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Tumors of the breast Course and slide seminar

Tumors of the breast Course and slide seminar. Zdeněk K I N K O R Bioptická laboratoř s.r.o. PLZEŇ 2006. Intraductal papillary lesions of the breast. Intraductal papillary lesions of the breast. actin. 3D studies. papilloma. papilom.

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Tumors of the breast Course and slide seminar

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  1. Tumors of the breast Course and slide seminar Zdeněk K I N K O R Bioptická laboratoř s.r.o. PLZEŇ 2006

  2. Intraductal papillary lesions of the breast

  3. Intraductal papillary lesions of the breast actin

  4. 3D studies papilloma papilom papillocarcinoma

  5. Intraductal papillary lesions • Intraductal papilloma • Atypical papilloma / DCIS arising in papilloma ? • Intraductal papillary carcinoma micropapillary DCIS - is not papillary per se micropapillary IDC - is not papillary per se radiology / macroscopy is not helpfull in discrimination of benign from malignant lesion ________________________________ ________________________________

  6. Intraductal papilloma 1. Central (solitary) - large ducts 2. Peripheral (multiple papillomatosis) - TDLU ____________________________________ • benign, complete myoepitelial rim - globoid cells ! • necrosis, apocrine / squamous metaplasia, hyperplasia, sclerosis, pseudoinvasion! • peripheral - more often associated with ADH resp. DCIS (sampling?) • CNB - controversial - excision vs. watch and wait ? • variants - adenomyoepithelioma, mixed tumor, ductal adenoma nipple adenoma

  7. Intraductal papillary carcinoma 1. Central (intracystic, solitary) 2. Diffuse (multiple) - papillary DCIS __________________________________________ • 0,5 - 2 % of all breast carcinomas, in situ lesion ! • myoepithelial layer absent; papillary, cribriform, solid • pseudoinvasion, „epithelial displacement“ by CNB • CNB - excision ! - adjacentDCIS / IDC ≤ 50 % - margin ! • excellent prognosis - axillary/sentinel LN is not necessary • invasive component - usually nonpapillary G1 IDC

  8. Atypical papilloma(ADH / DCIS in papilloma) • controversial - rare, definition, interpretation (CK 5/6) • more often in peripheral papilloma, CNB - excision ! • structural a cytologic atypia - kvantitative criteria ? - confined to papilloma - atypical papilloma (AP) - adjacent ducts - analogous to ADH vs. DCIS • AP is not ! - problem papiloma vs. papillary carcinoma - florid ductal hyperplasia in papilloma • recurrences (DCIS, IDC) were found only in cases, where „atypia“ extended into surrounding ducts outside of original AP

  9. papillary carcinoma papiloma malignant (in situ !) benign atypical papiloma carcinoma (DCIS) in papilloma

  10. Take home message • central, solitary lesions are more indolent than peripheral and multiple • papilloma in CNB - excision required any time ?! - radiology • AP is rare; papillary carcinoma arises de novo • intraductal (intracystic) papillary carcinoma - in situ lesion does not metastasize ! • prognosis (biology?) of papillary lesion is determined mainly by findings in surrounding ducts • conservative approach (even at invasion) - margin ! (SLN?)

  11. …let´s move to the scope

  12. Breast on Earth Let´s have a rest

  13. …even cancer cells are miracle of the nature…

  14. Low-grade adenosquamous carcinoma actin Cam 5.2

  15. Low-grade adenosquamous carcinoma • Rosen - 11 cases (AJSP, 1987); 50 cases in total • recurrent, rarely metastasizing lesions - two cases described • bland-looking → mimic benignancy - RSL, nipple syringoma, FT,.. • biphasic lesion - both components are tumorous ! 1)epithelial - oval/curved glandular structures display variable luminal squamous differentiation (distinct imunophenotype) - one/two flat layers of cells lacking overt atypia - absent myoepithelial rim? 2) mesenchymal - mostly hypocellular, collagenous fibrous stroma - heterologous differentiation - extremely rare

  16. LGASC - differential diagnosis • radial scar - CD34+ desmoplastic stroma with central elastosis - complex ductal epithelial proliferation, calcification - intact myoepithelial layer - origin of LGASK in radial scar ? (Gobbi et al.) • phylloid tumor- benign epithelial component, myoepithelial rim - CD34/CD10/CD117+ stromal projection in cystic epithelial spaces, squamous diff. rare - structural heterogeneous; „stromal overgrowth“ • nipple syringoma / microcystic adnexal carcinoma - benign and malignant adnexal skin lesions, not related to glandular breast tissue, different nonneoplastic stroma

  17. The natural beauty of the Silicon valley ( have you ever been there ?! )

  18. Wherever I go the „breast topic“ attracts me…

  19. Wherever I go the „breast topic“ attacs me…

  20. female, 81-year-old

  21. Benign spindle cell stromal tumors of the breast desmin

  22. Benign spindle cell stromal tumors of the breast • heterogeneous group of lesions with functional variability and combination of morpho- and immunophenotype 1)spindle/oval cells, storiform or hemangiopericytoma- like pattern, lipo-, chondro-, osteometaplasia, „floret-like“ cells., nc. palisading, myxoid change, collagen ropes,… 2)CD34, bcl2, CD99, actin, desmin, ER, PR, AR • common precursor - vim+/CD34+ stromal cell • hybrid a NOS features - genetics? (spindle cell lipoma,..)

  23. Benign spindle cell stromal tumors of the breast vim+/CD34+ stromal cell myofibroblastoma leiomyoma myofibroblastic plasticity of morfofology a immunofenotype (CD34, bcl2, CD99, actin,desmin, ER, PR, AR) spindle cell lipoma-like tumor fibroblastic solitáry fibrous tumor fibrohistiocytic spindle cell tumor NOS fibrous histiocytoma mixed combinations of…

  24. Benign fibromatosis nodular fasciitis schwannoma, neurofibroma perineurioma inflammatory pseudotumor Malignant metaplastic carcinoma malignant myoepithelioma ? MPNST synovial sarcoma myofibroblastic sarcoma leiomyosarcoma BSST - differential diagnosis

  25. Future or the past , the breast will never stop to interest the mankind

  26. 30-year-old female

  27. Angiomatosis of the breast Actin S

  28. Hemangioma of the breast AVL ?

  29. Low-grade angiosarcoma of the breast

  30. High-grade angiosarcoma of the breast

  31. Benign vascular lesions of the breast • perilobular hemangioma - microscopic lesion ( mm sized ) - the only one that invades in TDLU ! • hemangioma - capillary, cavernous, complex,.. • angiomatosis • subcutaneous nonparenchymal hemangioma

  32. Benign vascular lesions of the breast • well circumscribed, < 2cm , ouside the TDLU but ! - angiomatosis - widely dissects throughout the stroma • structural homogeneous, feeding vessel at the periphery, noncommunicating labyrinth of vascular channels - not absolutely valid • papillary endothelial hyperplasia - confusion with AS ! ( reactive, superficial, circumscribed, intravascular - trombus ) • CNB - distinction of low-grade AS mostly impossible

  33. Malignant vascular lesions of the breast • unlimited, > 3 cm , intralobular extension • diffuse growth, structuraly heterogeneous - low-grade periphery often mimics benign lesion ( caveCNB ! ) • complex anastomosing vasoformative labyrinth permeating the stroma • nuclear atypia, hyperchromasia, endothelial piling, papillary projections - at least in the center • grade does not realiably predict prognosis

  34. Angiosarcoma of the breast • parenchymal - rare, low-grade lesions prevail • postradiation - high-grade, generally cutaneous - AVL - low-grade precursor ? - better outcome ?? • in axillary dissection lymphedema (Stewart-Treves syndrom) • heterologous component - phylloid tumor - metaplastic carcinoma

  35. AVL - atypical vascular lesion of the breast ? • controversial, extremely rare lesion (Rosen) • small solitary or multiple red maculopapules arising in radiated skin - shorter half-time, < 3 years • tiny dermal gaping vascular proliferation, hyperchromasia, hobnail cc., inflammatory background; absent: atypia, mitoses, necrosis, endothelial piling,.. • association (progression) with AS - no mets so far - part of morphologic spectrum of AS(Brenn et al.) - foci of angiosarcoma undiscernible from AVL ??

  36. The End

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