malignant breast diseases
TRANSCRIPT
Malignant Breast Diseases
Breast Cancer
• Most common site-specific cancer in women• Leading cause of death from cancer 20-59
years• Primary Breast Cancer– 80% productive fibrosis that involves epithelial
and stromal tissue– Skin retraction – shortening of Cooper’s
suspensory ligaments – Ulceration – invasion of the skin
Metastasis
• Axillary Lymph Node Metastasis– Via lymphatics– Level 1 (low) > level II (apical) > Level III (axillary)– Axillary LN status – most important prognostic
correlate of disease free and overall survival• Distant Metastasis– Neovascularization– Batson’s plexus of veins or axillary and intercostal
veins– Bone>lung>pleura>soft tissue>liver
Carcinoma In Situ
• Does not invade basement membrane
Lobular CIS
• Lobular CIS– Usually incidental finding– (-) calcification– Younger women– Histo
• Distention and distortion terminal duct lobular units• Cytoplasmic mucoid globules
– Almost always ER and PR (+)– Higher propensity to be bilateral– Sx: (B) prophylactic mastectomy, tamoxifen
Ductal CIS
• Ductal CIS– 15-30%– Mammogram calcification
• Papillary growth pattern• Cribiform growth pattern• Solid growth pattern• Comedo growth pattern
– Anatomic precursor of invasive ductal CA– 5x increase for invasive breast CA– Mastectomy – curative in 95% but BCT is SOC
BRCA1 vs BRCA 2
• BRCA1– Only females– Poorer differentiation– Aggressive clinical
course– Do not express hormone
receptors – Over expression of Her 2
ne
• BRCA2– Both males and females– Poor differentiation– ER (+)
Invasive Breast CA
• Paget’s Disease of the Nipple• Invasive Ductal Carcinoma– Adenocarcinoma with productive fibrosis 80%– Medullary carcinoma– Muinous carcinoma– Papillary carcinoma– Tubular carcinoma
• Invasive Lobular Carcinoma• Rare cancers (adenoid cyst, squamous cell,
apocrine)
Paget’s Disease of the Nipple
• Unilateral chronic eczematous eruption• Ulcerated weeping lesion• Associated with extensive DCIS• Pathognomonic sign: large vacuolated cells
(Paget Cells) in the Rete pegs of the epithelium
• Sx: lumpectomy, mastectomy, MRM
Invasive Ductal CA
• Most common• Poorest prognosis
IDC: Adenocarcinoma with productive fibrosis
• 60% of axillary lymph node metastasis• Perimenopausal/postmenopausal – 5th to 6th
decades• Solitary firm mass, poorly defined margins• Central satellite configuration with chalky
white or yellow streaks
IDC: Medullary Carcinoma
• BRCA1• Soft and hemorrhagic• Rapid increase in size -> necrosis and
hemorrhage• Bulk, well circumscribed and often positioned
deep within the breast• 50% are associated with DCIS
IDC: Mucinous Carcinoma
• Elderly • Bulky tumor• Histo– Extracellular pools of mucin, which surround aggregates of
low grade cancer cells– Glistening and gelatinous
• 66% have hormone receptors• 33% have lymph node mets• 5 year survival – 73%• 10 year survival – 59%
IDC: Papillary Carcinoma
• 7th decade of life• Small <3cm• With papillae with fibrovascular stalks and
multilayered epithelium
IDC: Tubular Carcinoma
• Perimenopausal or early menopausal• Histo:– Haphazard array of small randomly arranged
tubular elements• Distant metastases are rare• Only 10% have lymph node metastases
Histologic grading system for Invasive Breast CA
Invasive Lobular Carcinoma
• 2nd most frequent type (5-10%)• Replaces the entire breast with poorly define
mass• Multifocal, multicentric, bilateral• Hallmark– single file pattern• Bone mets more common (mets to
leptomeninges, peritoneum, GI tract and reproductive organs)
Phyllodes Tumors
• Benign, borderline, malignant• Sharply demarcated• Bulk is connective tissue with mixed
gelatinous, solid and cystic areas• Cut surface: leaf life appearance• Rare axillary LN mets
Inflammatory Breast CA
• Stage IIIB• Skin changes:– Brawny induration, erythema with a raised edge
and edema (peau d’orange)• Frequent distant mets