Breast pathology

Purulent mastitis (701)

in the beginning of lactation (M.
puerperalis)
favor fill of milk and small injury of
nipple
caused by streptococcus and
staphylococcus
It is purulent inflammation and without
antibiotics therapy causing growth an
abscess of the breast. Surgical
intervention is needed.
Micro: inflammatory infiltrate. Lactation

Interlobular septa
(typical of lactating
mammary gland)
Alveoli dilated with milk

Fibrocystic change (4)

the most common benign changes in the
breast
the most common cause of noncancerous breast lumps in women is
not a risk factor for breast cancer
usually related to hormonal fluctuations.
Most frequently in premenopausal
women (ages 20 to 50)
more than 50% of women have
fibrocystic breast symptoms at some
point in their lives.
Signs: lumpiness, tenderness, cysts,
areas of thickening, fibrosis, breast pain
Estrogens stimulate proliferation of
connective tissue with the development
of fibrosis
fibrosis causes obstruction of ductules
that gradually dilate and become cystic
as a result of persistent cyclic epithelial
secretion
grossly, the specimen or breast tissue
contains several small, randomly
distributed blue-domed or clear cysts.
fibrocystic changes: cysts, apocrine
metaplasia (cells resemble apocrine
sweat glands) (characteristic for
fibrocystic change), fibrosis, adenosis,
calcification, chronic inflammation
Metaplastic apocrine cells (granular,
eosinophilic cytoplasm and round nuclei)
Microscopically:
cystically dilated round to oval spaces
lined by slightly attenuated epithelial
and myoepithelial cell layers
stroma between lobules are frequently
sclerotic
smaller cysts coalesce, form large cysts
lined by attenuated epithelial and
myoepithelial cells
metaplastic aporcrine cells may be
present
when cysts rupture, an inflammatory
response results and subsequent
reparative changes causes additional
fibrosis

Fibroadenoma (704)
the most common breast tumor in
women under 35 years
benign
characterized by proliferation of both
glandular and stromal elements
solid, firm, smooth, movable and usually
painless or only slightly tender, slow
growing
Grossly: less than 3 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 fibroblastic
stroma. Proliferating epithelium appears
normal

fibroadenomas may be sub-classified

into 3 types:
intracanalicular show predominant
stromal proliferation that compresses
ducts, which are irregular and
reduced to slits
pericanalicular : fibrous stromal
proliferation around ductal spaces
that allows the duct spaces remain
round or oval
mixed
proliferation of intralobular stroma
distorts the epithelium.

Phyllodes tumor (705)

phyllodes is Greek for leaflike
very rare breast tumor
arise from intralobular stroma (like
fibroadenoma)
usually age 60
typically large, fast growing. Form from
periductal stromal cells of breast in adult
women
fibroepithelial tumor composed of
epithelial and cellular stromal
component
symptoms: rapid but painless growth of
smooth, bulky mass within affected
breast.
If malignant, usually the stromal
element. (check for atypia in stroma)
can be benign, borderline, or malignant.

High cellularity

Paget's disease of the breast (709)

combination of scaly skin changes of
nipple resembling eczema and
underlying cancer of the breast. Nipple
is inflamed because of presence of
Paget's cells
most often in women over 50
most women with Paget's disease of the
breast have underlying infiltrating ductal
breast cancer
Nipple and areola are typically red,
inflamed, and itchy. May be crusting,
bleeding, or ulceration. Nipple may be
inverted.
Micro: characteristic large cells
surrounded by clear halo-like area,
invade the epidermis; underlying ductal
carcinoma almost always present.
Inflammatory infiltrate under
epidermis

Pagets cells

Pagets cells

Breast cancers
second most common type of cancer after lung cancer
often in the upper outer quadrant. Left breast more often affected
4 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 Bloom-Richardson grade system
based on 3 elements: gland formation, polymorphism, mitotic figures
Protein & gene status cancers are tested for expression, or detectable effect, of the estrogen
receptor (ER), progesterone receptor (PR) and HER2/neu proteins. The profile of expression of
tumor helps predict its prognosis and helps an oncologist choose the most appropriate treatment.
Comedocarcinoma Preinvasive, necrotic center surrounded by solid sheets of pleomorphic cells
with high-grade hyperchromatic nuclei
Main risk factors:
sex, 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 (HERT))
high fat diet, obesity
others: environment factors exposure to radiation
Factors for predictive of outcome:
size of tumor and stage
surgical margins
involvement of lymph nodes
sentinel node
hormone receptor status / HER2 levels
metastasis
Triple test includes:
examination of the breast
imaging of the breast through mammography or ultrasound
sampling of the breast tissue with fine needle aspiration (FNA), core biopsy or open biopsy

Invasive ductal carcinoma (706)

most common type (70-80%)
cancer cells resemble the ducts of the
breast
developing in the milk ducts of breast,
but breaks out of the duct tubes, and
invades or infiltrates surrounding
tissues.
scirrhous carcinomas with cells often
arrange in nests or cords or streams in a
very desmoplastic stroma
Micro: tumor cells arranged in cords,
island and glands embedded in a dense
fibrosis stroma

Many ducts

Invasive lobular carcinoma (707)

2nd most common type of breast cancer
(5-10%)
often multifocal within a breast (small
nests), and are often bilateral
micro: strands of small tumor cells
exhibit low cohesion and forms Indian
files. The strands of tumor cells are
arranged concentrically around normal
ducts. This has been know as targetoid
arrangement
Characteristic 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

Cancer cells arranged in lines (Indian file)