Breast pathology - Revision history

Michael: /* Columnar cell change */ split out

2016-07-01T04:47:37Z

Columnar cell change: split out

← Older revision		Revision as of 04:47, 1 July 2016
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	==Columnar cell change==		==Columnar cell change==
	*Abbreviated ''[[CCC]]''.		{{Main\|Columnar cell change of the breast}}
	*[[AKA]] ''blunt duct adenosis''.
	~~===General===~~
	*Columnar cell change ~~is associated with (benign) calcification - '''key point'''.~~

	~~===Microscopic===~~
	~~Features:~~
	*Secretory cells (line gland lumen) have columnar morphology.
	*May have "apical snouts".
	**Blebs or round balls eosinophilic material appear to be adjacent to the ~~cell at their luminal surface.~~
	**The snouts are attached to the cell-- appear as round ball only in the plane of section.
	*Cytoplasm +/-eosinophilia.
	*Often purple luminal calcifications

	~~DDx:~~
	*Flat epithelial atypia (>2 cell layers).{{Fact}}
	**If the columnar cells shows low to intermediate grade atypia the process is termed "flat epithelial atypia"
	**If higher grade atyia is present the lesion is termed "flat DCIS" (clinging carcinoma)

	~~Image:~~
	*[http://webpathology.com/image.asp?case=652&n=1 Columnar cell change (webpathology.com)].

	==Gynecomastoid hyperplasia==		==Gynecomastoid hyperplasia==

Michael: /* Sclerosing adenosis */ split out

2016-06-22T05:29:20Z

Sclerosing adenosis: split out

← Older revision		Revision as of 05:29, 22 June 2016
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	==Sclerosing adenosis==		==Sclerosing adenosis==
	~~===General===~~		{{Main\|Sclerosing adenosis of the breast}}
	*Can be scary... can look like [[ductal carcinoma]].
	*Derived from ''sclerosing''<ref>URL: [http://dictionary.reference.com/browse/sclerosis http://dictionary.reference.com/browse/sclerosis]. Accessed on: 16 March 2011.</ref> (hardening) and ''adenosis~~'' (glandular enlargement).~~
	**Think ''scaring'' + ''lotsa glands'' and you're pretty close.
	*Management: follow-up, no further treatment.<ref>URL: [http://www.breastcancercare.org.uk/breast-cancer-information/breast-awareness/benign-breast-conditions/sclerosing-lesions http://www.breastcancercare.org.uk/breast-cancer-information/breast-awareness/benign-breast-conditions/sclerosing-lesions]. Accessed on: 30 April 2012.</ref>
	~~===Microscopic===~~
	~~Features:~~
	*Acini are smaller than usual and there are more of ~~them.~~
	**Acini often slit-like.
	*Fibrosis (scleroses) - pink on H&E surrounds the ~~acini.~~
	**Can mimic a [[desmoplastic reaction]].

	~~Notes:~~
	*The acini should:
	**Be in lobular arrangements, i.e. in groups (benign appearance at low power) - '''key feature'''.
	**Have two cell layers like well-behaved breast ~~glands do.~~

	~~DDx:~~
	*Low-grade [[Invasive ductal carcinoma of the breast\|ductal carcinoma]].
	*[[Tubular adenoma of the breast]].
	*[[Adenomyoepithelioma]].<ref name=chu>Chu et al. (2006). Adenomyoepithelioma of the Breast — A Case Report. Tzu Chi Med J. Vol. 18 No. 1. URL:URL: [http://www.tzuchi.com.tw/file/tcmj/95-1/2-8.pdf http://www.tzuchi.com.tw/file/tcmj/95-1/2-8.pdf]. Accessed on: 28 April 2012.</ref>
	*Breast adenosis - should have visble lumens.

	==Flat epithelial atypia==		==Flat epithelial atypia==

Michael at 20:34, 7 June 2016

2016-06-07T20:34:17Z

← Older revision		Revision as of 20:34, 7 June 2016
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	[[Image:Diagram showing the lobes and ducts of a breast CRUK 307.svg\|thumb\|250px\|Diagram of the structure of breast. (CRUK/WC)]]		[[Image:Diagram showing the lobes and ducts of a breast CRUK 307.svg\|thumb\|250px\|Diagram of the structure of breast. (CRUK/WC)]]
	The '''breast''' is an important organ ~~for the continuance of the species and one~~ that [[pathologist]]s see quite often because it is often afflicted by [[breast cancer\|cancer]]. Before women started [[smoking]] in large numbers, it was ~~the number one~~ cause of cancer death in women ~~(in Canada)~~.		The '''breast''' is an important organ that [[pathologist]]s see quite often because it is often afflicted by [[breast cancer\|cancer]]. Before women started [[smoking]] in large numbers, it was a leading cause of cancer death in women.

	Fortunately, breast cancer, ~~these days~~, has a relatively good prognosis if it is detected early... and this is why there are week-ends to end breast cancer -- there are large numbers of breast cancer survivors that are well, wealthy and can advocate for better care and research into breast cancer.		Fortunately, breast cancer, in this day, has a relatively good prognosis if it is detected early.

	=Clinical=		=Clinical=

Michael: /* Microscopic */

2016-06-02T15:05:34Z

Microscopic

← Older revision		Revision as of 15:05, 2 June 2016
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	DDx:		DDx:
	*Low-grade ductal carcinoma.		*Low-grade [[Invasive ductal carcinoma of the breast\|ductal carcinoma]].
	*[[Tubular adenoma of the breast]].		*[[Tubular adenoma of the breast]].
	*[[Adenomyoepithelioma]].<ref name=chu>Chu et al. (2006). Adenomyoepithelioma of the Breast — A Case Report. Tzu Chi Med J. Vol. 18 No. 1. URL:URL: [http://www.tzuchi.com.tw/file/tcmj/95-1/2-8.pdf http://www.tzuchi.com.tw/file/tcmj/95-1/2-8.pdf]. Accessed on: 28 April 2012.</ref>		*[[Adenomyoepithelioma]].<ref name=chu>Chu et al. (2006). Adenomyoepithelioma of the Breast — A Case Report. Tzu Chi Med J. Vol. 18 No. 1. URL:URL: [http://www.tzuchi.com.tw/file/tcmj/95-1/2-8.pdf http://www.tzuchi.com.tw/file/tcmj/95-1/2-8.pdf]. Accessed on: 28 April 2012.</ref>
			*Breast adenosis - should have visble lumens.

	==Flat epithelial atypia==		==Flat epithelial atypia==

Michael: /* Breast radiology */

2016-05-22T16:34:14Z

Breast radiology

← Older revision		Revision as of 16:34, 22 May 2016
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	===Breast radiology===		===Breast radiology===
	~~BI-RADS =~~ Breast ~~Imaging Reporting And Data System:<ref>URL: [http://breastcancer.about.com/od/diagnosis/a/birads.htm http://breastcancer.about.com/od/diagnosis/a/birads.htm]. Accessed on: 16 March 2011.</ref>~~		{{Main\|Breast imaging reporting and data system}}

	*0: Incomplete - come back for more imaging.
	*1: Negative.
	*2: Benign finding(s).
	*3: Probably benign -- often short follow-up.
	*4: Suspicious abnormality -- needs biopsy.
	*5: Highly suggestive of malignancy.
	*6: [[Pathologist]] says there is a malignancy.

	=Specimens=		=Specimens=

Michael: /* Clinical Presentations of Breast Pathology */

2016-05-22T16:32:32Z

Clinical Presentations of Breast Pathology

← Older revision		Revision as of 16:32, 22 May 2016
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	**Suspicious microcalcifications and/or suspicious mass.		**Suspicious microcalcifications and/or suspicious mass.
	**Most common history on the specimen requisition		**Most common history on the specimen requisition
	**May be accompanied by a BI-RADS score ~~(see below)~~		**May be accompanied by a [[BI-RADS]] score.
	*Nipple discharge.		*Nipple discharge.
	*Pain.		*Pain.

Michael: tweak

2016-05-09T21:14:57Z

tweak

← Older revision		Revision as of 21:14, 9 May 2016
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	====Papillary Lesions====		====Papillary Lesions====
	*Nipple adenoma		*Nipple adenoma.
	*Intraductal papilloma		*Intraductal papilloma.
	*Papillary ductal carcinoma in situ		*Papillary ductal carcinoma in situ.
	*Intracystic papillary carcinoma		*Intracystic papillary carcinoma.
	*Intracystic papillary carcinoma with an invasive component		*Intracystic papillary carcinoma with an invasive component.
	*Invasive papillary carcinoma		*Invasive papillary carcinoma.

	====Basaloid Lesions====		====Basaloid Lesions====
	*Adenoid ~~Cystic Carcinoma~~ of the ~~Breast~~		*Adenoid cystic carcinoma of the breast.
	*Intracystic ~~Papillary Breast Carcinoma~~, ~~Solid Variant~~		*Intracystic papillary breast carcinoma, solid variant.
	*Invasive ~~Papillary Breast Carcinoma~~, ~~Solid Variant~~		*Invasive papillary breast carcinoma, solid variant.
	*Medullary ~~Breast Carcinoma~~		*Medullary breast carcinoma.
	*Medullary-like ~~Breast Carcinoma~~		*Medullary-like breast carcinoma.
	**Know when to start a discussion about BRCA mutations, triple negativity and the 'basal-like molecular phenotype'.		**Know when to start a discussion about BRCA mutations, triple negativity and the 'basal-like molecular phenotype'.

	====Spindle Cell Lesions====		====Spindle Cell Lesions====
	*Metaplastic ~~Breast Carcinoma~~		*Metaplastic breast carcinoma.
	*Treated ~~Breast Carcinoma~~		*Treated breast carcinoma.
	*Mammary ~~Myofibroblastoma~~		*Mammary myofibroblastoma.
	*Phyllodes ~~Tumor~~ - stromal component		*Phyllodes Tumour - stromal component.
	*Desmoid ~~Fibromatosis~~		*Desmoid fibromatosis.
	*Nodular ~~Fasciitis~~		*Nodular fasciitis.

	=== Additional resources ===		=== Additional resources ===
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	{{familytree \| D \| \| \| \| \| \| E \| \| \| \| \| \| F \|D=Unremarkable<br>papillae\|E=Atypia ''or'' arch. abnorm.<br>''or'' cellular proliferation\|F=Neoplastic cells<br>present}}		{{familytree \| D \| \| \| \| \| \| E \| \| \| \| \| \| F \|D=Unremarkable<br>papillae\|E=Atypia ''or'' arch. abnorm.<br>''or'' cellular proliferation\|F=Neoplastic cells<br>present}}
	{{familytree \| \|!\| \| \| \|,\|-\|-\|-\|+\|-\|-\|-\|.\| \| \| \|!\| \|}}		{{familytree \| \|!\| \| \| \|,\|-\|-\|-\|+\|-\|-\|-\|.\| \| \| \|!\| \|}}
	{{familytree \| G \| \| H \| \| I \| \| J \| \| K \|G=[[intraductal papilloma\|Benign<br>intraductal<br>papilloma]]\|H=High grade atypia\|I=Low grade atypia<br>''or'' abnorm. arch.\|J=''Only'' cellular<br>proliferation\|K=[[Encapsulated papillary carcinoma of the breast\|Intracystic<br> (encapsulated)<br>papillary ca.]]}}		{{familytree \| G \| \| H \| \| I \| \| J \| \| K \|G=[[intraductal papilloma of the breast\|Benign<br>intraductal<br>papilloma]]\|H=High grade atypia\|I=Low grade atypia<br>''or'' abnorm. arch.\|J=''Only'' cellular<br>proliferation\|K=[[Encapsulated papillary carcinoma of the breast\|Intracystic<br> (encapsulated)<br>papillary ca.]]}}
	{{familytree \| \| \| \| \| \|!\| \| \| \|!\| \| \| \|!\| \| \| \| \| \|}}		{{familytree \| \| \| \| \| \|!\| \| \| \|!\| \| \| \|!\| \| \| \| \| \|}}
	{{familytree \| \| \| \| \| L \| \| \|!\| \| \| N \| \| \| \| \|L=[[DCIS]] in<br>papilloma\|N=[[FEHUT]] in<br>papilloma}}		{{familytree \| \| \| \| \| L \| \| \|!\| \| \| N \| \| \| \| \|L=[[DCIS]] in<br>papilloma\|N=[[FEHUT]] in<br>papilloma}}
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	==Intraductal papilloma==		==Intraductal papilloma==
	*[[AKA]] ''papilloma''.		*[[AKA]] ''papilloma''.
	{{Main\|Intraductal papilloma}}		{{Main\|Intraductal papilloma of the breast}}

	==Lymphocytic mastitis==		==Lymphocytic mastitis==

Michael: /* Sign out */

2016-05-09T20:56:23Z

Sign out

← Older revision		Revision as of 20:56, 9 May 2016
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	*[http://www.breastpathology.info/Images/calcs/FatNec1_700.jpg Breast with calcifications (breastpathology.info)].		*[http://www.breastpathology.info/Images/calcs/FatNec1_700.jpg Breast with calcifications (breastpathology.info)].
	*[http://www.wjso.com/content/7/1/70/figure/F3 Resting breast tissue (wjso.com)].		*[http://www.wjso.com/content/7/1/70/figure/F3 Resting breast tissue (wjso.com)].

	~~===Sign out===~~
	~~====Reduction mammoplasty====~~
	~~<pre>~~
	~~A. Right Breast (630 grams), Reduction Mammoplasty:~~
	~~- Breast tissue and skin within normal limits.~~

	~~B. Left Breast (680 grams), Reduction Mammoplasty:~~
	~~- Breast tissue and skin within normal limits.~~
	~~</pre>~~

	==Lactational changes==		==Lactational changes==

Michael at 20:34, 5 May 2016

2016-05-05T20:34:26Z

← Older revision		Revision as of 20:34, 5 May 2016
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	***The myoepithelial layer is hard to see at times.		***The myoepithelial layer is hard to see at times.
	***IHC can aid in visualizing the myoepithelial layer.		***IHC can aid in visualizing the myoepithelial layer.
	***The immunostains used in breast pathology for the myoepithelial layer include: CK5/6, SMA, p63 and calponin		***The immunostains used in breast pathology for the myoepithelial layer include: [[CK5/6]], SMA, [[p63]] and calponin.

	===Questions to Ask===		===Questions to Ask===

Michael: /* Flat epithelial atypia */ split otu

2016-05-01T04:29:23Z

Flat epithelial atypia: split otu

← Older revision		Revision as of 04:29, 1 May 2016
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	==Flat epithelial atypia==		==Flat epithelial atypia==
	~~===General===~~		*Abbreviated ''FEA''.
	~~Epidemiology:~~		{{Main\|Flat epithelial atypia}}
	*~~Associated with ADH & DCIS; may represent a non-obligate precursor lesion of ADH & DCIS~~.~~<ref name=pmid18384213>~~{{~~Cite journal~~ \| ~~last1 = Lerwill \| first1 = MF. \| title =~~ Flat epithelial atypia ~~of the breast. \| journal = Arch Pathol Lab Med \| volume = 132 \| issue = 4 \| pages = 615-21 \| month = Apr \| year = 2008 \| doi = 10.1043/1543-2165(2008)132[615:FEAOTB]2.0.CO;2 \| PMID = 18384213 }}</ref>~~
	*Low risk of progression to invasive malignancy.<ref name=pmid12927037>{{Cite journal \| last1 = Schnitt \| first1 = SJ. \| title = The diagnosis and management of pre-invasive breast disease: flat epithelial atypia--classification, pathologic features and clinical significance. \| journal = Breast Cancer Res \| volume = 5 \| issue = 5 \| pages = 263-8 \| month = \| year = 2003 \| doi = 10.1186/bcr625 \| PMID = 12927037 }}~~</ref>~~

	~~Management:~~
	*Excision.

	~~===Microscopic===~~
	~~Features:~~
	*"Flat" ~ three cells thick.
	*Hypercellular gland -- several layers.
	*Columnar cell morphology.
	*+/-Apical snouts.

	~~===Images===~~
	~~<gallery>~~
	~~Image:Breast FlatAtypia (3) PA.JPG\|Breast - Flat Atypia (SKB)~~
	~~</gallery>~~

	~~DDx:~~
	*[[Columnar cell change]].
	*Columnar cell hyperplasia.
	*[[ADH]].
	*Flat [[DCIS]] (clinging carcinoma).
	*Apocrine cyst - granular cytoplasm.
	*[[Tubular carcinoma]] - should be considered due to the association.

	~~===Molecular===~~
	*Loss of 16q.
	**Not used for [[diagnosis]].

	==Complex sclerosing lesion==		==Complex sclerosing lesion==