Breast Cancer

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Strength does not come from winning. Struggles
Hardship develop strength. When you go through
hardship and decide not to surrender, that is
strength!
Arnold Schwarzenegger
Bodybuilder and Actor
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Pathology of Breast

• Dr. Venkatesh M. Shashidhar
• Senior Lecturer in Pathology
• Fiji School of Medicine

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Introduction

• Modified sweat glands.
• Lobes and lobules of gland
• in fat tissue stroma.
• Ducts emerge from acini of glands
• Smaller ducts join to form lactiferous ducts
• Lactiferous ducts merge just beneath the nipple
  to form a lactiferous sinus.
• Then individually open on nipple

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Normal Breast
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Normal Breast
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Myoepithelial Cells (ipx)
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Disorders

• Congenital
• Aplasia turners, Juvenile hypertrophy
• Accessory breasts along milk line.
• Inflammatory
• Infections/Inflammations acute/chronic
• Trauma - Fat necrosis
• Duct ectasia - discharge, sinus, Galactocele
• Fibrocystic disease common painful lumps
• Neoplastic
• Benign - Fibroadenoma
• Malignant Carcinoma

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Fibrocystic Disease

• Fibroadenosis, Fibrocystic change
• Commonest lumps, 10-50 women
• Periodic discomfort pain.
• Epithelial hyperplasia premalignant
• Irregular palpable lumps mimic ca.
• Adenosis hyperplasia - cysts papillomatosis
  metaplasia fibrosis.

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Fibrocystic Disease

• Common cause of surgery.
• 20-40 years of age
• Cystic hyperplasia of glands stroma.
• Estrogen excess / estrogen-progesterone imbalance
  / varying response to them.
• Irregular multiple nodules with cysts.
• Epithelial hyperplasia risk of cancer.
• Apocrine metaplasia,
• Radial scar

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Fibrocystic Disease
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Blue dome cyst
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Fibrocystic Disease
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Fibrocystic Disease Cysts fibrosis
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Sclerosing Adenosis
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Fibrocystic Disease Radial scar
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Benign Neoplasms

• Fibroadenoma
• Duct Papilloma
• Adenoma
• Connective tissue tumors
• Features (Fibroadenoma)
• Young age 3rd decade.
• Single, rounded, mobile, painless lumps.
• No scarring or calcification.
• Slit like glands in Fibrous stroma

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Fibroadenoma
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Fibroadenoma
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Fibroadenoma
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Fibroadenoma
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Breast Carcinoma

• 20 of all cancers in women
• Commonest cause of death - 35-55y
• In UK 1 in 10-12 chances
• 1 in 8 women in US
• Less incidence in Asia
• Majority of cancers arise in the ducts.
• Very rare before age 25

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Breast Ca
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Risk Factors

• Female sex..!, Age, Obesity, high fat diet
• Maternal relative with breast cancer.
• Longer reproductive span.
• Nulliparity, Oral contraceptives
• Later age at first pregnancy.
• Atypical epithelial hyperplasia.
• Previous breast cancer/Endometrial Ca.
• Geographic factors - country
• BRCA1 and BRCA2 genes

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Etiology of Breast Carcinoma
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Clinical Features

• Physiologic vs Pathologic changes
• Lump / lumps
• Lumps are much more common than Ca
• Characters of lump and age
• Discharge in many conditions.
• Hard, soft, inflammation
• Skin fixation / Skin retraction

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Diagnosis

• Mammorgraphy
• Ultrasound
• Fine Needle Aspiration Biopsy
• Core Biopsy
• Excision Biopsy
• Frozen section
• Immunoperoxidase,
• Molecular techniques Gene detection.

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Histological Types
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Good prognostic features

• Less than 2 cm in size
• Without axillary lymph node involvement
• That are non-invasive ductal carcinoma and LCIS
• With ER and PR positivity
• Which lack of aneuploidy

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Breast Carcinoma
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Breast Carcinoma
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Breast Carcinoma
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Breast Carcinoma - Schirrous
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Infiltrating Duct Carcinoma small hard
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Medullary Carcinoma Large soft
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Ca Breast fat removal
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Infiltrating Duct Carcinoma
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Infiltrating Duct Carcinoma
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Medullary Carcinoma Inflammation.
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Infiltrating Duct Carcinoma Fibrosis
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Schirrous Carcinoma
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Medullary CarcinomaSoft, inflammatory cells
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Intraductal in-situ Carcinoma
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Lobular Carcinoma
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Intraduct Carcinoma-in-situ
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Intraduct Carcinoma
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Lymphatic spread Peu-de Orange..
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Spread of Breast Carcinoma
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Pagets Disease
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Pagets Disease (Epidermal invasion)
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Tumor Markers in Breast Ca

• Estrogen receptor
• Progesterone receptor
• Cathepsin D
• HER2 (C-erb B2)

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Estrogen Receptor Prognosis

• Estrogen receptor expression is proportional to
  differntiation of tumor
• inversly proportional to prognosis and response
  to tamoxifen (receptor antagonist) therapy.
• Demonstrated by Immunoperoxidase special stain.

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HER2

• The HER2 proto-oncogene encodes a cell surface
  receptor that is overexpressed in approximately
  25-30 of breast cancers.
• Trastuzumab (Herceptin) is the first monoclonal
  antibody that targets the extracelluar domain of
  the HER2 protein, and inhibits growth of breast
  cancer cells that over express this protein.

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Estrogen receptor (ER) in nuclei
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Immunoperoxidase Positivity
Neg 1 2 3
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Mammorgrams
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Mammogram - Benign
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Mammogram - Benign
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Mammogram - Ca
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Mammogram - Ca
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Mammogram - Ca
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Mammogram Benign
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Mammogram Ca
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Mammogram Ca
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Mammogram Ca