Breast - Pathology - Lecture Slides, Slides for Pathology. Alagappa University

Pathology

Description: Breast, Lactiferous Ducts, Three Normal Phases, Stroma Ratio, Breast Pathology, Milkline Remnants, Accessory Breast Tissue, Nipple Inversion, Malignant Epithelial. A lecture from Pathology course to teach you a topic. Key points are given above.
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BREAST

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HISTOLOGY LOBE: (10 in whole breast) LOBULE: (many per lobe) ACINUS/I, aka ALVEOLUS/I: (many

per lobule) DUCT(S): INTRA- or INTER-

LOB(UL)AR, leading to the lactiferous ducts in the nipple

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THREE NORMAL PHASES

ACTIVE: about 50-50 Gland/Stroma ratio

LACTATING: Mostly Glands (like thyroid!!!), >>>50/50

ATROPHIC: mostly stroma, <<<50/50

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The most important thing to understand breast pathology is to get a solid IMAGE of the “NORMAL” breast lobule----ACINI, STROMA, BOUNDARIES

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BREAST PATHOLOGY

DEVELOPMENTAL: DEGENERATION: INFLAMMATION:

NEOPLASM: Docsity.com

DEVELOPMENTAL MILKLINE REMNANTS ACCESSORY (axillary) BREAST

TISSUE NIPPLE INVERSION MACROMASTIA

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DEGENERATION ATROPHY

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INFLAMMATION ACUTE, staph most common PERIDUCTAL DUCT-ECTASIA FAT NECROSIS, usually trauma LYMPHOCYTIC, i.e., diabetic GRANULOMATOUS, sarcoid, TB, etc.,

but mostly idiopathic Docsity.com

NEOPLASIA Benign epithelial Benign stromal Premalignant Malignant epithelial (ductal, lobular)

(adenocarcinomas) (in-situ, infiltrating)

Malignant stromal Docsity.com

CLINICAL PRESENTATIONS

MASS, palpable or mammographic

NIPPLE DISCHARGE PAIN

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NEOPLASIA BENIGN EPITHELIAL, aka, “FIBROCYSTIC”

disease NON-proliferative epithelium: i.e., cysts,

fibrosis, adenosis

PROLIFERATIVE epithelium: hyperplasia, sclerosing adenosis, papilloma, fibroadenoma

ATYPICAL epithelium

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NEOPLASIA BENIGN EPITHELIAL, aka, “FIBROCYSTIC”

disease NON-proliferative epithelium: i.e., cysts,

fibrosis, adenosis

PROLIFERATIVE epithelium: hyperplasia, sclerosing adenosis, papilloma, fibroadenoma

ATYPICAL epithelium

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NEOPLASIA BENIGN EPITHELIAL, aka, “FIBROCYSTIC”

disease NON-proliferative epithelium: i.e., cysts,

fibrosis, adenosis

PROLIFERATIVE epithelium: hyperplasia, sclerosing adenosis, papilloma, fibroadenoma

ATYPICAL epithelium

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FEATURES OF “ATYPIA” LOSS OF STROMA BETWEEN ACINI “SWISS CHEESE” HYPERPLASIA* CRIBRIFORMING** CELLULAR PLEOMORPHISM CELLULAR HYPERCHROMASIA INCREASED/ABNORMAL MITOSES* “ROMAN” BRIDGES*** NECROSIS*** (“COMEDO-carcinoma”)

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LCIS Usually hangs around MANY MANY years

before it infiltrates, in contrast to DCIS The BEST management may be judicious

neglect, i.e., observation If it does infiltrate, however, it is at least as

bad as DCIS infiltrating, or probably WORSE, showing “indian” files

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BREAST CANCER RISK FACTORS

Age Menarche Age, early menarche is a risk First Live BirthFirst-Degree Relatives with Breast CancerBreast BiopsiesRace (caucasian the highest) Estrogen Exposure, prolonged, early menarche, late menopauseRadiation ExposureCarcinoma of the contralateral breast or endometriumGeographic InfluenceDiet (high fat diet is riskiest) ObesityExerciseLack of breast feeding is a risk, Lack of prior pregnancy is a risk.Environmental ToxinsTobaccoABORTIONS?

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BREAST CANCER PROGNOSTIC FACTORS

STAGING, especially POS or NEG lymph nodes, TNM, etc.

AGE GENERAL HEALTH and IMMUNITYHistologic degree of differentiation, i.e., GRADINGERA/(PRA) Her2, aka Her2-Neu

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STAGING, TNM, based on biologic behavior

IN-SITU EARLY disruption of the basal lamina, i.e., basement

membrane STROMAL infiltration LYMPHATIC vessels SENTINAL lymph node metastasis MORE lymph node metastases Adjacent structures, skin, ie, “inflammatory” DISTANT, METASTASES, LIVER, BONE, LUNGS, BRAIN,

EVERYWHERE Docsity.com

Total Cancers

Per Cent

In Situ Carcinoma * 15–30 Ductal carcinoma in situ, DCIS 80

Lobular carcinoma in situ, LCIS 20

Invasive Carcinoma 70–85 No special type carcinoma ("ductal") 79

Lobular carcinoma 10

Tubular/cribriform carcinoma (Better prognosis than average)

6

Mucinous (colloid) carcinoma (Better prognosis than average)

2

Medullary carcinoma (Better prognosis than average) 2

Papillary carcinoma 1

Metaplastic carcinoma, (Squamous)

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HISTOLOGIC TIDBITS INFILTRATING DUCTAL INFILTRATING LOBULAR (INDIAN FILE) TUBULAR (LOOKS LIKE SCLEROSIS, BUT NO

BASEMENT MEMBRANE) MUCINOUS (COLLOID) MEDULLARY (LOTS of LYMPHOCYTES)

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NEOPLASIA, STROMAL

Cysto-”SARCOMA” PHYLLODES (aka, PHYLLODES TUMOR), Looks like a

giant fibroadenoma, really NOT a sarcoma

SARCOMAS, true, are RARE!!!! Docsity.com

MALE BREAST GYNECOMASTIA (related to hyperestrogenism)

CARCINOMA (1% of ♀ )

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