Breast cancer pathology ( Ref: bailey & love 26th edition ) -
ABDULLHA TASKIN ABDULBARI
4TH YEAR MEDICAL STUDENT – SULAIMAN ALRAJHEE COLLGES
NORMAL HISTOLOGY OF THE BREAST
2 cell types :–
1. Contractile MYOEPITHELIAL
CELLS lie on the BM assist
in milk ejection during lactation
& provides structural support to
2. EPITHELIAL CELLS Luminal –
Epithelial & Myoepithelial cells
lie on the basement membrane.
Breast cancer may arise from the epithelium of the duct system
• anywhere from the nipple end of the major lactiferous ducts to the
terminal duct unit, which is in the breast lobule.
• The disease may be
• in situ
• Or : invasive cancer.
• The degree of differentiation of the tumour is usually described using
• well differentiated,
• moderately differentiated or
• poorly differentiated.
• Ductal carcinoma is the most : common variant with lobular
• occurring in up to 15 per cent of cases.
• There are sub- types of lobular cancer including:
• the classical type : which carries a better prognosis than
• the pleomorphic type.
• Occasionally, the picture may be mixed with both ductal and
• immunohistochemical : analysis using the e-cadherin antibody,
which reacts positively in lobular cancer, will help in diagnosis.
RARER HISTOLOGICAL VARIANTS
• colloid or mucinous carcinoma:
• whose cells produce abundant mucin,
• medullary carcinoma,
• with solid sheets of large cells often associated with a marked
• tubular carcinoma.
• Invasive lobular carcinoma is commonly multifocal and/or bilateral,
hence the increasing use of MRI for assessment.
• Inﬂammatory carcinoma
• highly aggressive cancer
• presents as a :
• painful, swollen breast, which is warm with cutaneous oedema.
• This is the result of :
• blockage of the subdermal lymphatics with carcinoma cells.
• Inﬂammatory cancer : usually involves at least one-third of the breast
and may mimic a breast abscess.
• A biopsy : will conﬁrm the diagnosis and show undifferentiated carcinoma
In situ carcinoma :
• is prei-nvasive cancer that has
• not breached the epithelial basement membrane.
• usually : asymptomatic, ﬁnding in breast biopsy specimens
• > 20 % of cancers detected by screening in the UK.
• In situ carcinoma may be:
• ductal (DCIS) or
• lobular (LCIS), the latter often being multi-focal and bilateral.
• Both are markers for the later development of invasive cancer,
• which will develop in at least 20 per cent of patients.
• mastectomy : is curative !!
DCIS may be classiﬁed using, the Van Nuys system
• which combines the patient’s :
• age, type of DCIS and presence of microcalciﬁca-tion, extent of
resection margin and size of disease.
• Patients with a high score : beneﬁt from radiotherapy after excision,
• low grade : whose tumour is completely excised, need no further
Staining for oestrogen and progesterone receptors :
• now considered routine,
• their presence :
• Rx : adjuvant hormonal therapy with tamoxifen or an aromatase
Staining for c-erbB2 (also known as HER-2/neu) :
• positive > Rx > : monoclonal antibody trastuzumab (Herceptin®),
Paget’s disease of the nipple :
• is a superﬁcial manifestation of an underlying breast carcinoma.
• It presents as :
• an eczema-like condition of the nipple and areola, which persists
despite local treatment.
• The nipple is eroded slowly and eventually disappears.
• If left, : the underlying carcinoma will sooner or later become
• nipple eczema : should be biopsied if there is any doubt about its
• characterised by : the presence of :
• large, ovoid cells with abundant, clear,
• in the Malpighian layer of the epidermis.
The spread of breast cancer :
• Blood stream
Local spread :
• The tumour increases in size
• and invades other portions of the breast.
• It tends to involve : skin , pectoral muscles and chest wall.
Lymphatic metastasis :
• primarily : to the axillary and the internal mammary lymph nodes.
• Tumours in the posterior one-third of the breast are to drain to :
• the internal mammary nodes.
• It represents :
• the spread of the carcinoma .
• marker for the metastatic potential of that tumour.
Spread by the bloodstream :
• It is by this route that skeletal metastases occur :
• the lumbar vertebrae, femur, thoracic vertebrae, rib and
skull are affected
• these deposits are generally osteolytic.
• Metastases may also commonly occur in :
• the liver, lungs and brain and, the adrenal glands and