breast pathology

cyclic

blue domed cyst

apocrine metaplasia

adenosis

fibrocystic changes

increased epithelial layer of duct

slit like spaces

usual duct hyperplasia

bloody nipple discharge

intraductal papilloma

increased acini and storma fibrosis

mimics carcinoma

sclerosing adenosis

staphylococcus aureus

nipple cracks=infection

lactational

lactational mastitis (acute)

localized pus

fluctuate tenderness

breast abscess (acute mastitis)

vitamin a deficiency

SMOLD

keratin

subareolar

abscess

periductal mastitis / zuska’s disease (chronic)

plasma cell

dilated duct

ropiness on surface

destroyed elastic tissue

fibrous tissue

cheesy inspissated secretion

periductal and interstitial inflammation

mammary duct ectasia (chronic mastitis)

non caseating

hypersensitivity reaction during lactation

idiopathic granulomatous mastitis (chronic-specific)

mycobacterium tuberculosis (tb)

caseating

sinuses on breast surface

hemorrhagic, lymphatic and direct spread

tuberculous mastitis (chronic-specific)

systemic sarcoidosis

specific non-infectious granulomatous mastitis (chronic-specific)

after mastectomy or cosmetic surgery

silicone breast implants (chronic-specific mastitis)

trauma

foamy cytoplasm

giant cell

dystrophic calcification

mimics breast cancer

fat necrosis (chronic mastitis)

milk accumulation =cyst

clumps

no tenderness

while lactating

normal duct epithelium

galactocele

in male

imbalanced estrogen and androgens

no acini

decreased testosterone = testicular atrophy & Klinefelter syndrome

increased estrogen = cirrhosis & hyperthyroidism

gynacomastia

breast mouse

homogeneous

lobulated/nodular

without cysts

highly mobile

intracanalicular pattern (slit like clefts)

pericanalicular pattern (fibrous stroma)

fibroadenoma

in 50-60 y/o

leaf like clefts

can be premalignant in older people, shows atypia and mitosis

giant fibroadenoma - phyllodes tumor

effect of late parity/nulliparous on breast carcinoma

increased risk

effect of prolonged estrogen exposure on breast cancer and endometrial cancer

increased risk- breast cancer

decreased risk- endometrial cancer

what does the presence of BRCA 1 and BRCA 2 gene mutations imply

increased risk of breast carcinoma

list 4 precancerous lesions

1- premalignant proliferative lesion w/ atypia

2- atypical hyperplasia

3- atypical lobular hyperplasia

4- duct papilloma w/ atypia

atypical ductal hyperplasia

cribriform pattern

atypical lobular hyperplasia

premalignant proliferative with atypia

pathogenisis of breast carcinoma

hyperplasia-dysplasia-cancer-invasion

enumerate precursor lesions

1- ductal carcinoma in situ

2- lobular carcinoma in situ

enumerate invasive breast carcinoma

1- invasive breast ductal carcinoma of no special type (IBC-NST)

2- IBC.NST with medullary pattern

3- invasive lobular carcinoma

4- tubular carcinoma

5- cribriform carcinoma

6- mucinous carcinoma

7- invasive papillary carcinoma

8- metaplastic carcinoma

bleeding from the nipple and serous discharge

necrotic paste like yellowish material

intact basement membrane

several layers of malignant cells

central eosinophilic necrosis

ductal carcinoma in situ

list 4 growth patterns of ductal carcinoma in situ

1- cribriform

2- papillary

3- solid

4- comedo (central eosinophilic necrosis)

multifocal

palpable mass

intact basement membrane

proliferation of monomorphic cells filling lobules without invasion

lobular carcinoma in situ

tumor arises in upper outer quadrant of breast

>1cm

non capsulated

irregular and spiky

grayish white and hard

early mobile, late fixed

concave cut surface

gritty sensation when cutting

desmoplastic reaction

invasive breast ductal carcinoma of no special type (IBC-NST)

list gross picture of IBC-NST

(size, shape, colour, consistency, mobility and cut surface)

size- >1cm

shape- non capsulated, irregular and spiky

color- greyish white

consistency- hard

mobility- early mobile, late fixed

cut surface- greyish white, concave, gritty sensation

soft and well circumscribed

bulging cut surface with areas of hemorrhage and necrosis

skin ulceration

scanty stroma with lymphocytic infiltration

syncytial / sheet like appearance

large pleomorphic cells

large nuclei and prominent nucleoli

numerous mitosis

indistinct cell borders

IBC-NST with medullary pattern

microscopic picture of IBC-NST w/ medullary pattern

scanty stroma with lymphocytic infiltration

syncytial / sheet like appearance

large pleomorphic cells

large nuclei

prominent nucleoli

numerous mitosis

indistinct cell borders

in post menopausal females

jellylike mass

subtle clusters of malignant cells

malignant acini floating in mucin lakes

mucinous carcinoma

multicentric

more ER+

indian file pattern within dense fibrous stroma

rubbery-hard consistency

poorly circumscribed diffuse

invasive lobular carcinoma

what are the two methods of lymphatic spread of breast cancer

1- lymphatic emboli

2- lymphatic permeation (leads to lymphedema)

what does lymphatic permeation cause

1- skin nodularity

2- peau d’orange

3- canceur en-cuirasse

where does a lymphatic emboli reach

outer part: axillary and supraclavicular lymph nodes

inner part: internal mammary lymph nodes

edema caused by lymphatic blockage

nipple retraction

fibrosis

ulceration

dermal infiltration

pea d’orange

what causes peau d’orange

lymphedema

what causes nipple retraction in peau d’orange

secondary to fibrosis

what causes ulceration in peau d’orange

dermal infiltration

eczema in nipple and aerola

affects old people

ulceration

large malignant cells w/ clear cytoplasm and large hyperchromatic nuclei

could be intraductal or invasive carcinoma

nipple paget disease

nipple eczema in a young person indicates

acute mastitis

nipple eczema in an old person indicates

paget disease

list prognostic factors in breast carcinoma

tumour: size, type, grade and stage

hormone receptors (ER & PR)

Her-2 status

proliferation index (Ki67)

tumors are graded according to?

1- tubule formation

2- nuclear pleomorphism

3- mitotic count

TNM STAGING;

size less than 2cm

T1

TNM STAGING;

size less than 2-5cm

T2

TNM STAGING;

size less than more than 5cm

T3

TNM STAGING;

tumor extends to skin or chest wall

T4

TNM STAGING;

no lymph node metastasis

N0

TNM STAGING;

metastasis to ipsilateral movable axillary LNs

N1

TNM STAGING;

metastasis to ipsilateral fixed axillary or IM LNs

N2

TNM STAGING;

metastasis to infra/supraclavicular LNs

or axillary IM LNs

N3

TNM STAGING;

no distant metastasis

M0

TNM STAGING;

distant metastasis

M1

mention luminal A receptors and prognosis

receptors: ER+ PR+ HER2-

prognosis: best

mention luminal B receptors and prognosis

receptors: ER+ HER2±

prognosis: intermediate

mention HER2 enriched receptors and prognosis

receptors: HER2+

prognosis: aggressive but treatable

mention triple negative receptors and prognosis

receptors: ER- PR- HER2-

prognosis: worst

why does the male breast carcinoma have bad prognosis?

due to early invasion of the chest wall