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Breast Pathology
Breast Pathology
16
Medical
Professional
02/11/2006

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Term
Fibroadenoma
Definition
--breast nodule
--in lobular stroma
--BENIGN
--smooth, firm,
Term
Acute mastitis
Definition
usually due to infants sucking on the nipple, causing cracking and making it prone to bacterial infection.
Term
Fibrocystic changes
Definition
BILATERAL! Most common cause of palpable brast mass in patients between the ages of 25-50. Risk of cancer is clear when hyperplastic epithelium demonstrates atypia.

nonproliferative breast changes (no increased risk of cancer)
cysts and fibrosis
apocrine metaplasia
adenosis

proliferative breast disease without atypia
epithelial hyperplasia
sclerosing adenosis
complex sclerosing lesion (radial scar)
papillomas

proliferative breast disease with atypia
atypical ductal hyperplasia (ADH)
atypical lobular hyperplasia (ALH)

characterized morphologically by
1. fibrosis of varying extent
2. cysts that are grossly visible or may be evident only on histologic exam; may be filled w/ fluid, which may appear blue when seen through the cyst wall (blue dome cyst)
3. epithelial changes-- lining of the epi may be flattened, may show apocrine metaplasia, or may be hyperplastic.
--hyperplastic epi may show varying degrees of cellular atypia: adenosis is the proliferation of small ducts and myoepithelial cells, when combined w/ fiboris is it called "sclerosing adenosis"
Term
Invasive Ductal Carcinoma
Definition
accounts for 70 to 80% of breast carcinomas
most often firm, irregular, tan mass on gross sectioning
tumors graded from well to moderate to poorly differentiated based on tubule formation, nuclear atypia, and mitotic rate
ER, PR, and HER2/neu status are important for prognosis and treatment
concurrent DCIS is frequently present with similar histologic features
Term
Invasive Lobular Carcinoma
Definition
may present as palpable mass or mammographic density, often subtle due to diffuse infiltrative pattern of growth
traditional thought to have greater incidence of bilaterality (this has been challenged)
histologic pattern of single infiltrative tumor cells “Indian filing”, sometimes forming concentric rings around benign ducts
small tumor cells with occasional intracytoplasmic (mucin positive) vacuoles giving a signet ring appearance; no tubule formations; e-cadherin negative
Term
Medullary Carcinoma
Definition
Cellular w/ scant stroma; soft, fleshy; lymphocytic infiltrate

clinically and radiographically well-circumscribed mass with pushing borders
soft, fleshy consistency due to lack of desmoplasia
solid, syncytial sheets of highly pleomorphic cells with frequent mitoses surrounded by a lymphoplasmocytic infiltrate
no lymphovascular space invasion, lymph node metastases are relatively infrequent
slightly better prognosis than invasive ductal carcinoma
Term
Mucinous Carcinoma
Definition
unusual variant which tends to be well-circumscribed and occurs in older women
grossly very soft mucoid consistency
histologically clusters of bland tumor cells within pools of extracellular mucin
most express estrogen and progesterone receptors
slightly better prognosis than invasive ductal carcinoma
Term
Tubular Carcinoma
Definition
accounts for only 2% of all breast carcinomas, but 10% of mammographically detected carcinomas less than 1 cm in diameter
often multifocal and may be bilateral
well formed tubules with angulated borders and absence of myoepithelial cells
may see cribriform spaces, apocrine snouting, and calcifications
well differentiated by definition, most express hormone receptors, lymph node metastases rare (<10%); excellent prognosis
Term
Fibroadenoma
Definition
most common benign tumor of the breast, more frequently seen before age 30
well-circumscribed, freely mobile mass or mammographic density
hormonally response (may enlarge during pregnancy, reduced size in postmenopause)
predominance of stroma (generally low cellularity and no cytologic atypia, mitoses rare) surrounding glandular and cystic epithelium
treatment is simple surgical excision
Term
Phyllodes Tumor
Definition
A large, bulky mass of variable malignancy w/ ulceration of overlying skin. It is characteized by cystic spaces containing leaf like projections from the cyst walls and myxoid contents.

most occur in older women (sixth decade)
usually palpable multinodular mass
“leaf-like” pattern grossly and microscopically due to nodules of proliferating cellular stroma covered by epithelium
low grade tumors have increased cellularity and mitoses; can recur locally
high grade tumors also demonstrate cytologic atypia, atypical mitoses, stromal overgrowth, and infiltrative borders; can recur locally and metastasize hematogenously (axillary lymph node dissection is not indicated)
wide resection margins are required
Term
Gynecomastia
Definition
benign enlargement of the male breast
may be unilateral or bilateral
indicator of hyperestrinism (cirrhosis, testicular tumors, exogenous steroid hormones, marijuana, Klinefelter Syndrome)
proliferation of the specialized intralobular stroma and associated ductal epithelium
treated by simple excision and addressing the underlying cause
Term
Carcinoma of the breast
Definition
--second most common malignancy of women (to the lung)
--mets to axillary lymph nodes, lung, liver, bone
--several histologic types
--demonstrates estrogen and progesterone receptors in some tumors but not in others...presence is correleated w/ a better prognosis.
--hyperexpression of HER2/neu is associated w/ a poorer prognosis.
--NOT predisposed by current regimens of oral contraceptive therapy
Term
Risks of Carcinoma of the Breast
Definition
Incidence increases with: increasing age, # of first degree relatives, BRCA1 or 2, hx of breast cancer, early menarche and late menopause, obesity (estrogen), nulliparity, first pregnancy after age 30, high animal fat diet
Term
Paget disease of the breast
Definition
Eczematoid lesion of the nipple or areola; neoplastic Paget cells, characteristic large cells surrounded by a clear halo like area, invade the epidermis; underlying ductal carcinoma almost always present.
Term
Intraductal carcinoma in situ
Definition
Tumor cells fill ducts; tumor cell necrosis results in a cheese like consistency
Term
Lobular carcinoma in situ
Definition
Clusters of neoplastic cells fill intralobular ductules and acini; may lead to invasive carcinoma in the same or in the contralateral breast; often bilateral at the time of the initial diagnosis
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