Breast cancer is the most common cancer in women, affecting 1 in 9 women in the United States. It usually presents as a solitary, painless lump that is detected by self-examination. The incidence is highest in perimenopausal women and is rare before age 25. While the majority of breast cancers are invasive ductal carcinomas, other types include invasive lobular carcinoma, tubular carcinoma, medullary carcinoma, and Paget's disease of the nipple. Risk factors include family history, early menarche, late first childbirth, and genetic mutations such as BRCA1 and BRCA2.

1. TUMOUR OF THE
BREAST
DR. ROOPAM JAIN
PROFESSOR & HEAD, PATHOLOGY

2. • In the United States, carcinoma of the breast constitutes about 25% of
all cancers in females and causes approximately 20% of cancer deaths
among females.
• Cancer of the male breast, on the other hand, is quite rare and
comprises 0.2% of malignant tumours (ratio between male-female
breast cancer is 1:150).
• The incidence of breast cancer is highest in the perimenopausal age
group and is uncommon before the age of 25 years.

3. • Clinically, the breast cancer usually presents as a solitary, painless,
palpable lump which is detected quite often by selfexamination.
• Higher the age, more are the chances of breast lump turning out to be
malignant.
• Thus, all breast lumps, irrespective of the age of the patient must be
removed surgically. Currently, emphasis is on early diagnosis by triple
technique: palpation, mammography, and fine needle aspiration
cytology (FNAC). Additional techniques such as stereotactic biopsy and
frozen section are immensely valuable to the surgeon for immediate
pathological diagnosis in doubtful cases.

4. • Carcinoma of the breast is the most common cancer in women and
affects 1 in 9 women in the United States.
• It is also the second most common cause of cancer death.
• The incidence is increasing and is higher in the United States than in
Japan.

5. RISK (EPIDEMIOLOGIC) FACTORS
• 1. Geographic and racial factors
• 2. Family history
• First-degree relatives (mother, sister, daughter) of women with breast
cancer have 2 to 6-fold higher risk of development of breast cancer. The
risk is proportionate to a few factors:
a. Number of blood relatives with breast cancer.
b. Younger age at the time of development of breast cancer.
c. Bilateral cancers.
d. High risk cancer families having breast and ovarian carcinomas.

6. • Hereditary influences are thought to be involved in 5–10% of breast
cancers, with important genes as follows:
• • BRCA1 (error-free repair of DNA double-strand breaks) chromosome
17q21
• • BRCA2 (error-free repair of DNA double-strand breaks) chromosome
13q12.3
• • TP53 germline mutation (Li-Fraumeni syndrome)

7. RISK (EPIDEMIOLOGIC) FACTORS
• 3. Menstrual and obstetric history
• there is increased risk of breast cancer development in women who had
early menarche,
nulliparity,
late age of first childbirth and
delayed menopause.
• 4. Fibrocystic change
• Fibrocystic change, associated with atypical epithelial hyperplasia, has
about 5-fold higher risk of developing breast cancer subsequently.

8. RISK (EPIDEMIOLOGIC) FACTORS
• 5. Miscellaneous factors - environmental influences and dietary
factors associated with increased risk of breast cancer:
• i) Consumption of large amounts of animal fats, high calorie foods.
• ii) Cigarette smoking.
• iii) Alcohol consumption.
• iv) Breast augmentation surgery.
• v) High breast density.
• vi) Exposure to ionising radiation during breast developement.

9. Topographic considerations in breast cancer

10. • Carcinoma of the breast arises from the ductal epithelium in 90% cases
while the remaining 10% originate from the lobular epithelium.
• For variable period of time, the tumour cells remain confined within the
ducts or lobules (non-invasive carcinoma) before they invade the breast
stroma (invasive carcinoma).
• While only 2 types of non-invasive carcinoma have been described—
• intraductal carcinoma
• lobular carcinoma in situ.

11. Classification of carcinoma of the breast

12. A. NON-INVASIVE (IN SITU) BREAST
CARCINOMA
• In general, two types of non-invasive or in situ carcinoma
intraductal carcinoma
& lobular carcinoma in situ
• characterised histologically by presence of tumour cells within the ducts
or lobules respectively
• without evidence of invasion.

13. Intraductal Carcinoma
• Intraductal Carcinoma Carcinoma in situ confined within the larger
mammary ducts is called intraductal carcinoma
• Clinically, it produces a palpable mass in 30-75% of cases and
presence of nipple discharge in about 30% patients.
• Approximately a quarter of patients of intraductal carcinoma treated
with excisional biopsy alone

14. Intraductal Carcinoma
MORPHOLOGIC FEATURES Grossly
• may vary from a small poorly-defined focus to 3-5 cm diameter mass.
• On cut section, the involved area shows cystically dilated ducts
containing cheesy necrotic material (in comedo pattern), or the
intraductal tumour may be polypoid and friable resembling intraductal
papilloma (in papillary pattern).

15. Intraductal Carcinoma
MORPHOLOGIC FEATURES
Histologically
• the proliferating tumour cells within the ductal lumina may have 4 types
of patterns in different combinations:
• solid,
• comedo,
• papillary and
• cribriform (Fig.

17. Lobular Carcinoma in Situ
• Lobular carcinoma in situ is not a palpable or grossly visible tumour.
• Patients of in situ lobular carcinoma treated with excisional biopsy alone
develop invasive cancer of the ipsilateral breast in about 25% cases in
10 years

19. B. INVASIVE BREAST CARCINOMA
Infiltrating (Invasive) Duct Carcinoma-NOS
• Infiltrating duct carcinoma-NOS (not otherwise specified) is the classic
breast cancer
• most common histologic pattern accounting for 80% cases of breast cancer.
• Clinically, majority of infiltrating duct carcinomas have a hard consistency
due to dense collagenous stroma (scirrhous carcinoma).
• They are found more frequently in the left breast, often in the upper
outer quadrant.
• Retraction of the nipple and attachment of the tumour to
underlying chest wall may be present.

20. Infiltrating duct carcinoma-NOS.
The breast shows a tumour extending up to nipple and areola.
Cut surface shows a grey white firm tumour extending irregularly into
adjacent breast parenchyma.

21. Infiltrating duct carcinoma-NOS
Microscopic features - formation of solid nests, cords, gland-like structures
& intraductal growth pattern of anaplastic tumour cells. There is infiltration
of densely collagenised stroma by these cells in a haphazard manner

22. Infiltrating (Invasive) Lobular
Carcinoma
• Invasive lobular carcinoma comprises about 10% of all breast cancers.
• more frequently bilateral;
• and within the same breast,
• it may have multicentric origin.
• Histologically, there are 2 distinct features (Fig.
Tubular Carcinoma
Medullary Carcinoma

23. Medullary carcinoma breast
Microscopy shows two characteristic features—large tumour cells forming
syncytial arrangement and stroma infiltrated richly with lymphocytes

24. Infiltrating (Invasive) Lobular Carcinoma
Invasive lobular carcinoma.
Characteristic histologic features are: one cell wide files of round regular
tumour cells (‘Indian file’ arrangement) infiltrating the stroma and
arranged circumferentially around ducts in a target-like pattern.

25. Other Morphologic Forms
• 1. Papillary carcinoma
• 2. Adenoid cystic carcinoma
• 3. Secretory (Juvenile) carcinoma
• 4. Inflammatory carcinoma
• 5. Metaplastic carcinoma

26. C. PAGET’S DISEASE OF THE
NIPPLE
• Paget’s disease of the nipple is an eczematoid lesion of the nipple,
• often associated with an invasive or non-invasive ductal carcinoma of
the underlying breast.
• The nipple bears a crusted, scaly and eczematoid lesion with a palpable
subareolar mass in about half the cases.