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Category Archives: Breast
Breast Carcinoma In Situ
Breast Carcinoma In Situ
Histologic classification
DCIS
o Solid
o Cribriform
o Papillary
o Micropapillary
o Comedocarcinoma
o Cystic hypersecretory
o Apocrine
o Neuroendocrine
o Signet ring
LCIS
Microscopic features of comedocarcinoma type
· Solid sheets of pleiomorphic cells with high-grade nuclei, at least 3 times the size of an erythrocyte, and central necrosis
· The necrotic cell membranes sometimes calcify (seen on mammography as linear and branching, or as clusters)
· Periductal concentric fibrosis and chronic inflammation are common
Clinical behaviour and prognosis
· Will progress to invasive carcinoma if left untreated (10 times the risk of the normal population)
· DCIS treated with mastectomy is curative in >95% of cases
· Deaths from DCIS in treated women are very rare (<2%)
· Prognosis is based on:
o Grade
o Size
o Margins
Posted in Breast
Tagged , Breast Carcinoma In Situ, Ductal carcinoma in situ, Lobular carcinoma in situ
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Breast Cytology
Breast Cytology
Fine-needle aspiration cytology of the breast
Adequacy criteria
• For solid nodules
o At least 6-10 clusters of epithelial cells containing 5-10 cells per cluster
o Triple test should be applied in each case
• For cystic lesions
o Need for presence of epithelial cells is waived since the large majority of cystic lesions in mammary tissue are benign
o Presence of foamy macrophages +/- apocrine metaplastic cells is enough to establish adequacy
Causes of false-positive diagnosis of ductal carcinoma
• Radiation changes
• Apocrine metaplastic cells
• Lactational changes
• Inflammatory lesions
• Fibroadenomas with atypical features
• Epithelial proliferations (hyperplasia)
• Phyllodes tumours
Causes of false-negative diagnosis of ductal carcinoma
• Inadequate sampling of lesion
• Missed lesion
• Extensive fibrosis
• Well differentiated tumors (Grade 1 tumors)
Characteristic findings of fibroadenoma
• Cellular sample with background of bare nuclei
• Large, hyperplastic, cohesive sheets of ductal epithelium demonstrating branching, “antler” arrangement
• Stromal fragments of low cellularity
Posted in Breast
Tagged , Breast cytology, Breast cytology adequacy, Breast FNA, Fibroadenoma cytology, Fine needel aspiration breast, FNA breast
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Synoptic Report Ductal Carcinoma In Situ
Synoptic Report Features Ductal Carcinoma In Situ
What should be included in a report on DCIS
• Histologic type of DCIS
• Grade of DCIS; presence/absence of central necrosis
• Size of DCIS
• Presence/absence of invasive carcinoma
• Presence/absence of margin involvement; distance to closest margin
• Presence/absence of microcalcifications
• Hormone receptor status
• Involvement of lymph nodes (if lymph nodes taken)
Lobular Carcinoma In Situ
Lobular Carcinoma In Situ
LCIS
Histological features
• Small cells with round to oval nuclei and inconspicuous nucleoli
• Cells exhibit dyscohesion
• Some cells may demonstrate intracytoplasmic lumina
• Cells fill up >50% of the lobule and cause its marked distension
Lobular Carcinoma In Situ Prognosis and Clinical Issues
• Thought to be a “marker” of risk for breast carcinoma; often bilateral and multicentric
• Women with LCIS develop breast cancer at a frequency similar to women with untreated DCIS
• Over a 20 year period, 20-35% of women with LCIS developed breast carcinoma (at a rate of 1% per year)
• Older studies indicated that both breasts were at equal risk, however recent studies indicate that ipsilateral breast may be at greater risk
• Women with LCIS have a 3-fold greater likelihood of developing invasive lobular carcinoma, but majority do not generally show lobular morphology
Clinical management
• Treatment options include prophylactic bilateral mastectomy, tamoxifen, or close surveillance and mammographic screening
Posted in Breast
Tagged , breast cancer, Breast cancer precursor, LCIS, Lobular carcinoma in situ, Lobular carcinoma in situ breast
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Invasive Lobular Carcinoma
Breast Invasive Lobular Carcinoma
Architectural features
1. Malignant cells that infiltrate breast tissue in single file
2. “Targetoid” pattern of growth (cells arranged in concentric rings around preserved ductal elements)
3. Signet-ring like morphology
Cytological features
1. Cellular dyscohesion
2. Intracytoplasmic lumina
3. Small cells with less cytoplasm, less nuclear pleomorphism than ductal carcinoma, inconspicuous nucleoli
Genetic changes
1. Loss of E-cadherin
2. ?loss of beta-catenin
3. ?BRCA2 (recall BRCA1 have medullary/basal cell pattern)
Other special types of breast cancer with relatively good prognosis
1. Tubular carcinoma
2. Mucinous carcinoma
3. Infiltrating cribriform carcinoma
Posted in Breast
Tagged breast lobular, breast lobular cancer, E-cadherin, Invasive Lobular Carcinoma, lobular
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Papillary Lesions
Breast Papillary Lesions
Features that differentiate papillary carcinoma from papillary carcinoma in situ (or papillary carcinoma in situ from papilloma?)
Papillary carcinoma in situ versus papilloma
- Monomorphism of cells (one cell population vs. two) with lack of myoepithelial cells
- Concurrent DCIS in surrounding breast tissue
- Nuclear hyperchromasia, high N:C ratio, pleomorphism, mitotic figures
- Delicate papillary structures with lack of apocrine metaplasia, presence of rigid cribriform/trabecular architecture
Management if a diagnosis of papillary lesion is made on core biopsy?
Excision of the lesion with histologic examination is key (ie. rule out concurrent invasive carcinoma should lesion turn out to be papillary DCIS)
Further management dependent on histologic diagnosis (ie. papilloma: no further management other than excision; papillary DCIS: excision with clear margins, hormonal therapy, radiotherapy; invasive papillary carcinoma: excision with clear margins with sentinel lymph node dissection, radiotherapy, +/- hormonal therapy, +/- chemotherapy)
Histologic features of florid nipple adenomatosis (nipple adenoma)
Rounded outline with haphazardly arranged proliferating tubular structures surrounded by fibrous stroma
Abrupt junction between proliferating tubular glands and squamous epithelium of skin
Two cell types (epithelial and myoepithelial); epithelial cells are columnar/cuboidal, +/- apocrine or squamous metaplasia
No evidence of cribriform architecture or luminal bridging
Epithelium may be hyperplastic, but no evidence of atypia; stroma is benign
Clinical presentations of florid nipple adenomatosis (nipple adenoma)
Soreness, swelling, ulceration, crusting of nipple (may simulate Paget’s disease)
Bloody discharge from nipple
Posted in Breast
Tagged , breast core biopsy, breast papilloma, florid nipple adenomatosis, nipple adenoma, papillary carcinoma, papillary carcinoma in situ, papillary lesion
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Ductal carcinoma in situ
In situ diseases of the breast
Ductal carcinoma in situ (DCIS)
Ductal carcinoma in situ is a malignant population of ductal cells limited to ducts and lobules by the basement membrane. A clonal proliferation which usually involves a single ductal system.
Types of ductal carcinoma in situ (DCIS)
1. Comedocarcinoma
2. Cribriform DCIS
3. Papillary DCIS
4. Micropapillary DCIS
5. Solid DCIS
6. Cystic hypersecretory DCIS
Paget’s Disease
Paget’s Disease
Posted in Breast, Skin
Tagged , breast cancer, epidermis cancer skin, extramammary paget's disease, milk lines, paget disease, Paget's disease, skin cancer
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Cancer Calcifications
Cancer Calcifications
Posted in Breast, Cancer, Prostate
Tagged , Breast, calcification, calcifications, Cancer, carcinoma, detection, Prostate
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