Breast cancer pathology ( Ref: bailey & love 26th edition ) -
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Breast cancer pathology ( Ref: bailey & love 26th edition ) -



pathology of breast cancer ...

pathology of breast cancer

ductal carcinoma , lobular carcinoma
In situ , Invasiv , vannusclassification
paget disease
inflammatory cancer
local , lymphatic , blood spreading & metastasis



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Breast cancer pathology ( Ref: bailey & love 26th edition ) - Breast cancer pathology ( Ref: bailey & love 26th edition ) - Presentation Transcript

  • NORMAL HISTOLOGY OF THE BREAST  2 cell types :–  line ducts  lobules. 1. Contractile MYOEPITHELIAL CELLS  lie on the BM  assist in milk ejection during lactation & provides structural support to the lobules 2. EPITHELIAL CELLS  Luminal – produce milk.  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 three grades: • well differentiated, • moderately differentiated or • poorly differentiated.
  • • Ductal carcinoma is the most : common variant with lobular carcinoma • 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 lobular features. • 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 lymphocytic reaction, • tubular carcinoma. • Invasive lobular carcinoma is commonly multifocal and/or bilateral, hence the increasing use of MRI for assessment. •
  • • Inflammatory carcinoma • Rare • 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 cells.
  • 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 treatment.
  • Staining for oestrogen and progesterone receptors : • now considered routine, • their presence : • Rx : adjuvant hormonal therapy with tamoxifen or an aromatase inhibitor 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 clinically evident • nipple eczema : should be biopsied if there is any doubt about its cause.
  • • Microscopically: • characterised by : the presence of : • large, ovoid cells with abundant, clear, palstaining cytoplasm • in the Malpighian layer of the epidermis.
  • The spread of breast cancer : • Local • Lymphatic • 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 ovaries.