CLinic- Single mobile encapsulated nodule 1-10 cm Gets larger in later part of menstrual cycle, pregnancy Mam- Popcorn calcification
Fibroadenoma
Clinic- Periareolar mass Thick white nipple secretion Skin retraction
Duct Ectasia
What is HER2 (human epidermal growth factor receptor)
Is a prognostic and predictive marker EGF receptor family Her2/neu oncogene (17q21) regulates cell proliferation, survival, motility, invasion Overexpression has worse clinical outcome
HER2/Neu status determines
Response to herceptin (humanized monoclonal antibody directed against cells that express Her2/neu Herceptin does not cross BBB
Most common benign tumor of breast
Fibroadenoma
Solitary Situated in lactiferous sinuses of nipple Bloody discharge
Large duct papilloma
What are the types of noninfiltrating breast ca
Ductal carcinoma in situ Lobular carcinoma in situ (based on architecture)
Peak age of breast ca
75-80
Equivocal (score 2+) HER2 result
complete intense circumferential membrane staining
Lobular carcinoma in situ types
Infiltrating carcinoma Ductal (80%) Lobular (10%) Tubular/Cribiform (6%) Mucinous, medullary, papillary, metaplastic (4-5%)
Stroma- Fibrosis • Epithelial proliferation -Mild simple severe atypical ± cysts (micro, macro) • Mammography may show microcalcifications in concretions of secretions or necrosed epithelial cell heaps- mistaken for carcinoma
FCC
How to diff fibroadenoma from CA
DX
What group is at increased risk for genetic breast ca
Ashkenazi
Histo Necrotic center (toothpaste) Intraduct tumor
Comedocarcinoma (high grade DCIS)
Major prognostic factors of breast ca
Distant mets In absence of distant mets- axillary lymph node presence
Is intraduct papilloma Benign or malignant
Benign
Staph infection on breast
Small Localized inflammation under nipple May leave scar
Clinic Ipsilateral node Entire lobule distended Lack E-cadherin Noncohesive cells, no pleomorphism or mitoses
Lobular carcinoma in situ
Most common lobular carcinoma in situ
Infiltrating duct Ca NST (no special type) (75%)
• Sclerosing adenosis • Florid benign hyperplasia • Radial scar/Complex sclerosing lesion • Papilloma • Fibroadenoma with complex features
Proliferative disease without atypia (RR - 1.5-2.0) Epithelial lesions
Staging - In situ and pagets
I- up to 2cm, no LN 80% II- 2-5cm + regional LN 65% III >or =5 CM +other LN 40% IV any size + distant met 10% Percentages are 5 year survival
Positive (score 3+) HER2 result
Complete, intense, circumferential membrane staining >10% of invasive tumor cells
Benign cysts filled by serous fluid often have this blue color when viewed from the outside.
Blue dome cysts found in FCC
Where does breast ca metastasize to
Lungs, Bones, Liver, Adrenals may appear 15 years after tx of primary lesion
Histo Compressed glands in middle Dialated glands in the periphery Fibrous stroma Double layer of myoepithelial cells
Sclerosing adenosis
Simple FCC (no epithelial hyperplasia), FA
Non-proliferative Epithelial lesions (RR – 1)
Luminal A
40-55% of ductal carcinomas ER+, HER2/NEU -ve Postmenopausal Slow growing Well differentiation Responds to hormonal tx not ctx
Grading based on
Tubule formation Nuclear atypia Mitosis Score these from 1-3
Modified Radical processing
pectoralis major muscles include Axillary LNs
CLinic- Serous discharge Nipple retracted No inflammation Firm subareolar lump
Intraduct papilloma RR 1.5- 2
