Markers for comedocarcinoma
Less often ER, PR positive, HER2Neu positive High recurrence rate
Breast CA age
Over 40, 25% postmenopausal
Sclerosing adenosis age
young
Clinic- Spread to leptomeninges, GIT, Gyne, peritoneum May present with duct carcinoma Histo- Single file lines Bulls eye pattern (tumor cells around normal acini and ducts
Lobular carcinoma
Intracanalicular fibroadenoma
Elongated compressed distorted ducts
Characteristics of Ductal carcinoma in situ
Calcifications Vague palpable mass Malignant clonal population of cells to ducts and lobules, preserved myoepithelial cells Bilateral 10-20%
Molecular classification of Ductal carcinoma
Luminal A Luminal B Normal breast like Basal like HER2+
Pathogenesis of FCC
Exaggerated,distorted cyclical changes associated with hormonal changes of menstrual cycle • Cysts, Fibrosis, Adenosis - Blue dome cysts - “Milk of calcium
Other terms for Duct ectasia
plasma cell mastitis Granulomatous mastitis
Pagets is associated to what
DCIS
Etiology fibroadenoma
Related to excess estrogen, prepubertal and young women, drugs such as cyclosporine
What is the prognosis for inflammatory carcinoma
poor
Malignant phyllodes tumour
>10 HPF (high power field) inflitrative borders Mod-marked atypia
Clinic- Swollen erythematous breast -> d/t dermal lymphatics Underlying carcinoma diffusely infiltrative
Inflammatory carcinoma
Age of lobular carcinoma in situ
Younger women Incidental finding
ER/PR testing
Estrogen and progesterone receptor testing Done in all newly dx invasive breast ca
Histo- Loose edematous myxoid fibroblastic stroma Mixed pattern
Fibroadenoma
Breast ca proliferation stages
I proliferative dz w/o atypia- 2 layers II Atypical ductal hyperplasia- 2 layers w/ nuclei changes III Ductal Carcinoma in situ- multiple layers for epi cells but within meoepithelial cells IV Invasive ductal carcinoma- Epi cells break from myoepithelial cell and spread
Common cause of abnormal nipple discharge
Intraduct papilloma
Clinic 2.5cm nodule Upper outer quadrant Firm, ill defined borders Skin dimpling Skin adherent to mass Axillary LN enlarged
Carcinoma
Breast ca tx
Lumpectomy Simple mastectomy +/- LN dissection Postop irradiation Chemo Immuno (herceptin) Hormone tx (tamoxifen)
Pericanalicular fibroadenoma
Oval ducts, surrounded by stroma
Polythelia
Accessory nipples along milk line
Pathogenesis of duct ectasia
Dilated duct ruptures causing inflammation, plasma cells repleased with histicytes, giant cells , granulomas
Her2 positive
7-12% ER-Her2+ Poorly diff, high freq of brain mets
What is the most COD malignancy in woment
Lung
What has the same invasive freq as DCIS
Lobular carcinoma in stiu
Scirrhous- hard dense desmoplasia 3-4cm infltrative edge Cords and nests of cells Necrosis, calcification
Infiltrating duct Ca
Clinic- Large pendulous breast Mimics carcinoma
Traumatic fat necrosis
Age of duct ectasia
5-6th decade
