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Breast Disease - Part 2

Terms in this set (53)

lobular neoplasia and tubular carcinom preceded by
Columnar cell change and Flat Epithelial Atypia
Rosen Triad
The histologic triad of tubular carcinoma (TC),
columnar cell lesion (CCL), and lobular carcinoma in situ (LCIS)
Necrosis (usually associated with high grade DCIS) usually calcifies,
نيكروسس مع هاي قريد دكتال كارسينوما ان سيتو
What stain to do to amke sure that myoepithelial is intact
Stains used commonly p63, SMA, calponin هذي الستين مبوحق نيوبلاستك

immunostains often used to
demonstrate absence/presence of myoepithelial
layer
،،،،،،،،،،،،which receptor is common;
Ampliication/overexpression of estrogen/ progesterone receptors or c-erbB2 (HER2, an EGF receptor)
triple negative form more aggressive.
ER ⊝,
PR ⊝,
and HER2/neu ⊝,
Arises from ductal atypia. Often seen early as microcalciications on mammogram
DCIS
Early malignancy without basement membrane penetration.

Usually does not produce a mass.
DCIS
Comedocarcinoma
Subtype of DCIS. Cells
have high-grade nuclei with extensive central necrosis and dystrophic calciication.
Irregular infiltrating cords and nests of malignant cells
IDC- NOS
-Desmoplastic stroma
-tubular formation prominent in well differentiate
Grade 1 tumor IDC
Sheet of pleomorphic epithelial cells W/ readily identifieable mitotic figures in poorly differentiate
Grade 3 tumour IDC
-Often multifocal and bilateral
-Often bilateral with multiple lesions in the same location.
Invasive Lobular Carcinoma
In ▪ Microscopy we see :
•Single files of cells
•Monotonous cells
Invasive Lobular Carcinoma
E-cadherin expression orderly row of cells ("single ile" E ) and no duct formation.
Often lacks desmoplastic response.
Invasive Lobular Carcinoma
Biphasic epithelial and mesenchymal neoplasm of breast characterized by variably cellular stroma and benign double-layered epithelial cells
Phyllodes Tumor
Increased stroma. Cellularity ,particularly next to glandular stracture
...
Expansion and inc cellularity of stroma. Compenent resulting in leaf like pattern
...
Metaplastic Carcinoma
Metaplastic Carcinoma

Encompasses a group of neoplasms characterized by differentiation of neoplastic epithelium into squamous
cells and/or mesenchymal-looking elements
Including spindle, chondroid, osseous and rhabdomyoid cells
Anastomosing vascular channel, lined by atypical endothelial cells , dissect interlobular breast stroma

Vascular channed have wide lumina W red blood cells

Tumour forming discrenible vascular channel
Well differentiate AS
Inter- anastomosing vascular channel are intermingled W solid endothelial or spindle area
...
Poorly-differentiated AS - malignant spindle cells. Diagnosis made based on either
other typical areas in tumor or with immunostains demonstrating vascular differentiation.
Most common in adult females:

Most common in adult men:
Female: Melanoma, Lung carcinoma

Male : Prostate carcinoma
Gastric carcinoma:
signet ring carcinoma are
histologically similar/identical to some invasive lobular carcinomas (latter ER+/PR+/CDX2-)
Comedo DCIS
Several adjacent ducts are filled by tumor associated with large central zones of necrosis and calcified debris. This type of DCIS most frequently is detected as radiologic calcifications.
Noninvasive (in situ) Carcinoma
DCIS and LCIS

both types usually arise from cells in the terminal duct lobular unit.

DCIS tends to fill and distort ductlike spaces.

LCIS usually expands but does not alter the acini of lobules.


Both are confined by a basement membrane and do not invade into stroma or lymphovascular channels.
DCIS has a wide variety of histologic appearances.
Architectural patterns often are mixed and include solid, comedo, cribriform, papillary, micropapillary, and "clinging" types.

Necrosis may be present in any of these types.
The comedo subtype is dis-
tinctive and is characterized by
cells with high-grade nuclei with extensive central necrosis
Calcifications frequently are associated with ..........., originating as either calcified necrotic debris or calcified secretory material.
DCIS الكالسفكيشن مرتبط مع الدكتال
LCIS has a
uniform appearance.
The cells are monomorphic with bland, round nuclei and occur in loosely cohesive clusters within the lobule
Intracellular mucin vacuoles (sometimes forming signet ring cells) are common.
LCIS
LCIS is virtually always an incidental finding, because unlike DCIS, it is only rarely associated with calcificatio
LCIS نادر يصير له كالسفكيشن على عكس الدكتال
LCIS is both a marker of an increased risk of carcinoma in both breasts and a direct precursor of some cancers.
...
A monomorphic population of small, rounded, loosely cohesive cells fills and expands the acini of a lobule. The underlying lobular architecture is intact.
LCIS
This type of cancer usually is associated with DCIS and,
Invasive ductal carcinoma
Most ductal carcinomas produce a desmoplastic response, which replaces normal breast fat (resulting in a mammographic density) and forms a hard, palpable mass
الدكتال كارسينوما يسوي ديسموبلاستك ريسبونس وهي تقوم تبدل النورمل تيشو للصدر وتخليه صلب
microscopic appearance of invasive ductal carcinoma
is quite heterogeneous, ranging from tumors with well developed tubule formation and low-grade nuclei to tumors consisting of sheets of anaplastic cells .

The tumor margins typically are irregular.

Invasion of lymphovascular spaces may be seen.
Invasive lobular carcinoma consists of cells morpho- logically identical to the cells of .
LCIS
The cells invade individu- ally into stroma and are often aligned in "single-file" strands or chains.
LCIS
In LCIS The growth pattern correlates with the presence of mutations that
abrogate the function of E-cadherin, تبطل هالمكاردهيرن
Lobular carcinomas have a unique pattern of metastases among breast cancers;
they more frequently spread to cerebrospinal fluid, serosal surfaces, gastrointestinal tract, ovary, uterus, and bone marrow.
also are more frequently multicentric and bilateral
Lobular carcinomas
In low grade DCIS
Tuft عنقود of proliferation epithi cells projecting into the ductal lumen > W/O fibrovascular core
The tip of epithi tuft may fuse together forming [bridge and aracdes]
Comedocarcinoma—Subtype of DCIS. Cells
have high-grade nuclei with extensive central necrosis and dystrophic calciication.
Often seen early as microcalciications on m am mo g r aphy.
DCIS
Lobulocentric proliferation of small , monotonous, loosely cohesive cells
LCIS
Medium/ large dyscohesive cells W Eosinophilic , granular and occasionally vacolayed cytoplasm, eccentricity plased nuclei , moderate pleomorphism
Pleomorphism LCIS
Firm, fibrous, "rock-hard" mass with sharp margins and small, glandular, duct-like cells in desmoplastic stroma.
Invasive ductal
Often bilateral with multiple lesions in the same location.
Invasive lobular
-E-cadherin expression orderly row of cells ("single ile" )
- no duct formation.
-Often lacks desmoplastic response
Lobular carcinoma
-Anastomosing vascular channel, lined by atypical endothelial cells, dissect interlobular breast stroma

-Vascular channel have relatively wide lumina W red blood cells

--Tumor forming discernible vascular channel
Well - differentiate AS
-inter-anastomosing vascular channel are intermingled W solid endothelial or spindled area
Poorly differentiate
Poorly-differentiated AS - malignant spindle cells. Diagnosis made based on
either other typical areas in tumor or with immunostains demonstrating vascular differentiation.
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