Breast Pathology .pdf

breast lesions

1. LESIONS OF BREAST
DRMANJULANMBBS
MD(Pathology)

2. ANATOMY OF BREAST
Clinical notes onbreast
cancer:
1.Majority ofcancers
develop in upper
outerquadrant
2.Largeamountof
glandulartissue
here
3.An axillary tail of
breast tissue often
extends intoaxilla

3. ANATOMY OF
BREAST

4. BENIGN LESIONS OF BREAST

5. BENIGN LESIONS
1.Fibroadenoma
2.Phyllodes tumour
3.Ductal hyperplasia
4.Lipoma

6. A fibroadenoma is a smooth, discrete breast lump consisting of fibrous and adenomatous
(glandular) tissue. It is firm and mobile that it appears to shift position and is commonly
referred to as a ‘breastmice’.

7. ❑Fibroadenomas are the second most common solid tumor
after breast cancer and most common benign tumor in
women.
❑Painless, firm, solitary, mobile, slowly growing breast mass.
❑It is the most common breast tumor in young women usually
under 30 years of age and growth may be accelerated
during pregnancy.
❑It is usually detected when it is 2 or 3 cm in size.
❑Fibroadenomas can cause drastic asymmetrical growth of
the breast.
❑When larger than 5 cm, they are classified as Giant
Fibroadenomas.

8. CLINICAL FEATURES
▪The typical presentation is in a woman of reproductive age with a mobile palpable
breast lump.
▪Due to their hormonal sensitivity, the fibroadenoma commonly enlarges during
pregnancy and involute atmenopause.
▪Hence, they rarely present after the age of 40years.
▪The lesions are well defined and well circumscribed clinically and the overlying skin is
normal.
▪The lesions are not fixed to the surrounding parenchyma and slip around underthe
palpating hand, hence the colloquial term a breast‘mouse’.

9. GROSS FEATURES
➢Round
➢Well encapsulated
➢Greyish white
➢Solitary
➢Firm consistency
➢Nodular
➢1-5cm diameter

10. MICROSCOPY

11. INVESTIGATIONS
1.Mammogram
2.Ultrasound
3.Fine needle aspiration cytology

12. MANAGEMENT
1.Lumpectomy
2.Cryoablation
3.Ultrasound guided percutaneous suctioning

13. PHYLLODES TUMOUR
It is formed by excessive proliferation of stroma over ductal element.
The proliferating stroma gives rise to leaf like appearance.

14. INTRODUCTION
▪Also known as cystosarcoma phylloides or Brodie’s tumour.
▪It’s not a sarcoma but may recur locally after simple excision.
▪It does not metastasize.
▪It is presents in middle-aged female.
▪It can be only distinguished on histology.
▪Overlying skin may go necrosis.
▪Recurrence is seen commonly
▪High grade tumours show metastasis
▪Metastasis can be via blood stream to lungs and bones
▪Lymph node metastasis is rare.

15. GROSS AND MICROSCOPY
Gross:
•Round to oval mass
•Well circumscribed
•Encapsulated
•Vary in size
Microscopy:
•Slit like compressed glands
•Leaf like stromal proliferation

16. MALIGNANT TUMOURS OF
BREAST

17. INTRODUCTION
▪It the most commonly diagnosed cancer in women (29.9 % of all new cancers).
▪Breast cancer is the commonest cancer in all ethnic groups and in all age groups in
females from the age of 15 years onwards.
▪The incidence of breast cancer increased steadily starting from age of 30 years with a
peak age specific incidence rate in the 50 - 59 age groups.
▪The incidence rate then declined in the older age groups.

18. RISK FACTORS
1.GENDER
Female has higher risk to develop breast cancer than their male
counterparts.
2.AGE
The risk increases from the age of 40 years old for pre-menopausal group
and 50 years old for the post-menopausal group.

19. RISK FACTORS
3.HISTORY OF NEOPLASTIC DISEASE OF THE BREAST
a.Prior history of breast cancer carries an elevated risk of developing new
primary breast cancer.
b.Person with breast carcinoma in situ (lobular carcinoma in situ and ductal
carcinoma in situ) are at high risk to develop invasive breast carcinoma.
c.Person with breast tissue biopsy showing proliferative disease with and without
atypical cells has an increased risk to develop future breast cancer.
d.Benign breast disease with atypical hyperplasia lesion carries the highest risk to
develop breast cancer.

20. RISK FACTORS
4. FAMILY HISTORY
a.Family history of breast cancer is an independent risk factor.
b.The risk is higher in women with breast cancer among young first-
degree relatives.
c.Sister carries more risk than mother
d.Carriers of BRCA1 and BRCA2 genetic mutation are at high risk
to develop future breast cancer.

21. RISK FACTORS
5.Reproductive Factors
6.Breast Density
7.Life style
8.Previous radiation exposure
9.Hormonal Factors

22. PATHOPHYSIOLOGY

24. METASTASIS
▪The skeleton - especially the lumbar spine, causing back pain and reduced spinal
movements, and pathological fractures in the long bones. There may be paraplegia
from cord compression.
▪The lungs - causing pleural effusions. Lung parenchymal involvement, in the form of
diffuse lymphatic movement known as lymphangitis carcinomatoses, may cause
severe dyspnea
▪The liver - making it palpable and causing jaundice and ascites
▪The skin - producing multiple hard nodules within the skin. These are usually in the
skin of the breast containing the cancer, but may be seen in the neck, trunk and
further away.
▪The brain - producing any variety of neurological symptoms and signs.

25. INVASIVE DUCTAL CARCINOMA, NOS
Most common cancer of breast
Also known as Scirrhous carcinoma
Morphologically no typical character
seen
Cannot be classified into a specific
type
Gross:
Generally 2-3cm in diameter but
can be massive.
Commonly arise in upper outer
quadrant
Grey white cut surface
Hard in consistency
Gritty, well circumscribed, nodular
Can show nipple areolar ulceration

26. PROGNOSTIC FACTORS
1.Tumour staging
2.Histologic grade
3.Oestrogen and progesterone receptors
4.Oncogene expression

27. SCREENING AND DIAGNOSIS
1.Breast cancer screening programme – screening mammography
2.FNAC
3.Core biopsy
4.Frozen section
Also awareness among the general population is very
important for early diagnosis and treatment.

28. THANK YOU