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Breast Pathology .pdf
The document provides comprehensive notes on breast lesions, including benign tumors such as fibroadenomas and phyllodes tumors, as well as malignant breast cancers. It highlights the clinical features, risk factors, and pathophysiology of breast cancer, emphasizing the importance of screening and early diagnosis. The incidence of breast cancer rises with age, especially in women over 40, and various genetic and lifestyle factors contribute to risk.
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Breast Pathology .pdf
- 1. LESIONS OF BREASTDR MANJULA N MBBS MD (Pathology)
- 2. ANATOMY OF BREAST Clinicalnotes onbreast cancer: 1. Majority of cancers develop in upper outer quadrant 2. Large amount of glandular tissue here 3. An axillary tail of breast tissue often extends into axilla
- 3.
- 4. BENIGN LESIONS OFBREAST
- 5. BENIGN LESIONS 1. Fibroadenoma 2.Phyllodes tumour 3. Ductal hyperplasia 4. Lipoma
- 6. A fibroadenoma isa smooth, discrete breast lump consisting of fibrous and adenomatous (glandular) tissue. It is firm and mobile that it appears to shift position and is commonly referred to as a ‘breast mice’.
- 7. ❑ Fibroadenomas arethe second most common solid tumor after breast cancer and most common benign tumor in women. ❑ Painless, firm, solitary, mobile, slowly growing breast mass. ❑ It is the most common breast tumor in young women usually under 30 years of age and growth may be accelerated during pregnancy. ❑ It is usually detected when it is 2 or 3 cm in size. ❑ Fibroadenomas can cause drastic asymmetrical growth of the breast. ❑ When larger than 5 cm, they are classified as Giant Fibroadenomas.
- 8. CLINICAL FEATURES ▪ Thetypical presentation is in a woman of reproductive age with a mobile palpable breast lump. ▪ Due to their hormonal sensitivity, the fibroadenoma commonly enlarges during pregnancy and involute at menopause. ▪ Hence, they rarely present after the age of 40 years. ▪ The lesions are well defined and well circumscribed clinically and the overlying skin is normal. ▪ The lesions are not fixed to the surrounding parenchyma and slip around under the palpating hand, hence the colloquial term a breast ‘mouse’.
- 9. GROSS FEATURES ➢Round ➢Well encapsulated ➢Greyishwhite ➢Solitary ➢Firm consistency ➢Nodular ➢1-5cm diameter
- 10.
- 11. INVESTIGATIONS 1. Mammogram 2. Ultrasound 3.Fine needle aspiration cytology
- 12. MANAGEMENT 1. Lumpectomy 2. Cryoablation 3.Ultrasound guided percutaneous suctioning
- 13. PHYLLODES TUMOUR It isformed by excessive proliferation of stroma over ductal element. The proliferating stroma gives rise to leaf like appearance.
- 14. INTRODUCTION ▪ Also knownas cystosarcoma phylloides or Brodie’s tumour. ▪ It’s not a sarcoma but may recur locally after simple excision. ▪ It does not metastasize. ▪ It is presents in middle-aged female. ▪ It can be only distinguished on histology. ▪ Overlying skin may go necrosis. ▪ Recurrence is seen commonly ▪ High grade tumours show metastasis ▪ Metastasis can be via blood stream to lungs and bones ▪ Lymph node metastasis is rare.
- 15. GROSS AND MICROSCOPY Gross: •Round to oval mass • Well circumscribed • Encapsulated • Vary in size Microscopy: • Slit like compressed glands • Leaf like stromal proliferation
- 16.
- 17. INTRODUCTION ▪ It themost commonly diagnosed cancer in women (29.9 % of all new cancers). ▪ Breast cancer is the commonest cancer in all ethnic groups and in all age groups in females from the age of 15 years onwards. ▪ The incidence of breast cancer increased steadily starting from age of 30 years with a peak age specific incidence rate in the 50 - 59 age groups. ▪ The incidence rate then declined in the older age groups.
- 18. RISK FACTORS 1. GENDER Femalehas higher risk to develop breast cancer than their male counterparts. 2. AGE The risk increases from the age of 40 years old for pre-menopausal group and 50 years old for the post-menopausal group.
- 19. RISK FACTORS 3. HISTORYOF NEOPLASTIC DISEASE OF THE BREAST a. Prior history of breast cancer carries an elevated risk of developing new primary breast cancer. b. Person with breast carcinoma in situ (lobular carcinoma in situ and ductal carcinoma in situ) are at high risk to develop invasive breast carcinoma. c. Person with breast tissue biopsy showing proliferative disease with and without atypical cells has an increased risk to develop future breast cancer. d. Benign breast disease with atypical hyperplasia lesion carries the highest risk to develop breast cancer.
- 20. RISK FACTORS 4. FAMILYHISTORY a. Family history of breast cancer is an independent risk factor. b. The risk is higher in women with breast cancer among young first- degree relatives. c. Sister carries more risk than mother d. Carriers of BRCA1 and BRCA2 genetic mutation are at high risk to develop future breast cancer.
- 21. RISK FACTORS 5. ReproductiveFactors 6. Breast Density 7. Life style 8. Previous radiation exposure 9. Hormonal Factors
- 22.
- 24. METASTASIS ▪ The skeleton- especially the lumbar spine, causing back pain and reduced spinal movements, and pathological fractures in the long bones. There may be paraplegia from cord compression. ▪ The lungs - causing pleural effusions. Lung parenchymal involvement, in the form of diffuse lymphatic movement known as lymphangitis carcinomatoses, may cause severe dyspnea ▪ The liver - making it palpable and causing jaundice and ascites ▪ The skin - producing multiple hard nodules within the skin. These are usually in the skin of the breast containing the cancer, but may be seen in the neck, trunk and further away. ▪ The brain - producing any variety of neurological symptoms and signs.
- 25. INVASIVE DUCTAL CARCINOMA,NOS Most common cancer of breast Also known as Scirrhous carcinoma Morphologically no typical character seen Cannot be classified into a specific type Gross: Generally 2-3cm in diameter but can be massive. Commonly arise in upper outer quadrant Grey white cut surface Hard in consistency Gritty, well circumscribed, nodular Can show nipple areolar ulceration
- 26. PROGNOSTIC FACTORS 1. Tumourstaging 2. Histologic grade 3. Oestrogen and progesterone receptors 4. Oncogene expression
- 27. SCREENING AND DIAGNOSIS 1.Breast cancer screening programme – screening mammography 2. FNAC 3. Core biopsy 4. Frozen section Also awareness among the general population is very important for early diagnosis and treatment.
- 28.