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

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  • 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. Pathology of Breast Cancer Dr. Venkatesh M. Shashidhar Senior Lecturer in Pathology Fiji School of Medicine
  • 3. 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
  • 4. Normal Breast
  • 5. Myoepithelial Cells (ipx)
  • 6. 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
  • 7. 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.
  • 8. 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
  • 9. 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
  • 10. 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
  • 11. Etiology of Breast Carcinoma:
  • 12. 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 *
  • 13. Diagnosis:
    • Mammorgraphy
    • Ultrasound
    • Fine Needle Aspiration Biopsy
    • Core Biopsy
    • Excision Biopsy
    • Frozen section
    • Immunoperoxidase,
    • Molecular techniques – Gene detection.
  • 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. Breast Carcinoma
  • 16. Breast Carcinoma
  • 17. Breast Carcinoma - Schirrous
  • 18. Infiltrating Duct Carcinoma: small hard
  • 19. Medullary Carcinoma: Large soft
  • 20. Infiltrating Duct Carcinoma
  • 21. Infiltrating Duct Carcinoma
  • 22. Medullary Carcinoma: Inflammation.
  • 23. Infiltrating Duct Carcinoma: Fibrosis
  • 24. Schirrous Carcinoma
  • 25. Medullary Carcinoma Soft, inflammatory cells
  • 26. Intraductal in-situ Carcinoma
  • 27. Lobular Carcinoma
  • 28. Intraduct Carcinoma-in-situ
  • 29. Intraduct Carcinoma
  • 30. Lymphatic spread – Peu-de Orange..
  • 31. Spread of Breast Carcinoma:
  • 32. Pagets Disease
  • 33. Pagets Disease (Epidermal invasion)
  • 34. 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.
  • 35. 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.
  • 36. Estrogen receptor (ER) in nuclei
  • 37. Immunoperoxidase Positivity Neg 1+ 2+ 3+
  • 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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