BENIGN
TUMOR
CAUSE
FIBROADENOMA Increased

PHYLLODES
TUMOR

INTRADUCTAL
PAPILLOMA

MORPHOLOGY

Gross
estrogen
Firm, freely movable
level
nodule(1-10 cm)
White on cut section with
yellow specs of glandular area
Micro
Loose fibroblastic stroma with
duct like epithelial lined specs
Pericanalicular- open duct
space
Intracanalicular- slit like duct
space
Periductal
Gross
stroma
Large
proliferation Leaf like clefts and slits on
section due to lobulation and
cysts
Increased stromal cellularity,
anaplasia and mitotic activity
Principal
Small, solitary
lactiferous
Multiple papillaeducts/sinuses
Central connective tissue
Cuboidal or columnar cell
lining
Frequently double layered
epith,
basal layermyoepithelial

C/F
Monoclonal
cells
Never become
malignant

Benign
Localized and
cured by
excision
Most
malignant may
metastasise
Benign
Multiple
papillomas in
several ducts
and absence of
myoepithelium
indicates
malignancy

CARCINOMA
CAUSES
Hormone replacement therapy for osteoporosis
OCPs
Ionizing radiations
Genetic
HER2/NEU
RAS, MYC amplification
RB, p53 mutation
5 subtypes based on gene profiling
Luminal A
Luminal B
HER2/NEU overexpressing
Basal like
Normal breast like

CLASSIFICATION
Non invasive
DCIS
LCIS
Invasive
IDC (Scirrous tumor)
ILC
Medullary carcinoma
Colloid carcinoma
Tubular carcinoma
Other types

- estrogen receptor positive

- estrogen receptor positive
- estrogen receptor negative
- estrogen receptor and HER2/NEU negative

NON INVASIVE
DCIS
Terminal duct lobular unit
Origin
Fill distort, unfold lobules involved and
Gross
Histology

appear to involve duct like spaces

Wide variety of appearance
Solid, comedo, cribriform, papillary,
micropapillary, clinging
Low and high

Nuclear
grade
Hormone Positive
receptors
Prognosis Excellent

Treatment Simple mastectomy

Antiestrogenic therapy, tamoxifilin

Aromatase inhibitors

C/F

Palapable mass or nipple discharge

LCIS
Terminal duct lobular unit
Expand, but dosent alter the
underlying str
Uniform
Loosely cohesive clusters
Signet ring cells
Low
----High chance for invasive
carcinoma and developing
in both breasts
Clinical and radiological
follow up
Bilateral prophylactic
mastectomy
Often incidential finding
No masses or calcification

PAGETS DISEASE
Extension of DCIS to lactiferous ducts and contiguous skin around nipple
Disrupt epidermal barrier
Unilateral crusting

INVASIVE CARCINOMA
TYPE
MORPHOLOGY
Gross
DUCTAL

Produce desmoplastic
response
Microscopy
Heterogeneous

LOBULAR

Gross
Bilateral and multicentric
more frequently than others
Microscopy
Cells identical to LCIS
Allined in strands or chains
Bulls eye pattern occationally

PROGNOSIS RECEPTORS
Vary according
to type. But
generally poor

2/3 have
hormone
receptors
1/3 have
HER2/NEU

Metastasise
Hormone
more frequently receptors
to CSF, ovary,
serosa, uterus,
GIT, BM

COMMON FEATURES
1)Tendency to become adherent to pectoral fascia, muscles and skin
2) Dimpling of skin,
3) lymphedema

SPREAD
Lymphatic and hematogenous
Metastasis mainly to lungs, skeleton, adrenals, liver and less commonly to brain and
pituitary

COURSE
Solitary, movable painless mass
2-3 cm when palpable and 1 cm when just detectable by mammography

PROGNOSIS
TNM
Grade well differentiated, moderate differentiated, poorly differentiated based on
Tubule formation
Nuclear grade
Mitotic rate
Histology
Presence of hormone receptors is a slightly better prognosis
Proliferation rate
Aneuploidy
Overexpression of HER2NEU is bad prognosis

STAGING

STAGE 1
STAGE 2
STAGE 3

STAGE 4

Invasive carcinoma <=2 cm without nodes

Carcinoma insitu with micro invasion
Invasive carcinoma <=5 cm with 3 axillary lymph nodes
>5 cm without lymph nodes
Invasive carcinoma <=5 cm with >4 lymph nodes
Invasive carcinoma >5 cm with nodal involvement
Invasive carcinoma of any size with > 10 nodes
Invasive carcinoma of any size with ipsilater IMN involvement
Invasive carcinoma of any size with skin involvement
Inflammatory carcinoma
Distant metastasis

87%
75%
46%

13%