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Breast Cancer Pathology
Greg Wolgamot, MD PhD
Jan 16, 2016
Agenda
1. Pathology processing
2. Breast neoplasia 101
3. Pathology report
Agenda
1. Pathology processing2. Breast neoplasia 101
3. Pathology report
Agenda
1. Pathology processing
2. Breast neoplasia 1013. Pathology report
A smorgasboard of pathology!
Normal breast lobule
Normal changes with age
Fibrocystic change (apocrine metaplasia)
Complex sclerosing lesion (radial scar)
Fibroadenoma
Intraductal papilloma
Ductal carcinoma in situ (DCIS)
Invasive carcinoma
Hyperplasia- in situ neoplasia - carcinoma
Progression
Progressive risk of invasive carcinoma
3%
5-7% 13-17% 25-30%
Is DCIS cancer?
Is DCIS cancer?
Semantics. DCIS itself cannot
metastasize, but can progress to invasive
carcinoma, which can metastasize.
From a patient’s perspective, DCIS is
treated like cancer.
Are atypical ductal hyperplasia and DCIS always completely distinct?
Are atypical ductal hyperplasia and DCIS always completely distinct?
Not always. They can form a spectrum, whether analyzed by morphology, genetic techniques, or risk to invasive carcinoma.
Ductal vs. Lobular
Why is it important to distinguish ductal from lobular carcinomas?
Why is it important to distinguish ductal from lobular carcinomas?
Different growth patterns may necessitate
different imaging, surgical, and pathology
approaches. In some cases lobular
carcinomas forms discrete masses, and in
other cases can be deceptively sneaky!
Agenda
1. Pathology processing
2. Breast neoplasia 101
3. Pathology report
Inflammatory breast carcinoma
Inflammatory breast carcinoma
Paget’s Disease (of breast)
Paget’s Disease (of breast)
Paget’s Disease (of breast)
ER
HER-2
What are the most important prognostic indicators?
What are the most important prognostic indicators?
1. Distant metastases
2. Nodal metastases
3. T stage
TNM!
Breast Cancer Pathology
Greg Wolgamot, MD PhD
Jan 16, 2016
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