lab - breast pathology (1)
TRANSCRIPT
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7/23/2019 Lab - Breast Pathology (1)
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Breast pathology
Purulent mastitis (701)
in the beginning of lactation (M.puerperalis)
favor fill of milk and small injury of
nipple
caused by streptococcus andstaphylococcus
It is purulent inflammation and without
antibiotics therapy causing growth anabscess of the breast. Surgical
intervention is needed.
Micro: inflammatory infiltrate. actation
Interlobular septa(typical of lactating
mammary gland)
!lveoli dilated with milk
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Fibrocystic change (4)
the most common benign changes in the
breast
the most common cause of non"
cancerous breast lumps in women # is
not a risk factor for breast cancer
usually related to hormonal fluctuations.
Most fre$uently in premenopausal
women (ages %& to '&)
more than '& of women have
fibrocystic breast symptoms at some
point in their lives.
Signs: lumpiness tenderness cystsareas of thickening fibrosis breast pain
*strogens stimulate proliferation of
connective tissue with the developmentof fibrosis
fibrosis causes obstruction of ductulesthat gradually dilate and become cysticas a result of persistent cyclic epithelial
secretion
grossly the specimen or breast tissuecontains several small randomly
distributed blue"domed or clear cysts.
fibrocystic changes: cysts apocrine
metaplasia (cells resemble apocrinesweat glands) (characteristic for
fibrocystic change) fibrosis adenosis
calcification chronic inflammation
Microscopically:
cystically dilated round to oval spaces
lined by slightly attenuated epithelialand myoepithelial cell layers
stroma between lobules are fre$uently
sclerotic
smaller cysts coalesce form large cysts
lined by attenuated epithelial and
myoepithelial cells
metaplastic aporcrine cells may bepresent
when cysts rupture an inflammatory
response results and subse$uentreparative changes causes additional
fibrosis
Metaplastic apocrine cells (granular
eosinophilic cytoplasm and round nuclei)
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Fibroadenoma (704)
the most common breast tumor in
women under +' years
benign
characteri,ed by proliferation of both
glandular and stromal elements
solid firm smooth movable and usuallypainless or only slightly tender slow
growing
-rossly: less than + cm round or ovoid
elastic nodular smooth surface sharply
demarcated
cut surface homogeneous and firm
grey"white or tan
micro: proliferation forms duct"like
spaces surrounded by fibroblasticstroma. roliferating epithelium appearsnormal
fibroadenomas may be sub"classified
into + types:
intracanalicular show predominant
stromal proliferation that compresses
ducts which are irregular andreduced to slits
pericanalicular : fibrous stromal
proliferation around ductal spacesthat allows the duct spaces remain
round or oval
mi/ed
proliferation of intralobular stroma
distorts the epithelium.
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Phyllodes tumor (705)
phyllodes is -reek for 0leaflike1
very rare breast tumor
arise from intralobular stroma (like
fibroadenoma)
usually age 2&
typically large fast growing. 3orm fromperiductal stromal cells of breast in adult
women
fibroepithelial tumor composed ofepithelial and cellular stromal
component
symptoms: rapid but painless growth of
smooth bulky mass within affected
breast.
If malignant usually the stromalelement. (check for atypia in stroma)
can be benign borderline or malignant.
4igh cellularity
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Paget's disease of the breast (70)
combination of scaly skin changes of
nipple resembling ec,ema andunderlying cancer of the breast. 5ipple
is inflamed because of presence of
aget6s cells
most often in women over '& most women with aget6s disease of the
breast have underlying infiltrating ductalbreast cancer
5ipple and areola are typically red
inflamed and itchy. May be crusting
bleeding or ulceration. 5ipple may beinverted.
Micro: characteristic large cellssurrounded by clear halo"like area
invade the epidermis7 underlying ductalcarcinoma almost always present.
Inflammatory infiltrate underepidermis
aget8s cells
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Breast cancers
second most common type of cancer after lung cancer often in the upper outer $uadrant. eft breast more often affected
9 different classification schemes each based on different criteria and serving different purpose:
pathology # almost always adenocarcinoma most common types are ductal and lobular
grade of tumor # determined by using the loom";ichardson grade system
based on + elements: gland formation polymorphism mitotic figures
rotein < gene status # cancers are tested for e/pression or detectable effect of the estrogen
receptor (*;) progesterone receptor (;) and 4*;%=neu proteins. >he profile of e/pression of
tumor helps predict its prognosis and helps an oncologist choose the most appropriate treatment.
?omedocarcinoma # reinvasive necrotic center surrounded by solid sheets of pleomorphic cells
with high"grade hyperchromatic nuclei Main risk factors:
se/ increasing age family history proliferative breast disease
hormonal factors: early menstruation late menopause late or few pregnancies long term
estrogen therapy (oral contraceptive pill or hormone replacement therapy (4*;>))
high fat diet obesity
others: environment factors # e/posure to radiation
3actors for predictive of outcome:
si,e of tumor and stage
surgical margins
involvement of lymph nodes
sentinel node
hormone receptor status = 4*;% levels
metastasis
>riple test includes:
e/amination of the breast
imaging of the breast through mammography or ultrasound
sampling of the breast tissue with fine needle aspiration (35!) core biopsy or open biopsy
aget8s cells
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!n"asi"e ductal carcinoma (70#)
most common type (@&"A&)
cancer cells resemble the ducts of thebreast
developing in the milk ducts of breast
but breaks out of the duct tubes and
invades or infiltrates surroundingtissues.
0scirrhous1 carcinomas with cells often
arrange in nests or cords or streams in avery desmoplastic stroma
Micro: tumor cells arranged in cordsisland and glands embedded in a dense
fibrosis stroma
Many ducts
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!n"asi"e lobular carcinoma (707)
%ndmost common type of breast cancer
('"B&)
often multifocal within a breast (small
nests) and are often bilateral
micro: strands of small tumor cellse/hibit low cohesion and forms Indian
files. >he strands of tumor cells arearranged concentrically around normal
ducts. >his has been know as targetoid
arrangement
?haracteristic features:
tumor cells are small
polymorphism is slight
intercellular cohesion is reduced
tumor cells arranged in Indian files targetoid arranged of tumor cells
around normal ducts
?ancer cells arranged in lines (Indian file)