breast surgical pathology

1. Surgical Pathology
Breast
Department of General Surgery
Cairo University

2. Fibrocystic Breast
• Exact cause is not known
• It is thought to represent an aberration of the normal changes
that take place in a healthy breast

3. Fibrocystic Breast
• Breast mass excised
because of suspicion of
malignancy
• Grossly the cut section
shows areas of fibrosis and
multiple cysts
• Fibrosis that surrounds a
tense cyst give a clinical
feeling of a hard mass
Cut section

4. Fibrocystic Breast
• Microscopically there are also
adenosis (non-neoplastic
glandular hyperplasia) and
epitheliosis (epithelial
hyperplasia within the small
ducts)
• This is likely to be an
operative specimen as
excision biopsy is
recommended for masses
suspicious of malignancy
Cut section

5. Fibrocystic Breast
• Fibrocystic breast changes rarely turn malignant.
However, if the pathologist reports “atypical
epithelial hyperplasia”, regular follow-up is
recommended as this form may turn malignant
• The 4 components of a fibrocystic breast are:
– Adenosis
– Epitheliosis
– Fibrosis
– Cyst formation

6. Chronic Breast Abscess
• Surgical specimen from the
breast.
• Notice the yellow fat
lobules, the very thick
fibrous wall and the central
cavity.
• DD includes:
 Cancer with central breakdown
 Chronic breast abscess,
 Plasma cell mastitis (duct
ectasia)

7. Fibroadenoma
• Benign neoplasm of both
fibrous and glandular elements
of the breast
• Note how it is easily
enucleated at surgery because
it is well-encapsulated, i.e., it
does not invade the
surrounding tissues (clinically
freely mobile)

8. Fibroadenoma
• This specimen
demonstrates the intact
capsule
• The surface may be smooth
or lobulated, as in this case
• The cut section bulges
forwards, in contrast to that
of a cancer mass
Cut section

9. Breast Cancer
• Excision biopsy specimen of a mass
from a female breast
• Mass is grey and is surrounded
with a rim of healthy yellow breast
tissue
• No capsule. Poorly-defined edge
• Gave a griity sensation when cut
• Cut surface retracts in
Cut section

10. Breast Cancer
• Notice the gross infiltration
of the surrounding breast
tissue.
• Some cancers grossly give a
false impression of a
capsule. This is particularly
true of renal cell carcinoma
and some thyroid cancers.
Invasion is confirmed
microscopically
Cut section

11. Breast Cancer
• Female breast with underlying
pectoral muscle. The specimen
is bisected longitudinally
• Nipple is retracted and there is
an irregular underlying grayish
mass
• Mass has no capsule and its cut
surface retracts back
• An enlarged axillary lymph
node is seen
• This is a classic radical
mastectomy specimen
Pectoralis
major
Lymph
node
mass

12. Breast Cancer
Mastectomy specimen that
contains a cancer mass
•Breast cancer may arise from
the lobules or the ducts
•The tumour arises from duct
epithelium in the majority of
cases
•It may remain within the
epithelium (in situ) or, more
frequently, it invades (infiltrates)
the basement membrane
•Invasive duct carcinoma is the
commonest histological type

13. Breast Cancer
Mastectomy specimen
Locally advanced cancer
because of extensive skin
infiltration

14. Breast Cancer
Paget’s disease of the nipple is a variant of duct carcinoma but
the tumour arises from one of the ducts as it opens on the
nipple. It presents with nipple erosion