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    Pathology+of+breast+carcinoma+fsm.ac.fj Pathology+of+breast+carcinoma+fsm.ac.fj Presentation Transcript

    • “ Strength does not come from winning. Struggles & Hardship develop your strength. When you go through hardship and decide not to surrender, that is strength” Arnold Schwarzenegger Bodybuilder and Actor
    • Pathology of Breast Cancer Dr. Venkatesh M. Shashidhar Senior Lecturer in Pathology Fiji School of Medicine
    • Introduction
      • Modified sweat glands.
      • Lobes and lobules of gland
      • in fat tissue stroma.
      • Ducts emerge from acini of glands
      • Smaller ducts join to form lactiferous ducts
      • Lactiferous ducts merge just beneath the nipple to form a lactiferous sinus.
      • Then individually open on nipple
    • Normal Breast
    • Myoepithelial Cells (ipx)
    • Disorders
      • Congenital
        • Aplasia – turners, Juvenile hypertrophy
      • Inflammatory
        • Infections acute/chronic – Trauma Fat necrosis
        • Duct ectasia discharge, sinus
        • Fibrocystic disease – common – painful lumps
      • Neoplastic
        • Benign - Fibroadenoma
        • Malignant – Ca
    • Fibrocystic Disease
      • Fibroadenosis, Fibrocystic change, etc.
      • Commonest lump, 10-50% women
      • ? Hormonal
      • Periodic discomfort – pain.
      • Eipethilial hyperplasia – premalignant
      • Irregular palpable lumps – mimic ca.
        • Adenosis – hyperplasia - cysts – papillomatosis – metaplasia – fibrosis.
    • Benign Neoplasms:
      • Fibroadenoma
      • Duct Papilloma
      • Adenoma
      • Connective tissue tumors
      • Features (Fibroadenoma)
        • Young age 3 rd decade.
        • Single, rounded, mobile, painless lumps.
        • No scarring or calcification.
        • Slit like glands in Fibrous stroma
    • Breast Carcinoma
      • 20% of all cancers in women
      • Commonest cause of death - 35-55y
      • In UK 1 in 10-12 chances
      • 1 in 8 women in US
      • Less incidence in Asia
      • Majority of cancers arise in the ducts.
      • Very rare before age 25
    • Risk Factors:
      • Female sex..!, Age, Obesity, high fat diet
      • Maternal relative with breast cancer.
      • Longer reproductive span.
      • Nulliparity, Oral contraceptives
      • Later age at first pregnancy.
      • Atypical epithelial hyperplasia.
      • Previous breast cancer/Endometrial Ca.
      • Geographic factors - country
      • BRCA1 and BRCA2 genes
    • Etiology of Breast Carcinoma:
    • Clinical Features:
      • Physiologic vs Pathologic changes
      • Lump / lumps
      • Lumps are much more common than Ca
      • Characters of lump * and age *
      • Discharge in many conditions.
      • Hard, soft, inflammation
      • Skin fixation / Skin retraction *
    • Diagnosis:
      • Mammorgraphy
      • Ultrasound
      • Fine Needle Aspiration Biopsy
      • Core Biopsy
      • Excision Biopsy
      • Frozen section
      • Immunoperoxidase,
      • Molecular techniques – Gene detection.
    • Histological Types Histologic Type Freq. (UK) Infiltrating Duct Ca 63.6 (75) Lobular Carcinoma 5.9 (10) Infiltrating Ductal & Lobular Ca 1.6 Medullary Carcinoma 2.8 (3) Mucinous (colloid) Carcinoma 2.1 (3) Comedocarcinoma 1.4 Carcinoma-In-Situ 5%
    • Breast Carcinoma
    • Breast Carcinoma
    • Breast Carcinoma - Schirrous
    • Infiltrating Duct Carcinoma: small hard
    • Medullary Carcinoma: Large soft
    • Infiltrating Duct Carcinoma
    • Infiltrating Duct Carcinoma
    • Medullary Carcinoma: Inflammation.
    • Infiltrating Duct Carcinoma: Fibrosis
    • Schirrous Carcinoma
    • Medullary Carcinoma Soft, inflammatory cells
    • Intraductal in-situ Carcinoma
    • Lobular Carcinoma
    • Intraduct Carcinoma-in-situ
    • Intraduct Carcinoma
    • Lymphatic spread – Peu-de Orange..
    • Spread of Breast Carcinoma:
    • Pagets Disease
    • Pagets Disease (Epidermal invasion)
    • Estrogen Receptor & Prognosis:
      • Estrogen receptor expression is proportional to differntiation of tumor
      • inversly proportional to prognosis and response to tamoxifen (receptor antagonist) therapy.
      • Demonstrated by Immunoperoxidase special stain.
    • HER2
      • The HER2 proto-oncogene encodes a cell surface receptor that is overexpressed in approximately 25%-30% of breast cancers.
      • Trastuzumab (Herceptin®) is the first monoclonal antibody that targets the extracelluar domain of the HER2 protein, and inhibits growth of breast cancer cells that over express this protein.
    • Estrogen receptor (ER) in nuclei
    • Immunoperoxidase Positivity Neg 1+ 2+ 3+
    • Stag Definition 5-year Surv (%) 7-year Surv (%) I Tumor 2 cm or less without spread 96 92 II Tumor 2-5cm with regional lymph node involvement but without distant metastases, OR > 5 cm in diameter without spread 81 71 III Any size with skin/chest wall fixation, & axillary or internal mammary nodal involvement, without distant metastases 52 39 IV Tumor of any size with or without regional spread but with evidence of distant metastases 18 11