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Breast Pathologies

Breast Pathologies. A: Mammogram in young female; radiodense or white in appearance. B: Predom. of fibrous interlobular stroma and paucity of adipose tissue.

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Breast Pathologies

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  1. Breast Pathologies

  2. A: Mammogram in young female; radiodense or white in appearance B: Predom. of fibrous interlobular stroma and paucity of adipose tissue C: During pregnancy: branching of terminal ducts produces more numerous, larger lobules. Luminal cells within lobules undergo lactational change, a precursor to milk formation. D. Older female. Lobules decrease in size and number; interlobular stroma is replaced by adipose tissue. E. Older female, mammogram. More radiolucent w/ age as a result of the increase in adipose tissue, which facilitates the detection of radiodense mass-forming lesions and calcifications.

  3. Acute Mastitis: • most cases assoc w/ breastfeeding • Path: cracks or fissures in nipples --> S. aureus or less commonly streptococci invade breast tissue • s/s: breast = erythematous & painful • +/- fever CURRENT Medical Dx & Tx > Chapter 17. Breast Disorders > Carcinoma of the Female Breast > Special Clinical Forms of Breast Cancer > Inflammatory Carcinoma >

  4. Fat necrosis: • A. oil cysts lined by foamy macrophages • Red circle: large central calcification • can present as painless palpable mass, skin thickening or retraction, mammographic density, or mammographic calcifications • majority have a hx of breast trauma or prior sx

  5. Apocrine cysts: • A. Clustered, rounded calcifications seen in a radiograph • B. Gross appearance of typical cycts filled w/ dark, turbid fluid contents (“blue-dome cysts) • C. Cysts = lined by apocrine cells w/ round nuclei and abundant granular cytoplasm. Note luminal calcifications. • Fibrocystic changes: • 1. cystic change (often w/ apocrine metaplasia) • 2. fibrosis • 3. adenosis

  6. Fibroadenoma • A. radiogram shows a characteristically well-circumscribed mass • B. Gross: rubbery, white, well-circumscribed mass is clearly demarcated from the surrounding yellow adipose tissue (absence of adipose tissue accounts for the radiodensity of lesion) • C. proliferation of intralobular stroma surrounds, pushes, and distorts the associated epithelium. Border is sharply delimited from the surrounding tissue. • most common in females <35yo • most common benign tumor of the female breast • discrete, movable, painless or painful mass • benign tumor derived from stroma • does not progress to cancer; however, breast ca may develop secondary within ductal epithelial cells as a separate event

  7. Phyllodes Tumor: • Compared to a fibroadenoma, there is increased stromal cellularity, cytologic atypia, and stromal overgrowth, giving rise to the typical leaflike architecture. • arise from intralobular stroma • most present in 6th decade • present w/ palpable masses but a few are found by mammography • most are benign

  8. DCIS: • 5 architectural subtypes: comedocarcinoma, solid, cribiform, papillary, micropapillary • 15-30% of carcinomas in well-screened populations • most frequently presents as mammographic calcifications • majority of cases of DCIS cannot be detected by either palpation or visual inspection • less typically presents as a mammographic density, vaguely palpable mass, or nipple discharge • consists of a malignant population of cells limited to ducts and lobules by the basement membrane • when DCIS involves lobules, the acini are usually distorted and unfolded and take on the appearance of small ducts

  9. LCIS: • infrequent (1-6% of all carcinomas) • not associated with calcifications or a stromal reaction that would form a density --> always incidental finding on biopsy • 20-40% of LCIS cases = bilateral (compared to 10-20% of DCIS cases) • LCIS is more common in young women (80-90% of cases occur prior to menopause) • consists of a malignant population of cells (identical in appearance to the cells of invasive lobular carcinoma (but limited by the BM)

  10. Invasive Ductal Carcinoma (invasive carcinoma, no special type): • Top: Invasive ductal carcinoma with productive fibrosis (scirrhous, simplex, no special type) • Bottom: Mammogram. Note spiculated mass in the upper outer quadrant of this otherwise fatty breast. • includes majority of carcinoma (70-80%) • Gross exam: most are firm/hard and have an irregular border • wide range of histological appearances (depending on the level of differentiation of the tissue) • 2 extremes • well-differentiated tumors consisting of tubules lined by minimally atypical cells (typically express hormone receptors, and don’t over-express HER2/neu) • anastomosing sheets of pleomorphic (typically less likely to express hormone receptor and more likely to over-express HER2/neu) • HER2/neu: cell membrane surface-bound receptor tyrosine kinase involved in signal transduction pathways leading to cell growth and differentiation

  11. A. well-differentiated invasive carcinoma of no special type consists of tubules or a cribriform pattern of cells with small monomorphic nuclei B. moderately differentiated carcinoma shows less tubule formation and more solid nests of cells and pleomorphic nuclei C. poorly differentiated invasive carcinoma of no special type infiltrates as ragged sheets of pleomorphic cells w/ numerous mitotic figures and central areas of tumor necrosis D. Gross specimen of invasive ductal carcinoma. Central white area = hard (scirrhous appearance --> neoplasm is producing a desmoplastic reaction w/ lots of collagen and/or focal dystrophic calcification giving the cut surface a gritty feature. http://library.med.utah.edu/WebPath/NEOHTML/NEOPL030.html

  12. Invasive Lobular Carcinoma • Uniform, relatively small lobular carcinoma cells are seen arranged in a single-file orientation (“Indian file” • Usually present as a palpable mass or mammographic density (but in 25% of the cases, the tumor infiltrates tissue diffusely) • Range of types: • well and moderately-differentiated; usually diploid; express hormone receptors; usually associated with LCIS; rarely over-express HER2/neu • poorly differentiated; usually aneuploid; often lack hormone receptors; may over-express HER2/neu

  13. Gynecomastia: • Top: Terminal ducts (w/o lobule formation) are lined by a multilayered epithelium w/ small papillary tufts. There is typically surrounding periductal hyalinization and fibrosis. • may be unilateral or bilateral • imbalance between estrogens and androgens • can occur during puberty • other causes of hyperestrinism • cirrhosis of liver • in older males: relative increase in adrenal estrogens as the androgenic function of the testis fails • drugs: alcohol, marijuana, heroin, antiretroviral therapy, anabolic steroids, some psychoactive drugs • rarely seen in Kleinfelter’s (XXY), functioning testicular neoplasms

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