pathology of breast carcinoma

8/14/2019 Pathology of Breast Carcinoma

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Strength does not come fromStrength does not come from

winning. Struggles & Hardshipwinning. Struggles & Hardship

develop your strength. When you godevelop your strength. When you gothrough hardship and decide not tothrough hardship and decide not to

surrender, that is strengthsurrender, that is strength

Arnold SchwarzeneggerArnold Schwarzenegger

Bodybuilder and ActorBodybuilder and Actor


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Pathology of BreastPathology of BreastCancerCancer

Dr. Venkatesh M. ShashidharDr. Venkatesh M. Shashidhar

Senior Lecturer in PathologySenior Lecturer in Pathology

Fiji School of MedicineFiji School of Medicine


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IntroductionIntroduction

Modified sweat glands.Modified sweat glands.

Lobes and lobules of glandLobes and lobules of gland

in fat tissue stroma.in fat tissue stroma.

Ducts emerge from acini of glandsDucts emerge from acini of glands Smaller ducts join to form lactiferousSmaller ducts join to form lactiferous

ductsducts

Lactiferous ducts merge just beneath theLactiferous ducts merge just beneath thenipple to form a lactiferous sinus.nipple to form a lactiferous sinus.

Then individually open on nippleThen individually open on nipple


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Normal BreastNormal Breast


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Myoepithelial Cells (ipx)Myoepithelial Cells (ipx)


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DisordersDisorders

CongenitalCongenital Aplasia turners, Juvenile hypertrophyAplasia turners, Juvenile hypertrophy

InflammatoryInflammatory

Infections acute/chronic Trauma Fat necrosisInfections acute/chronic Trauma Fat necrosis Duct ectasia discharge, sinusDuct ectasia discharge, sinus Fibrocystic disease common painful lumpsFibrocystic disease common painful lumps

NeoplasticNeoplastic Benign - FibroadenomaBenign - Fibroadenoma Malignant CaMalignant Ca


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Fibrocystic DiseaseFibrocystic Disease

Fibroadenosis, Fibrocystic change, etc.Fibroadenosis, Fibrocystic change, etc. Commonest lump, 10-50% womenCommonest lump, 10-50% women

? Hormonal? Hormonal

Periodic discomfort pain.Periodic discomfort pain.

Eipethilial hyperplasia premalignantEipethilial hyperplasia premalignant

Irregular palpable lumps mimic ca.Irregular palpable lumps mimic ca. Adenosis hyperplasia - cysts papillomatosis Adenosis hyperplasia - cysts papillomatosis

metaplasia fibrosis.metaplasia fibrosis.


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Benign Neoplasms:Benign Neoplasms:

FibroadenomaFibroadenomaDuct PapillomaDuct PapillomaAdenomaAdenoma

Connective tissue tumorsConnective tissue tumors

Features (Fibroadenoma)Features (Fibroadenoma)Young age 3Young age 3rdrd decade.decade. Single, rounded, mobile, painless lumps.Single, rounded, mobile, painless lumps. No scarring or calcification.No scarring or calcification. Slit like glands in Fibrous stromaSlit like glands in Fibrous stroma


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Breast CarcinomaBreast Carcinoma

20% of all cancers in20% of all cancers inwomenwomen

Commonest cause of death -Commonest cause of death -

35-55y35-55y In UK 1 in 10-12 chancesIn UK 1 in 10-12 chances 1 in 8 women in US1 in 8 women in US

Less incidence in AsiaLess incidence in Asia Majority of cancers arise inMajority of cancers arise in

the ducts.the ducts. Very rare before age 25Very rare before age 25


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Risk Factors:Risk Factors:

Female sex..!, Age, Obesity, high fat dietFemale sex..!, Age, Obesity, high fat diet

Maternal relative with breast cancer.Maternal relative with breast cancer.

Longer reproductive span.Longer reproductive span.

Nulliparity, Oral contraceptivesNulliparity, Oral contraceptives

Later age at first pregnancy.Later age at first pregnancy.

Atypical epithelial hyperplasia.Atypical epithelial hyperplasia.

Previous breast cancer/Endometrial Ca.Previous breast cancer/Endometrial Ca. Geographic factors - countryGeographic factors - country

BRCA1 and BRCA2BRCA1 and BRCA2 genesgenes


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Etiology of Breast Carcinoma:Etiology of Breast Carcinoma:


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Clinical Features:Clinical Features:

Physiologic vs Pathologic changesPhysiologic vs Pathologic changes Lump / lumpsLump / lumps

Lumps are much more common than CaLumps are much more common than Ca

Characters ofCharacters oflumplump* and* and ageage**

Discharge in many conditions.Discharge in many conditions.

Hard, soft, inflammationHard, soft, inflammation Skin fixation /Skin fixation / SkinSkin retractionretraction **


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Diagnosis:Diagnosis:

MammorgraphyMammorgraphy UltrasoundUltrasound

Fine Needle Aspiration BiopsyFine Needle Aspiration Biopsy

Core BiopsyCore Biopsy Excision BiopsyExcision Biopsy

Frozen sectionFrozen section

Immunoperoxidase,Immunoperoxidase, Molecular techniques Gene detection.Molecular techniques Gene detection.


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Histological TypesHistological TypesHistologic Type Freq. (UK)

InfiltratingDuctCa 63.6 (75)

Lobular Carcinoma 5.9 (10)

InfiltratingDuctal & Lobular Ca 1.6

Medullary Carcinoma 2.8 (3)

Mucinous (colloid) Carcinoma 2.1 (3)

Comedocarcinoma 1.4

Carcinoma-In-Situ 5%


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Breast Carcinoma - SchirrousBreast Carcinoma - Schirrous


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Infiltrating Duct Carcinoma: small hardInfiltrating Duct Carcinoma: small hard


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Medullary Carcinoma: Large softMedullary Carcinoma: Large soft


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Infiltrating Duct CarcinomaInfiltrating Duct Carcinoma


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Infiltrating Duct CarcinomaInfiltrating Duct Carcinoma


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Medullary Carcinoma: Inflammation.Medullary Carcinoma: Inflammation.


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Infiltrating Duct Carcinoma: FibrosisInfiltrating Duct Carcinoma: Fibrosis


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Schirrous CarcinomaSchirrous Carcinoma

C iM d ll C i


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Medullary CarcinomaMedullary Carcinoma

Soft, inflammatory cellsSoft, inflammatory cells


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Intraductal in-situ CarcinomaIntraductal in-situ Carcinoma


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Lobular CarcinomaLobular Carcinoma


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Intraduct Carcinoma-in-situIntraduct Carcinoma-in-situ


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Intraduct CarcinomaIntraduct Carcinoma


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Lymphatic spread Peu-de Orange..Lymphatic spread Peu-de Orange..


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Spread of BreastSpread of BreastCarcinoma:Carcinoma:


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Pagets DiseasePagets Disease


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Pagets Disease (Epidermal invasion)Pagets Disease (Epidermal invasion)


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Estrogen Receptor & Prognosis:Estrogen Receptor & Prognosis:

Estrogen receptor expression isEstrogen receptor expression isproportional to differntiation of tumorproportional to differntiation of tumor

inversly proportional to prognosis andinversly proportional to prognosis and

response to tamoxifen (receptor antagonist)response to tamoxifen (receptor antagonist)therapy.therapy.

Demonstrated by ImmunoperoxidaseDemonstrated by Immunoperoxidase

special stain.special stain.


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HER2HER2

The HER2 proto-oncogene encodes a cellThe HER2 proto-oncogene encodes a cellsurface receptor that is overexpressed insurface receptor that is overexpressed in

approximately 25%-30% of breast cancers.approximately 25%-30% of breast cancers.

Trastuzumab (Herceptin) is the firstTrastuzumab (Herceptin) is the firstmonoclonal antibody that targets themonoclonal antibody that targets the

extracelluar domain of the HER2 protein,extracelluar domain of the HER2 protein,

and inhibits growth of breast cancer cellsand inhibits growth of breast cancer cellsthat over express this protein.that over express this protein.


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Estrogen receptor (ER) in nucleiEstrogen receptor (ER) in nuclei


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St 5 7


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St

agDefinition

5-year

Surv (%)

7-year

Surv (%)

I Tumor 2 cm or less without spread 96 92

II

Tumor 2-5cm with regional lymph

node involvement but without distant

metastases, OR > 5 cm in diameterwithout spread

81 71

III

Any size with skin/chest wall fixation,

& axillary or internal mammary

nodal involvement, without distant

metastases

52 39

IV

Tumor of any size with or without

regional spread but with evidence of

di t t t t

18 11

pathology of breast carcinoma

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