Breast:

Biopsy specimens

- Core biopsy
- Excisional biopsy
- R/O malignancy
o Positive -> lumpectomy or mastectomy + sentinel lymph nodes/axillary dissection
o Lumpectomy: 6 margins
o Mastectomies: only deep margin

Normal histology

- TDLU: terminal duct lobular unit (stem and grapes).

o Ducts converge on nipple
o Lobules contain milk during lactation: “secretory change” or “lactational change”
- 2 cell types bounded by basement membrane
o Inner epithelial
o Outer myoepithelial
o In situ disease: two cell types
o Invasive disease: one cell types

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- Elston-Ellis grading
o Glandular/tubular differentiation
o Nuclear pleomorphism
o Mitotic count
o Scoring
 Grade 1: 3-5
 Grade II: 6-7
 Grade III: 8-9
- Microcalcifications
o Need to look for if seen on mammography
o Context
 “microcalcifications in benign tissue.”
 “macrocalcifications present in association with carcinoma in situ and benign tissue.”
o Can’t find them?
 X-ray block
 Call radiologist
 Deeper levels
 Calcium oxalate: best seen with polarized light
- No malignancy but clinical suspicion for a mass? Need to find an explanation
o Microcalcifications
o Fibrosis
o Cyst
o Fat necrosis
o Benign tumor