Breast Pathology
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BREAST PATHOLOGY Objectives → Recognize non-neoplastic & neoplastic diseases of the female & male breast → Correlate clinical manifestations of breast diseases with the pathologic findings → Discuss the etiopathogenesis of common breast disease → Discuss the pathologic factors that affect prognosis & response to modalities of treatment Situation 1
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A 22 year old woman has given birth to a healthy term baby following an uncomplicated pregnancy. She has been breast feeding for 2 months & notices that her right breast has gradually become swollen & painful to touch over the past week. On physical examination her temperature is 38.20°C Gross: Which of the two pictures is compatible with the patient’s condition? Describe the lesions in the pictures. Give the basis of your choice A: Acute mastitis Swollen Erythematous Inflamed B: Inverted nipple Slide: Describe the two pictures. Which among the two correlates with patient’s condition? A: Acute mastitis: Presence of neutophilic infiltrates B: Malignant Give your diagnosis of the case: Acute mastitis What is the most common risk factor in the development of this lesion? Lactating & nursing women Unhygienic practices Staphylococcus aureus & streptococcus passes through cracks & fissures Give the complications if untreated Infection may spread to entire breast Abscess formation because of necrosis
Situation 2 → A 20 year old woman notes a mass in her right breast during self examination. Her physician confirms the presence of 2 x 1 cm well circumscribed moveable firm mass in the upper outer quadrant. There is no nipple discharge nor pain. No axillary lymphadenopathy is noted. The overlying skin of the breast appears normal. Mammography confirms the presence of rounded density with no microcalcifications. The mass is excised Upper outer quadrant: Most common site Density: Fibroadenoma, cysts, invasive CA
Gross: Briefly describe the two gross specimens. Which of the above is consistent with patient’s history & physical findings? Give reasons for you choice A: Non-neoplastic Encapsulated Rubbery Compact B: Fibrocystic change Fatty, nodules Neoplastic Slide: Match the lesions with previous gross specimens. Which of these two lesions is a tumor? Is the tumor malignant or benign? Give basis. Which of these lesions carries a greater risk of evolving into malignancy? Explain. Discuss the pathogenesis of these lesion A: Fibroadenoma Increased stroma: fibrous Obliterated ducts & acini Biphasic Hormonal exposure: Proliferation of a pre malignant lesion B Enlargement of lobule Dilatation Hyperplasia
Situation 3
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A 52 tear old woman feels a lump in her left breast. On physical examination, her physician palpates a 2.5 cm nonmovable hard mass. A biopsy was performed Non-movable mass: Infiltrating lesion Hard: fibrous Gross: Indicate & describe the lesion. Is it benign or malignant? Give the basis. White necrotic center: High rate of growth, tumor necrosis factor No distinct capsule Not distinguishable from surrounding tissue Slide: Which of the two lesions is consistent with the previous gross picture? Indicate & describe. The patient was advised mastectomy, but due to fear & anxiety, the patient went home to the province & was treated by a “herbolario”. Two years after she returns to Manila & seeks consultation
CHRABI
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Gross: This is how the breast looks like upon seeing by the attending physician. Describe the gross findings. Discuss the evolution of the lesion. Necrosis Inflammation Carcinoma What are the risk factors in the development of breast carcinoma Proliferative breast disease Radio exposure Longer reproductive age Family history Increasing age What are the tumor markers that would help in the diagnosis? CA 125 p53 What is the role of hormone receptor assays Receptivity to hormones: Estrogen receptor Receptivity to progesterone Give the most common pattern of spread of this tumor To the left axillary lymph nodes: Lymphatic spread
Situation 4
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A 42 year old male patient is diagnosed to have cirrhosis due to excess intake of alcohol for the past 20 years. His breasts are noted to be symmetrically enlarged Gross: Discuss the etiopathogenesis of the breast enlargement Liver is responsible for metabolizing estrogens Imbalance between estrogens which stimulate breast tissue & androgens which counteract these effects Slide: Describe the histologic picture of this patient’s breast? Is this benign or malignant? Proliferation of dense, periductal hyaline collagenous connective tissue Micropapillary hyperplasia of ductal linings Regular, columnar Lobule formation is rare
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A 22 year old woman has given birth to a healthy term baby following an uncomplicated pregnancy. She has been breast feeding for 2 months & notices that her right breast has gradually become swollen & painful to touch over the past week. On physical examination her temperature is 38.20°C Gross: Which of the two pictures is compatible with the patient’s condition? Describe the lesions in the pictures. Give the basis of your choice A: Acute mastitis Swollen Erythematous Inflamed B: Inverted nipple Slide: Describe the two pictures. Which among the two correlates with patient’s condition? A: Acute mastitis: Presence of neutophilic infiltrates B: Malignant Give your diagnosis of the case: Acute mastitis What is the most common risk factor in the development of this lesion? Lactating & nursing women Unhygienic practices Staphylococcus aureus & streptococcus passes through cracks & fissures Give the complications if untreated Infection may spread to entire breast Abscess formation because of necrosis
Situation 2 → A 20 year old woman notes a mass in her right breast during self examination. Her physician confirms the presence of 2 x 1 cm well circumscribed moveable firm mass in the upper outer quadrant. There is no nipple discharge nor pain. No axillary lymphadenopathy is noted. The overlying skin of the breast appears normal. Mammography confirms the presence of rounded density with no microcalcifications. The mass is excised Upper outer quadrant: Most common site Density: Fibroadenoma, cysts, invasive CA
Gross: Briefly describe the two gross specimens. Which of the above is consistent with patient’s history & physical findings? Give reasons for you choice A: Non-neoplastic Encapsulated Rubbery Compact B: Fibrocystic change Fatty, nodules Neoplastic Slide: Match the lesions with previous gross specimens. Which of these two lesions is a tumor? Is the tumor malignant or benign? Give basis. Which of these lesions carries a greater risk of evolving into malignancy? Explain. Discuss the pathogenesis of these lesion A: Fibroadenoma Increased stroma: fibrous Obliterated ducts & acini Biphasic Hormonal exposure: Proliferation of a pre malignant lesion B Enlargement of lobule Dilatation Hyperplasia
Situation 3
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A 52 tear old woman feels a lump in her left breast. On physical examination, her physician palpates a 2.5 cm nonmovable hard mass. A biopsy was performed Non-movable mass: Infiltrating lesion Hard: fibrous Gross: Indicate & describe the lesion. Is it benign or malignant? Give the basis. White necrotic center: High rate of growth, tumor necrosis factor No distinct capsule Not distinguishable from surrounding tissue Slide: Which of the two lesions is consistent with the previous gross picture? Indicate & describe. The patient was advised mastectomy, but due to fear & anxiety, the patient went home to the province & was treated by a “herbolario”. Two years after she returns to Manila & seeks consultation
CHRABI
→
→
→
→
→
Gross: This is how the breast looks like upon seeing by the attending physician. Describe the gross findings. Discuss the evolution of the lesion. Necrosis Inflammation Carcinoma What are the risk factors in the development of breast carcinoma Proliferative breast disease Radio exposure Longer reproductive age Family history Increasing age What are the tumor markers that would help in the diagnosis? CA 125 p53 What is the role of hormone receptor assays Receptivity to hormones: Estrogen receptor Receptivity to progesterone Give the most common pattern of spread of this tumor To the left axillary lymph nodes: Lymphatic spread
Situation 4
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A 42 year old male patient is diagnosed to have cirrhosis due to excess intake of alcohol for the past 20 years. His breasts are noted to be symmetrically enlarged Gross: Discuss the etiopathogenesis of the breast enlargement Liver is responsible for metabolizing estrogens Imbalance between estrogens which stimulate breast tissue & androgens which counteract these effects Slide: Describe the histologic picture of this patient’s breast? Is this benign or malignant? Proliferation of dense, periductal hyaline collagenous connective tissue Micropapillary hyperplasia of ductal linings Regular, columnar Lobule formation is rare
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