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Breast

Breast. Dr. Raid Jastania. Breast. Definitions: Lactiferous ducts, Duct, Lobule, Terminal duct lobular unit Common presentations of diseases Lump, mass, pain, skin changes Mammography: fibrous thickening and calcifications Triple test: Clinical, mammography, biopsy. Rare conditions.

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Breast

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  1. Breast Dr. Raid Jastania

  2. Breast • Definitions: Lactiferous ducts, Duct, Lobule, Terminal duct lobular unit • Common presentations of diseases • Lump, mass, pain, skin changes • Mammography: fibrous thickening and calcifications • Triple test: Clinical, mammography, biopsy

  3. Rare conditions • Supernumerary nipples and breast • Congenital inversion of nipple • Galactocele

  4. Fibrocystic Change • Present as mass or lump • Hormonal related, Estrogen • Types • Proliferative fibrocystic change • Non-proliferative fibrocystic change

  5. Fibrocystic Change • Non-Proliferative fibrocystic change • Fibrosis • Cystic change • Apocrine metaplasia

  6. Fibrocystic Change • Non-Proliferative fibrocystic change • Multifocal, bilateral • Nodularity, fibrosis • Cysts 1-5 com, Blue dome cysts, lined by benign epithelium, myoepithelial cells present, • Apocrine metaplasia • Calcification

  7. Fibrocystic Change • Proliferative fibrocystic change • Epithelial hyperplasia • Sclerosing adenosis

  8. Fibrocystic Change • Proliferative fibrocystic change • Epithelial hyperplasia • Types: Ductal, Lobular • Grades: Mild, moderate, severe (florid), atypcial • Sclerosing adenosis

  9. Fibrocystic Change • Proliferative fibrocystic change • Epithelial hyperplasia • Sclerosing adenosis • Hard, rubbery • Fibrous stroma • Proliferation of small ducts (adenosis) with marked compression of the fibrous stroma (sclerosing)

  10. Fibrocystic Change • Risk of Cancer: • Family history: double the risk

  11. Carcinoma • Second to lung cancer as a cause of death • ¼ of women with the disease die • Lifetime risk is 1 in 8 women in US • Increasing incidence • 75% of patients are older than 50 y • 5% are younger than 40 y

  12. Carcinoma • L > R (slightly) • 4% bilateral • Upper outer quadrant: 50% • Central zone: 20% • All other quadrants: 10% each

  13. Carcinoma • Classification • Carcinoma In-situ • Ductal (DCIS) • Lobular (LCIS) • Invasive carcinoma • Ductal carcinoma (Scirrhous carcinoma) • Lobular carcinoma • Others: medullary, colloid, tubular…

  14. Ductal Carcinoma In-Situ DCIS • Terminal duct lobular unit • Large malignant cells, monotonous, within ducts • Pattern • Solid • Cribriform • Papillary • Micropapillary • Comedo: central necrosis

  15. Ductal Carcinoma In-Situ DCIS • Presentation • Mammography: calcifications • Can be palpable • Prognosis: 97% survival • 1/3 of cases progress to invasive cancer if untreated • Recurrence in 20-25%

  16. Lobular Carcinom In-Situ LCIS • Terminal duct lobular unit • Uniform, monomorphic, bland, discohesive cells, some with vacuoles (signet-ring) • 1/3 will develop invasive cancer, the risk is to both sides of breast • LCIS is a marker of increased risk • Presentation: incidental, not palpable, no calcification

  17. Invasive Ductal Carcinoma (NOS) or (NST) • 70-80% of invasive carcinoma • Associated with DCIS • Hard, palpable mass, irregular borders • Nipple retraction, Peau d’ orange • fixation to the chest wall

  18. Invasive Ductal Carcinoma (NOS) or (NST) • Invasive adenocarcinoma • Irregular glands lined by malignant cells • Grading: tubular formation, nuclear grade, mitosis • 2/3 ER/PR + • 1/3 HER2/NEU over expression

  19. Invasive Lobular carcinoma • 20% of invasive cancer cases • 2/3 are associated with LCIS • Most are palpable, but can be occult • More frequent multifocal, multicentric (10-20%)

  20. Invasive Lobular carcinoma • Single cells, indian file, targetoid arrangement • Signet-ring cells, intracytoplasmic lumina • Matastasize to serosal surfaces and CNS, ovary • All ER/PR + • HER2/NEU over expression is rare

  21. Medullary Carcinoma • Well circumscribed mass, pushing borders • Large anaplastic cells • Mixed with inflammatory cells • Cases of BRCA1 show medullary carcinom-like features • Lack ER/PR • HER2/NEU negative

  22. Colloid carcinoma (mucinous) • Well circumscribed mass • Pools of mucus • Malignant cells floating in mucus • ER/PR + • HER2/NEU negative

  23. Tubular carcinoma • Small <1cm • Irregular densities on mammography • Prognosis is excellent • ER/PR + • HER2/NEU negative

  24. Inflammatory Carcinoma • Usually ductal carcinoma NOS • Clinical: enlarged swollen, erythematous breast • Cancer seen in lymphatic channels in skin • Poor prognosis

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