1. Carcinoma of the female breast.(Incidence, Etiology and pathology) Flashcards
INCIDENCE of Carcinoma of female breast
- It is the commonest malignancy in female.
* In USA, 1 in every 9 women is expected to develop cancer breast in lifetime
Etiological factors of Carcinoma of female breast
- Genetic element
- High (Major) Risk Factors
- Intermediate Risk Factors
Genetic element of etiological factors of Carcinoma of female breast
Genetic element: mutation of the following tumour suppressor genes:
- BRCA 1 located on chromosome No.17
- BRCA 2 located on chromosome No.13
- TP53 (p53) located on chromosome No.17
Le Fromaini syndrome
(Mutation of p53 tumour suppressor gene) :
- colorectal cancer
- endometrial cancer
- cancer breast
High (Major) Risk Factors of breast cancer
- Female with cancer of one breast.
- Female with near relatives having history of cancer breast.
- Nulliparous female
- Fibroadenosis with papillomatosis.
- Atypical ductal hyperplasia.
- Duct papilloma
- Lobular carcinoma in situ
lntermediate Risk Factors of breast cancer
- It has a peak incidence at 45 - 55 y, 65 - 75 y.
- Females with early menarche .12 y or late menopause > 50 y.
- Infertility & delayed pregnancy.
- Prolonged use of contraceptive pills > 10 years.
- Obesity & White races.
- High socio-economic class.
- Artifrcial breast prosthesis.
- Smoking, coffee, red meat & high fat diet.
- Irradiations.
Pathology of breast cancer
Site
Types
Site in Pathology of breast cancer
Mostly affecting the upper outer quadrant (60%).
Types in Pathology of breast cancer
According to the cell of origin :
I- Ductal carcinoma. (80-85%)
Il- Lobular carcinoma. (10-15%)
III- Paget’s disease of the nipple. (1%)
IV- Rare types of carcinoma.(Mastitis carcinomatosa)
Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer
- Non-lnvasive Ductal Carcinoma (Ductal Carcinoma in situ)
2. lnvasive Ductal Carcinoma
Pathogenesis of Non-lnvasive Ductal Carcinoma (DCIS) in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer
- Low and intermediate grade DCIS:
2. High grade DCIS:
Pathogenesis of Low and intermediate grade DCIS in Pathogenesis of Non-lnvasive Ductal Carcinoma (DCIS) in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer
- Papillary & micropapillary DCIS
- Solid DCIS
- Cribriform DCIS
Pathogenesis of High grade DCIS in Pathogenesis of Non-lnvasive Ductal Carcinoma (DCIS) in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer
Comedo DCIS
Papillary & micropapillary DCIS in Pathogenesis of Low and intermediate grade DCIS in Pathogenesis of Non-lnvasive Ductal Carcinoma (DCIS) in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer
- Microscopic picture:
2. Clinical picture
Microscopic picture of Papillary & micropapillary DCIS in Pathogenesis of Low and intermediate grade DCIS in Pathogenesis of Non-lnvasive Ductal Carcinoma (DCIS) in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer
The cancer cells are arranged in a finger-like pattern within the duct
If the cells are very small, they are called micropapillary.
Clinical picture of Papillary & micropapillary DCIS in Pathogenesis of Low and intermediate grade DCIS in Pathogenesis of Non-lnvasive Ductal Carcinoma (DCIS) in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer
Leads to bleeding per nipple.
Microscopic picture of Solid DCIS in Pathogenesis of Low and intermediate grade DCIS in Pathogenesis of Non-lnvasive Ductal Carcinoma (DCIS) in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer
The tumor cells completely fill the involved ducts.
Microscopic picture of Cribriform DCIS in Pathogenesis of Low and intermediate grade DCIS in Pathogenesis of Non-lnvasive Ductal Carcinoma (DCIS) in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer
- There are gaps between cancer cells in the affected breast ducts
- like the pattern of holes in Swiss cheese.
Comedo DCIS in Pathogenesis of High grade DCIS in Pathogenesis of Non-lnvasive Ductal Carcinoma (DCIS) in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer
- Microscopic picture
2. Pathogenesis of Comedo necrosis
Microscopic picture of Comedo DCIS in Pathogenesis of High grade DCIS in Pathogenesis of Non-lnvasive Ductal Carcinoma (DCIS) in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer
The center of the breast duct is plugged with dead cancer cells scattered among the living ones.
Pathogenesis of Comedo necrosis in Comedo DCIS in Pathogenesis of High grade DCIS in Pathogenesis of Non-lnvasive Ductal Carcinoma (DCIS) in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer
Necrosis in malignancy usually means that the cancer is growing fast & some cells don’t get enough nourishment, these starved cells die off, leaving areas of necrosis.
Pathogenesis of lnvasive Ductal Carcinoma in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer
1- lnvasive duct carcinoma not otherwise specified “NOS” > 75 %
2- Medullary carcinoma: 5%
3- Mucinous carcinoma 1%
Pathogenesis of NOS in Pathogenesis of lnvasive Ductal Carcinoma in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer
- Alternative names for NOS
- Gross picture
- Cut section
- Microscopic picture
Alternative names for NOS in Pathogenesis of NOS in Pathogenesis of lnvasive Ductal Carcinoma in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer
NSP no special type
scirrhous carcinoma
meaning of scirrhous carcinoma
Means alot of fibrous tissue
Gross picture in Pathogenesis of NOS in Pathogenesis of lnvasive Ductal Carcinoma in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer
- Small, hard, irregular mass
- with flat under-surface
- fixed within the breast.
Cut section in Pathogenesis of NOS in Pathogenesis of lnvasive Ductal Carcinoma in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer
1- Gritty.
2- Retract (concave) due to the fibrous tissue inside.
3- Non-capsulated.
4- Pale grayish with yellowish white streaks
5- areas of hemorrhage & necrosis.
Meaning of Gritty
Full of fibrous tissue Akennak bte2ta3 fe kommetra
why some cut sections are concave others are convex ?
Concave : much fibrous tissue
Convex : little fibrous tissue
Microscopic picture in Pathogenesis of NOS in Pathogenesis of lnvasive Ductal Carcinoma in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer
1- Masses of small malignant spheroidal cells
2- arranged in irregular groups
3- separated by dense fibrous tissue
4- with areas of hemorrhage & necrosis.
5- The fibrous tissue element is more than the cellular element.
Pathogenesis of Medullary carcinoma in Pathogenesis of lnvasive Ductal Carcinoma in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer
- Alternative name for Medullary carcinoma
- Gross picture
- Cut section
- Microscopic picture
- Aggressiveness and prognosis
Alternative name for Medullary carcinoma in Pathogenesis of Medullary carcinoma in Pathogenesis of lnvasive Ductal Carcinoma in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer
encephaloid carcinoma
Gross picture in Pathogenesis of Medullary carcinoma in Pathogenesis of lnvasive Ductal Carcinoma in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer
Large, irregular mass & soft in consistency.
Cut section in Pathogenesis of Medullary carcinoma in Pathogenesis of lnvasive Ductal Carcinoma in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer
- Bulge (convex)
- Non-capsulated
- brain like appearance.
- areas of hemorrhage and central necrosis.
Microscopic picture in Pathogenesis of Medullary carcinoma in Pathogenesis of lnvasive Ductal Carcinoma in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer
1- Large masses of malignant spheroidal cells
2- arranged in pseudoacinus form.
2- The stroma is scanty and the vascularity is high.
3- cellular element > fibrous tissue element
4- Lymphocytic infiltration may be present.
Tumours with Lymphocytic infiltration:
1) seminoma
2) Medullary breast carcinoma
3) monomorphic adenoma of parotid
Aggressiveness and prognosis in Pathogenesis of Medullary carcinoma in Pathogenesis of lnvasive Ductal Carcinoma in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer
It’s less aggressive and metastasize later and hence has better prognosis than NOS
Pathogenesis of Mucinous carcinoma in Pathogenesis of lnvasive Ductal Carcinoma in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer
- Alternative name for Mucinous carcinoma
- Gross picture
- Cut section
- Microscopic picture
- Prognosis
Alternative name for Mucinous carcinoma in Pathogenesis of Mucinous carcinoma in Pathogenesis of lnvasive Ductal Carcinoma in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer
colloid carcinoma
Gross picture in Pathogenesis of Mucinous carcinoma in Pathogenesis of lnvasive Ductal Carcinoma in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer
Large cystic tumour
Cut section in Pathogenesis of Mucinous carcinoma in Pathogenesis of lnvasive Ductal Carcinoma in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer
Honey comb appearance due to colloid
Microscopic picture in Pathogenesis of Mucinous carcinoma in Pathogenesis of lnvasive Ductal Carcinoma in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer
Malignant cells producing abundant mucin giving the signet ring appearance.