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dr. Aswiyanti Asri,M.Si.

Med,SpPA

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Fibroadenoma mammae
Tumor jinak, ok estrogen , 20-35 th
Diameter 3 10 cm, berkapsul semu, putih, ke
abu-abuan, nekrosis (-)
Soliter, multipel
Jenis : Perikanalikular, Intrakanalikular, both
Complex FAM
Mikroskopik : Jaringan ikat , sel epitel kelenjar
Fibroadenoma mammae peri et intrakanalikulare

perikanalikulare

intrakanalikulare
Fibrocystic disease

Akhir 20-an
Massa tidak berbatas tegas
Massa putih bersih
Duktus melebar kistik, stroma relatif men
ingkat, proliferasi sel epitel
Tanpa epithelial proliferation : risiko BC (-
)
Intraductal proliferative lesions

Usual Ductal Hyperplasia (UDH


)
Atypical Ductal Hyperplasia (AD
H)
Epithelial hyperplasia of usual type

1. Duct lumina are alm


ost completely filled
with proliferating epi
thelium
2. No cytologic atypia
present
Atypical Ductal Hyperplasia

Ducts are filled with


markedly atypical cell
s
Proliferative breast disease and
risk of Cancer
Atypical epithelial hyperplasia increases the risk by 4 - 5 t
imes.

Epithelial hyperplasia of usual type increase risk by 1.5 -2


times.

Positive family history doubles these risks


1 dari 9 wanita
0.5% pada laki-laki
Prognosis tergantung stadium
90% pada tumor terlokalisir, 77% bila disertai metas
tasis KGB
50-70 tahun
Peringkat pertama di Sumbar.
diet, faktor reproduktif, hormon, western lifestyle
BRCA1 dan BRCA2
Genetic Predisposition

Positive Family history


5-10% of cancers related to specific inherited ge
ne mutations
BRCA1 and BRCA2 gene mutations
Li Fraumeni syndrome germline mutation of T
P53
Cowden syndrome -germline mutation in PTE
N.
Carcinoma of Breast

Carcinoma in situ (15-30%)

Ductal carcinoma in situ


( including Pagets disease of the nipple)

Lobular carcinoma in situ


Ductal carcinoma in situ
Lobular carcinoma in situ

Neoplastic cells filling the acini are small and uniform


Pagets disease of nipple

Large cells in the epidermis represent cancer cells from underlying breast can
cer which can be in situ or invasive.
Invasive carcinoma of No Special
Type (NST)

Dulu : Invasive ductal carcinoma


Terbanyak
1 cm 10 cm
Tumor iregular, keras, pinggir tidak tegas
Tidak memenuhi kriteria mikroskopik subti
pe lainnya
Invasive carcinoma of NST
IDC/invasive NST vs ILC/invasive lobular Ca
Mucinous carcinoma mammae
Medullary Carcinoma mammae
NST dan karsinoma invasif lainnya.
Modified Elston & Ellis.
> 75%; 10-7
5%; <10%

Small, regular, uniform; Tergantung micr


Moderate; oscope field area
Marked variation (mm)
Carcinoma of breast : Prognostic factors

Lymph node status/ Size /Grade (NPI)


Histologic type
Hormone receptor status
Lymphovascular invasion
Proliferative rate/ DNA content
Oncogene expression eg HER2 NEU
Gene expression profiling
Prognostic markers
Estrogen Reseptor/ER Nuclear staining,
Proporsi : < 20% 20 - 50 % 50 - 80 % >
80%Intensitas : Kuat Sedang Lemah Intensitas :
bisa dibandingkan dengan kontrol eksternal atau kontrol
internal (Kontrol internal dari kelenjar payudara normal
pada slaid yang sama)

Progesteron Reseptor/PR Nuclear staining,


Proporsi : < 20% 20 - 50 % 50 - 80 % >
80%Intensitas : Kuat Sedang Lemah Intensitas :
bisa dibandingkan dengan kontrol eksternal atau kontrol
internal (Kontrol internal dari kelenjar payudara normal
pada slaid yang sama)

HER2/CerbB2 Membran cell staining> 0 : no staining atau < 10%+ 1 : >


10%, incomplete+ 2 : > 10% incomplete staining,
sedang/lemah; atau < 10% tapi complete+ 3 : > 10%,
complete, kuat
Ki-67 Nuclear staining< 20%> 20%

Topoisomerase Nuclear staining, Persentase sel yang terwarnai


HER2 : IHK
Her2 : FISH
Phylodes tumor
Malignant phylodes tumor
Pemeriksaan Patologi Anatomi
Breast Lesion
FNAB
FS/VC

Mastektomi Neoplasm/Non Ne
oplasm
Core
Biopsy
Biopsi
Eksisi
FNAB pada breast cancer
Modified radical mastectomy
Mastectomy and level 1
axilliary clearance

Dimensions
65 x 45 to 35mm

Weighing 210g

Ellipse of skin measuring


65 x 20 mm

Nipple-areola (normal) di
mensions
80 x 45mm

Level 1 axillary lymph no


des present

1. Orientation and description of specimen Suture indicates superior


1. Orientation
A. KONFIRMASI GANAS/TID
AK
B. MARGIN TUMOR
GENE EXPRESSION PROFILE :
-genetic classification-
5 distinct patterns of gene expression which define intrinsic molecular subtypes
1. Luminal A low grade, ER + high level
2. Luminal B high grade, ER + low level, (some HER2+)
3. Basal type high grade, ER-, HER2 -, CK5/6,14 and 17+, EGFR+ TNBC (tri
ple negative breast cancer)
4. HER2 + type HER2+, ER -
5. (Normal Breast type)

Perou, Sorlie 2000, 2001


CLINICO - PATHOLOGY
TNBC NON TNBC
(N=165) (N=478)
AGE 5TH DECADE 5TH DECADE
SIZE LARGER SMALLER
HISTO GRADE HIGHER LOWER

METASTASIS/RECURRENCE HIGHER LOWER

LN POS LOWER HIGHER


VASC - INV LOWER HIGHER
Thank You