The breast diseases

1. The breast diseases • Proliferative breast diseases • Benign tumors • Breast carcinoma

5. There is a larger duct to the right and lobules to the left.

6.  Proliferative breast diseases Some benign diseases are associated with a risk of developing invasive carcinoma. ( e.g. epithelial hyperplasia, sclerosing adenosis, small duct papillomas) Epithelial hyperplasia The lesions are in the duct lumen. various degrees of atypical hyperplasia may be present. 1. adenosis 2..atypical ductal hyperplasia: the lesions resemble ductal carcinoma in situ but are limited in extent. The cells fail to completely fill ductal space. 2.atypical lobular hyperplasia: the lesions resemble those of lobular carcinoma in situ but do not distend more than 50 % of the acini within a lobule. • Both atypical ductal hyperplasia and atypical lobular hyperplasia are associated with a risk of developing invasive carcinoma.

7. Normal lobular

8. A duble-layered cuboidal epithelium is demonstrated in the fibroadenosis

9. This is the gross appearance of fibrocystic changes in the breast. This is the histologic appearance of fibrocystic changes in breast

10. Prominent sclerosing adenosis is demonstrated by the appearance of proliferation of small ducts in a fibrous stroma. Although it is benign, the gross and mammographic appearance may mimic carcinoma .

11. Adenosis: the number of acini is increased. The lobular arrangement is maintained

13. These breast ducts demonstrate epithelial hyperplasia. The epithelial cells are multilayered. There is no atypia.

14. Atypical epithelial hyperplasia of the breast is shown here. There is a slightly increased risk for breast carcinoma when such changes are present.

15. This mammogram demonstrates a suspicious area with microcalcifications that could be a carcinoma or just an area of fibrocystic changes On biopsy, this lesion had areas of fibrocystic changes with epithelial hyperplasia.

16. Atypical hyperplasia. The lumen is filled with atypical ductal epithelial cells.

19. A small benign intraductal papilloma appears here in a breast duct. An intraductal papilloma may be associated with a serous or bloody nipple discharge

20. Intraductal papilloma are composed of mutiple branching papillae.

21. Intraductal papilloma.

22. Tumors • Fibroadenoa • Carcinoma • Fibroadenoma Fibroadenoma are the commonest type of benign tumour of the breast, and are the commonest primary tumor in younger age groups (the greatest incidence is in the third decade). The tumor mass is well-circumscribed with a lobulated appearance, and range in size from 10-100mm in diameter. ( larger tumors can accur in juvenile) Tumor is composed of both fibrous and glandlar tissue.

23. This is a fibroadenoma. The mass is well-circumscribed.

24. The neoplasm itself is composed of a fibroblastic stroma in which are located elongated compressed ducts lined by benign appearing epithelium

25. Here is the microscopic appearance of a fibroadenoma. To the right is compressed breast connective tissue forming a "capsule" to this mass.

26. Carcinoma of the breast • Incidence : ~ increases with age form 1 in 232 in the fourth decade to 1 in 29 in the seventh decade. • Risk factors: female sex; risk increases with age obesity and high- fat diet family history of breast cancer and genetic factors geographic factors radiation atypical hyperplasia in previous breast biosy

27. Histologic types of breast cancer In situ carcinoma(15-30%) ductal carcinoma in situ (80%) lobular carcinoma in situ (20%) Invasive carcinoma (70-85%) ductal carinoma (80-85%) lobular carcinoma (10%) tubular/cribrifore carcinoma (2%) colloid (mucinous) carcinoma (2%) medullary carcinoma (<1%) papillary carcinoma (<1%) others (<1%)

28. This high power microscopic view demonstrates intraductal carcinoma. Neoplastic cells are still within the ductules and have not broken through into the stroma.

29. The classic cribriform pattern of intraductal carcinoma of the breast is shown here. The neoplastic epithelial cells within the duct show minimal hyperchromatism and pleomorphism

30. The gross appearance of a comedocarcinoma pattern of intraductal carcinomas seen here, with small, yellow central necrotic areas in the ducts.

31. Here is a comedocarcinoma pattern of intraductal carcinoma. Note the prominent central necrosis in the ducts.

32. The cells in the center of the ducts with comedocarcinoma are often necrotic and calcify and would show on a mammogram. The basement membrane is intact.

33. Both intraductal and infiltrating ductal carcinoma are seen here. Note the intraductal component in the center with cribriform pattern and prominent microcalcifications. Surrounding this are infiltrating carcinoma cells.

34. Paget's disease of the breast is shown here. the rough, red, scaling appearance seen grossly, and there is often ulceration.

35. Paget's disease of the breast . The large cells infiltrating into the epidermis represent intraepithelial extension of an underlying ductal carcinoma in situ (or invasive).

36. the large Paget's cells of Paget's disease of breast have abundant clear cytoplasm A PAS stain demonstrates mucin within the Paget's cells. This is evidence for their origin from an underlying ductal carcinoma

37. Here is an example of a large 4 cm mass with irregular margins seen on mammography. This proved to be an infiltrating ductal carcinoma of the breast.

38. The irregular mass lesion seen here is an infiltrating ductal carcinoma of breast. The center is very firm (scirrhous) and white because of the desmoplasia

39. A mastectomy specimen Involvement of dermal lymphatics gives the grossly thickened, erythematous, and rough skin surface with the appearance of an orange peel.

40. This infiltrating ductal carcinoma of breast appears to radiate from a central area of desmoplasia.This collagenous component gives the neoplasm a hard "scirrhous" consistency that is palpable.

41. Note the small nests and infiltrating strands of neoplastic cells with prominent bands of collagen between them in this ductal carcinoma of the breast

42. However, this ductal carcinoma is not confined to just the duct, but infiltrates outward into the surrounding stroma as an infiltrating ductal carcinoma.

43. the pleomorphism of the carcinoma cells within the duct in the center, as well as the neoplastic cells infiltrating through the stroma and fat.

44. Invasive lobular carcinoma of the breast is shown here. This neoplasm arises in the terminal ductules of the breast

45. At high magnification, the characteristic strands of infiltrating lobular carcinoma cells are seen in the fibrous stroma. Cells arranged as a parallel lines. Pleomorphism is not great.

47. Medullary carcinoma: sheets and nests of cells are surrounded by a lymphoid stroma with little desmoplasia.The prognosis with medullary carcinoma is better than for infiltrating ductal or lobular carcinoma.

49. This variant of breast cancer is known as colloid, or mucinous, carcinoma. Note the abundant bluish mucin. The carcinoma cells appear to be floating in the mucin. This variant is slower growing, and the prognosis is better than for non-mucinous, invasive carcinomas.