TransMed: Invasive Breast Ca

Invasive Carcinoma VI - Breast

VII. SLIDES - INVASIVE CARCINOMA OF THE BREAST

Slide 1: A mucinous carcinoma with a well-circumscribed border and lobulated, semitransparent cut surface.
Slide 2: A medullary carcinoma with a smooth, well-circumscribed border. It also has a homogeneous appearance, because of the lack of dense fibrous stroma.
Slide 3: A typical infiltrating ductal carcinoma with irregular borders and radiating pattern of infiltration into the adjacent fibroadipose tissue and pectoral fascia. The center of the tumor has yellow streaks corresponding to desmoplastic stromal reaction. The tumor extends to skin surface causing ulceration.
Slide 4: A low power view corresponding to radiating pattern of infiltration into the fibroadipose tissue.
Slide 5: A large infiltrating ductal carcinoma with central necrosis, hemorrhage, and cavitation.
Slide 6: A well-differentiated ductal carcinoma made up of small acini and glands. Nuclear atypia is mild.
Slide 7: Tumor cells are arranged in cords with invasion into adipose tissue.
Slide 8: A mixed pattern of small nests (center), irregular large sheets (left) and complex glands (right).
Slide 9: Irregular nests of tumor cells associated with fibrotic stroma.
Slide 10: Score 1-point for nuclear pleomorphism. Uniform nuclei with open chromatin and small nucleoli.
Slide 11: Score 2-point for nuclear pleomorphism. A moderate degree of nuclear irregularity for size and shape.
Slide 12: Score 3-point for nuclear pleomorphism. Large nuclei are markedly variable in size, shape, and hyperchromasia. Nucleoli are prominent. A mitosis is seen in the center field.
Slide 13: Desmoplastic stromal reaction characterized by proliferation of fibroblasts in a myxoid, fibrous stroma with dense eosinophilic collagen fibers.
Slide 14: Three aggregates of tumor cells are surrounded by empty spaces simulating vascular lymphatic vessels. These spaces result from shrinkage artefact of tumor cells. Notice the lack of endothelial cells lining these spaces.
Slide 15: A true vascular lymphatic space invasion. The space is lined by clearly identifiable endothelial cells.
Slide 16: A vein is invaded by tumor cells, which are accompanied by thrombus.
Slide 17: Coexistence of cribriform ductal carcinoma in situ (center field) and infiltrating ductal carcinoma.
Slide 18: Tubular carcinoma in a core biopsy. Irregular tubular glands arranged haphazardously in a fibrotic stroma without a lobular pattern. Coexisting cribriform ductal carcinoma in situ is seen in the right lower field.
Slide 19: Infiltrating of fibroadipose is a helpful sign of invasive carcinoma.
Slide 20: Tubular carcinoma. The irregular neoplastic glands are lined by a single layer of cells with mild nuclear hyperchromasia and irregularity. Benign ducts are lined by two layers of cells, epithelial and myoepithelial cells.
Slide 21: Mucinous carcinoma is characterized by tumor cells surrounded by abundant extracellular mucin. The degree of nuclear atypia is mild.
Slide 22: Papillary carcinoma forming complex papillary structures, some of which are supported by delicate fibrous stalks.
Slide 23: Papillary carcinoma with stromal invasion. In addition to large papillary tumor, notice small clusters of malignant cells in the right lower field indicative of invasion.
Slide 24: Typical medullary carcinoma with smooth borders, irregular sheets and nests of malignant cells, and stroma rich in lymphoid cells.
Slide 25: Tumor cells in a medullary carcinoma have anaplastic nuclei, prominent nucleoli, and ill-defined cell borders giving the appearance of a syncytial pattern.
Slide 26: Atypical medullary carcinoma. Although the tumor border is smooth, there is too much fibrous stroma and local infiltration for a typical medullary carcinoma.
Slide 27: Metaplastic carcinoma consists of epithelial nests and spindle cells.
Slide 28: The spindle cells are arranged in bundles simulating sarcoma.
Slide 29: Immunohistochemical stain for cytokeratin is strongly positive (brownish deposits in the cytoplasm) to support an epithelial neoplasm.
Slide 30: Inflammatory carcinoma with malignant cells in the dermal lymphatics, which are associated with lymphocytic infiltration and stromal edema.
Slide 31: Microinvasive carcinoma arising in the periphery of lobules replaced by solid type of ductal carcinoma in situ. This early stromal invasion in the form of tongue-like protrusion creates irregular nests of tumor cells. In lobules replaced by ductal carcinoma in situ without stromal invasion, the original round configuration of the acini and ductules is maintained.
Slide 32: Higher magnification of slide 31 to demonstrate irregular nests of tumor cells associated with fibrosis and chronic inflammation.
Slide 33: Lobular carcinoma in situ. Expanded lobules and ductules are filled with tumor cells. Notice the preservation of the smooth lobules in the periphery and terminal ductules in the center.
Slide 34: Lobular carcinoma in situ. Tumor cells fill the lobules and have uniformly round to oval nuclei, indistinct nucleoli, and scant cytoplasm.
Slide 35: Lobular carcinoma in situ. Sometimes the tumor cells are loosely cohesive and form intracytoplasmic lumen, a feature helpful to distinguish from ductal carcinoma in situ with lobular extension.
Slide 36: Lobular carcinoma in situ by mucicarmine stain. This special stain confirms the presence of mucinous material in the Intracytoplasmic lumens.
Slide 37: Lobular carcinoma in situ spread from lobules to interlobular ducts (center field).
Slide 38: Infiltrating lobular carcinoma presents as solid, firm mass.
Slide 39: Infiltrating lobular carcinoma spreads diffusely into the adipose tissue without creating a visible mass. The only abnormality is firmness by palpation.
Slide 40: Lobular carcinoma in situ with infiltrating lobular carcinoma
Slide 41: Classic type of infiltrating lobular carcinoma with tumor cells arranged in a single layer traveling between collagen fibers. The nuclei are small and relatively uniform in size and shape.
Slide 42: Pagetoid appearance of tumor cells around a benign duct.
Slide 43: Signet ring type of infiltrating lobular carcinoma. The nuclei are crescent in shape and compressed by vacuolated cytoplasm.
Slide 44: Solid type of infiltrating lobular carcinoma. The tumor cells are arranged in diffuse sheets closely resemble malignant lymphoma.
Slide 45: Pleomorphic type of infiltrating lobular carcinoma. The tumor cells form single files and have pleomorphic, hyperchromatic, irregular nuclei and small nucleoli.
Slide 46: Lymph node metastasis. Tumor cells enter into the lymph node from the afferent lymphatics (left lower field) and first localized in the subcapsular region.
Slide 47: Lymph node metastasis with extracapsular extension. Tumor cells involve the lymph node capsule and the adjacent fibroadipose tissue.
Slide 48: Infiltrating ductal carcinoma
Slide 49: Same tumor as shown in Slide 48. Estrogen receptor protein by immunohistochemical technique is located in the nuclei and strongly positive in most of the tumor cells.
Slide 50: Same tumor as shown in Slide 48. Progesterone receptor protein as demonstrated by immunohistochemical method is strongly positive (dark brown) in only a few cells. Some nuclei are weakly positive (pale brown).
Slide 51: Her-2/Neu oncogen is localized on the cell membrane of most tumor cells.
Slide 52: Comedo type of ductal carcinoma in situ having large pleomorphic nuclei and abundant eosinophilic cytoplasm.
Slide 53: Her-2/neu oncogen in the same tumor as shown in Slide 52. Almost all tumor cells are positive with brownish deposits in the cytoplasm and on the cell membranes.
Slide 54: Diploid pattern with a main peak at 37 units. A small peak at 75-80 units represents G2 and M cells.
Slide 55: Tetraploid pattern. The red peak represents diploid cells. The yellow peak is located exactly two times the amount of diploid DNA content.
Slide 56: Aneuploid pattern. The red peak at DNA content of 39 units represents diploid cells. The yellow peak has shifted to hyperdiploid range with DNA content of 48.2 units and DNA index of 1.24. S phase fraction is high with 12.6% and represented by cells having DNA content between 60 and 90 units. G2 and M cells are increased to 8.6% and corresponds to a small peak between 90-100 units.

VIII. REFERENCES

Palmer MK, Lythgoe JP, Smith A: Prognostic factors in breast cancer. Brit J Surg 1982;69:697-698.

Rosen PP, Goshen S, Saigo PE et al: Pathologic prognostic factors in stage I (T1N0M0) and stage II (T1N1M0) breast carcinoma: A study of 655 patients with median follow-up of 18 years. J Clin Oncol 1989;7:1239-1251.

Elston CW, Ellis IO: Pathological Prognostic Factors in Breast Cancer. I. The Value of Histological Grade in Breast Cancer: Experience from a large study with long term follow-up. Histopathology 19:403-410, 1991

Page D, Ellis I, Elston C: Histologic grading of breast cancer. Let's do it (editorial). Am J Clin Pathol 1995;103:123-124.

Rosen PP, Saigo PE, Braun DW Jr, Weathers E, DePalo A: Predictors of recurrence in stage I (T1N0M0 Breast Carcinoma). Ann Surg 193:15-25, 1981

Rosen PP, Saigo PE, Braun DW, Weathers E, Kinne DW: Prognosis in stage II (T1N0M0) breast cancer. Ann Surg 1981;194:576-584.

Schnitt SJ, Connolly JL, Harris JR et al.: Pathologic predictors of early local recurrences in stage I and II breast cancer created by Primary radiation therapy. Cancer 1984;53:1049-1057.

Tavassoli FA: Pathology of the Breast. Elsevier, New York, 1992

Rosen PP, Oberman HA: Tumors of the Mammary Gland. Atlas of Tumor Pathology, 3rd Series, Fascicle 7, Armed Forces Institute of Pathology, Washington, D.C., 1993

McDivitt W, Boyce W, Gersell D: Tubular carcinoma of the breast. Clinical and pathological observations concerning 135 Cases. Am J Surg Pathol 1982;6:401-411.

Peters GN, Wolff M, Haagensen CD: Tubular carcinoma of the breast. Clincial pathologic correlations based on 100 cases. Ann Surg 1981;193:138-149.

Wargotz ES, Silverberg SG: Medullary carcinoma of the breast: A

clinical pathologic study with appraisal of current diagnostic criteria. Human Pathology 1988;19:1340-1346.

Rosen PP; Adenoid cystic carcinoma of the breast. A morphologically heterogeneous neoplasm. Pathology Annual 24(Pt2):2372-254, 1989

Wargotz ES, Norris HJ: Metaplastic carcinomas of the breast: V. Metaplastic carcinoma with osteoclastic giant cells. Hum Pathol 1990;21:1142-1150.

Haagensen CD, Lane N, Lattes R, Bodian C. Lobular neoplasia (so-called lobular carcinoma in situ) of the breast. Cancer 1978;42:737-769.

Rosen PP, Lieberman PH, Braun DW, Kosloff C, Adair F. Lobular carcinoma in situ of the breast: detailed analysis of 99 patients with average follow-up of 24 years. Am J Surg Pathol 1978;2:225-251.

Steinbrecher JS, Silverberg SG: Signet-ring cell carcinoma of the breast. The mucinous variant of infiltrating lobular carcinoma. Cancer 37:828-840, 1976

DiCostanzo D, Rosen PP, Gareen I, Franklin S, Lesser M: Prognosis in Infiltrating Lobular Carcinoma. An analysis of "Classical" and variant tumors. Am J Surg Pathol 1990;14:12-23.

Early Breast Cancer Trialists' Collaborative Group. Systemic treatment of early breast cancer by hormonal, cytotoxic, or immune therapy: 133 randomized clinical trials involving 31,000 recurrences and 20,000 deaths among 75,000 women. Lancet 1992;339:1-15.

McGuire WL, Chamnes GC, Fuqua SA: Estrogen receptor variants in clinical breast cancer. Molecular Endocrinology 1991;5:1571-1577.

Allred DCA, Clark GM, Tandon AK et al: Her-2/neu in node negative breast cancer: Prognostic significance of overexpression influenced by the presence of in situ carcinoma. J Clin Oncol 1992;10:599-605.

Kallioniemi O, Blanco G, Alavaikko M, et al: Improving the prognostic value of DNA flow cytometry in breast cancer by combining DNA index and S-phase fraction. Cancer 1988;62:2183-2190.

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