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TUMORS OF THE BREAST

Type
Characteristics

INTRADUCTAL PAPILLOMA
(DUCT PAPILLOMA)
benign
Neoplastic papillary (epithelial) growth develops
within a principle lactiferous duct near the
nipple
To a women at / shortly before menopause
May / may not form a palpable mass:

Large solitary : palpable

Small multiple : impalpable

Clinical pictures

Morphology :
GROSSLY

MICROSCOPIC

Serous / bloody nipple discharge


Small subaerolar mass (few mm in diameter)
Rarely nipple retraction

Large papillomas :
Solitary
Delicate branching growth within a dilated duct
attached to wall of duct by fibrovascular stalk
Small duct papillomas :
Multiple
Deeply found within the duct
Composed of multiple papillae each lined by CT
cuboidal and myoepithelial cells
Solitary papillomas benign
Small multiple papillomas high risk of
malignancy duct carcinoma ; severe cytologic
atypia and abnormal mitotic figures

FIBROADENOMA
(breast mouse)
Benign
Most common benign tumor of female breast
Appears to women frequently before 35 years
old
Arises from terminal duct lobular unit
The stromal cell represent the neoplastic
element of the tumor.
Stromal cell may secrete chemical secretion
substance that cause proliferation of terminal
ducts and acini
An absolute / relative increase in estrogen
activities
Usually solitary, discrete movable painless mass
Slightly increase in size during late phase of
each menstrual cycle
Regression tumor usually occurs after
menopause
Complete surgical excision is curative
Usually spherical solitary and occasionally
multiple
Encapsulated and easily shelled out
Size varies 1-10cm in diameter
Firm in consistency
CS is grey-white (increase fibro CT)
Prolifreration of terminal ducts, acini and
stroma
Pericanalicular fibroadenoma : ductal and
glandular like spaces are open, round to oval
and regular
Intracanalicular fibroadenoma : ductal and
glandular like space are compressed by
extensive proliferation of the stroma in CS ;
slits / irregular star shape structures
Both are coexist with predominant on the other
and have no clinical significant

PHYLLODES TUMOR
(CYSTOSARCOMA PHYLLODES)
Benign / malignant
Occurs less commonly than
fibroadenoma
Arise from intralobular stroma (not
from preexisting fibroadenoma)
Occurs 10-20 years later than
fibroadenoma
Usually occur to premenopausal
women
Usually may be mistaken diagnose as
fibroadenoma

Painless mass

Small (3-4cm) but most grow to large


size
Become lobulated and cystic and
show leaf-like cleft and slits

Stromal hypercellularity
Few glandular elements
Benign : stromal cell shows no
cytologic evidence of malignancy
Malignant :
shows anaplastic and high mitotic
activity
tends to recur after excision
metastasize to distant sites
demonstrating only stromal
component

MALIGNANT TUMORS OF THE BREAST

PRIMARY

METASTATIC / 2NDRY

SARCOMA

(RARE)

Very rare
Maybe :
Sarcoma
Liposarcoma
Undifferentiated sarcoma

Metastases to breast are


rare

Metastases may arrived


from :

carcinoma of the
other breast

malignant melanoma

lung cancer

CARCINOMA

Ductal Carcinoma

A) Ductal Carcinoma In Situ (DCIS ; intra ductal carcinoma)


- comedocarcinoma
- non comedocarcinoma :
* solid
* cribriform
*papillary
B) Invasive (infiltrating) Ductal Carcinoma (IDC)
- infiltrating duct carcinoma of no special type (NST)
- medullary carcinoma
- colloid (mucinous) carcinoma
- tubular carcinoma
- invasive papillary carcinoma
C) Pagets Disease of the Nipple
D) Inflammatory Carcinoma

Lobular Carcinoma
CARCINOMA IN SITU (LCIS)
Characteristic

Grossly

Microscopic

INVASIVE LOBULAR CARCINOMA (ILC)

Arise in the terminal ducts and ductules


(acini)
Frequently multifocal within the same
breast
Usually bilateral
Do not form a palpable mass
Often discovered as an incidental finding
when a breast biopsy is performed

Confined to the lobule


Appears distended with loosely cohesive
tumor cell

5% of breast carcinoma
Especially noticed in post menopausal women
High incidence of bilateralism (20%)
mandates a careful clinical & histological
evaluation of the other breast
Poorly circumscribed
Rubbery in consistency

Composed of strands of tumor cell often one


cell in width are loosely dispersed in a fibrous
stroma (Indian files)
The tumor are small and uniform with little
pleomorphism