“ Strength does not come from winning. Struggles & Hardship develop your strength. When you go through hardship and decide...
Pathology of Breast Cancer Dr. Venkatesh M. Shashidhar Senior Lecturer in Pathology Fiji School of Medicine
Introduction <ul><li>Modified sweat glands. </li></ul><ul><li>Lobes and lobules of gland  </li></ul><ul><li>in fat tissue ...
Normal Breast
Myoepithelial Cells  (ipx)
Disorders <ul><li>Congenital </li></ul><ul><ul><li>Aplasia – turners, Juvenile hypertrophy </li></ul></ul><ul><li>Inflamma...
Fibrocystic Disease <ul><li>Fibroadenosis, Fibrocystic change, etc. </li></ul><ul><li>Commonest lump, 10-50% women </li></...
Benign Neoplasms: <ul><li>Fibroadenoma  </li></ul><ul><li>Duct Papilloma </li></ul><ul><li>Adenoma </li></ul><ul><li>Conne...
Breast Carcinoma  <ul><li>20% of all cancers in women </li></ul><ul><li>Commonest cause of death - 35-55y </li></ul><ul><l...
Risk Factors: <ul><li>Female sex..!,  Age, Obesity, high fat diet  </li></ul><ul><li>Maternal relative with breast cancer....
Etiology of Breast Carcinoma:
Clinical Features: <ul><li>Physiologic vs Pathologic changes </li></ul><ul><li>Lump / lumps </li></ul><ul><li>Lumps are mu...
Diagnosis: <ul><li>Mammorgraphy </li></ul><ul><li>Ultrasound </li></ul><ul><li>Fine Needle Aspiration Biopsy </li></ul><ul...
Histological Types Histologic Type Freq. (UK) Infiltrating   Duct   Ca 63.6 (75) Lobular Carcinoma 5.9 (10) Infiltrating  ...
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: <ul><li>Estrogen receptor expression is proportional to differntiation of tumor </li></ul><...
HER2 <ul><li>The HER2 proto-oncogene encodes a cell surface receptor that is overexpressed in approximately 25%-30% of bre...
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 ...
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Pathology+of+breast+carcinoma+fsm.ac.fj

  1. 1. “ 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
  2. 2. Pathology of Breast Cancer Dr. Venkatesh M. Shashidhar Senior Lecturer in Pathology Fiji School of Medicine
  3. 3. Introduction <ul><li>Modified sweat glands. </li></ul><ul><li>Lobes and lobules of gland </li></ul><ul><li>in fat tissue stroma. </li></ul><ul><li>Ducts emerge from acini of glands </li></ul><ul><li>Smaller ducts join to form lactiferous ducts </li></ul><ul><li>Lactiferous ducts merge just beneath the nipple to form a lactiferous sinus. </li></ul><ul><li>Then individually open on nipple </li></ul>
  4. 4. Normal Breast
  5. 5. Myoepithelial Cells (ipx)
  6. 6. Disorders <ul><li>Congenital </li></ul><ul><ul><li>Aplasia – turners, Juvenile hypertrophy </li></ul></ul><ul><li>Inflammatory </li></ul><ul><ul><li>Infections acute/chronic – Trauma Fat necrosis </li></ul></ul><ul><ul><li>Duct ectasia discharge, sinus </li></ul></ul><ul><ul><li>Fibrocystic disease – common – painful lumps </li></ul></ul><ul><li>Neoplastic </li></ul><ul><ul><li>Benign - Fibroadenoma </li></ul></ul><ul><ul><li>Malignant – Ca </li></ul></ul>
  7. 7. Fibrocystic Disease <ul><li>Fibroadenosis, Fibrocystic change, etc. </li></ul><ul><li>Commonest lump, 10-50% women </li></ul><ul><li>? Hormonal </li></ul><ul><li>Periodic discomfort – pain. </li></ul><ul><li>Eipethilial hyperplasia – premalignant </li></ul><ul><li>Irregular palpable lumps – mimic ca. </li></ul><ul><ul><li>Adenosis – hyperplasia - cysts – papillomatosis – metaplasia – fibrosis. </li></ul></ul>
  8. 8. Benign Neoplasms: <ul><li>Fibroadenoma </li></ul><ul><li>Duct Papilloma </li></ul><ul><li>Adenoma </li></ul><ul><li>Connective tissue tumors </li></ul><ul><li>Features (Fibroadenoma) </li></ul><ul><ul><li>Young age 3 rd decade. </li></ul></ul><ul><ul><li>Single, rounded, mobile, painless lumps. </li></ul></ul><ul><ul><li>No scarring or calcification. </li></ul></ul><ul><ul><li>Slit like glands in Fibrous stroma </li></ul></ul>
  9. 9. Breast Carcinoma <ul><li>20% of all cancers in women </li></ul><ul><li>Commonest cause of death - 35-55y </li></ul><ul><li>In UK 1 in 10-12 chances </li></ul><ul><li>1 in 8 women in US </li></ul><ul><li>Less incidence in Asia </li></ul><ul><li>Majority of cancers arise in the ducts. </li></ul><ul><li>Very rare before age 25 </li></ul>
  10. 10. Risk Factors: <ul><li>Female sex..!, Age, Obesity, high fat diet </li></ul><ul><li>Maternal relative with breast cancer. </li></ul><ul><li>Longer reproductive span. </li></ul><ul><li>Nulliparity, Oral contraceptives </li></ul><ul><li>Later age at first pregnancy. </li></ul><ul><li>Atypical epithelial hyperplasia. </li></ul><ul><li>Previous breast cancer/Endometrial Ca. </li></ul><ul><li>Geographic factors - country </li></ul><ul><li>BRCA1 and BRCA2 genes </li></ul>
  11. 11. Etiology of Breast Carcinoma:
  12. 12. Clinical Features: <ul><li>Physiologic vs Pathologic changes </li></ul><ul><li>Lump / lumps </li></ul><ul><li>Lumps are much more common than Ca </li></ul><ul><li>Characters of lump * and age * </li></ul><ul><li>Discharge in many conditions. </li></ul><ul><li>Hard, soft, inflammation </li></ul><ul><li>Skin fixation / Skin retraction * </li></ul>
  13. 13. Diagnosis: <ul><li>Mammorgraphy </li></ul><ul><li>Ultrasound </li></ul><ul><li>Fine Needle Aspiration Biopsy </li></ul><ul><li>Core Biopsy </li></ul><ul><li>Excision Biopsy </li></ul><ul><li>Frozen section </li></ul><ul><li>Immunoperoxidase, </li></ul><ul><li>Molecular techniques – Gene detection. </li></ul>
  14. 14. 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%
  15. 15. Breast Carcinoma
  16. 16. Breast Carcinoma
  17. 17. Breast Carcinoma - Schirrous
  18. 18. Infiltrating Duct Carcinoma: small hard
  19. 19. Medullary Carcinoma: Large soft
  20. 20. Infiltrating Duct Carcinoma
  21. 21. Infiltrating Duct Carcinoma
  22. 22. Medullary Carcinoma: Inflammation.
  23. 23. Infiltrating Duct Carcinoma: Fibrosis
  24. 24. Schirrous Carcinoma
  25. 25. Medullary Carcinoma Soft, inflammatory cells
  26. 26. Intraductal in-situ Carcinoma
  27. 27. Lobular Carcinoma
  28. 28. Intraduct Carcinoma-in-situ
  29. 29. Intraduct Carcinoma
  30. 30. Lymphatic spread – Peu-de Orange..
  31. 31. Spread of Breast Carcinoma:
  32. 32. Pagets Disease
  33. 33. Pagets Disease (Epidermal invasion)
  34. 34. Estrogen Receptor & Prognosis: <ul><li>Estrogen receptor expression is proportional to differntiation of tumor </li></ul><ul><li>inversly proportional to prognosis and response to tamoxifen (receptor antagonist) therapy. </li></ul><ul><li>Demonstrated by Immunoperoxidase special stain. </li></ul>
  35. 35. HER2 <ul><li>The HER2 proto-oncogene encodes a cell surface receptor that is overexpressed in approximately 25%-30% of breast cancers. </li></ul><ul><li>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. </li></ul>
  36. 36. Estrogen receptor (ER) in nuclei
  37. 37. Immunoperoxidase Positivity Neg 1+ 2+ 3+
  38. 38. 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
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