FEMALE REPRODUCTIVE SYSTEM

PATHOLOGY OF BREAST

ANATOMICAL PATHOLOGY DEPARTEMENT

FKUP/RSHS
2022
IMPORTANT FEATURES DISTINGUISH THE BREAST
FROM OTHER ORGANS:
1. Major function → nutritional support of the infant (rather
than for survival)
2. The structure of the organ undergoes marked changes
throughout life: menarche, periodic remodeling during
adulthood (pregnancy), and ultimately involution and
regression of lobules.
3. Breasts are visible → have a social, cultural, and personal
significance (not shared by other organs)

All of these features play a role when considering the origins,

presentations, and treatment of breast disease
 ANATOMY

• Located on the anterior thoracic wall

Extends horizontally from lateral
border of the sternum -mid-axillary
line.
Vertically, it spans between the 2nd - 6th
 costal cartilages.
Lies superficially to the pectoralis major
and serratus anterior muscles.

• Center of the breast → nipple, composed

mostly of smooth muscle fibres.
Surrounding the nipple is a pigmented
area of skin termed the areolae.
 Axillary artery → Lateral thoracic artery (main)

Arterial Supply Internal thoracic artery (medial mammary arteries)

Intercostal arteries (2nd, 3rd, 4th arteries branches)

Vascular Abnormalities of the Breast: Arterial and Venous Disorders, Vascular Masses, and Mimic Lesions with Radiologic-Pathologic Correlation. Robert A. Jesinger, Grant E. Lattin,
Jr, Elizabeth A. Ballard, Scott M. Zelasko, and Leonard M. Glassman. RadioGraphics 2011 31:7, E117-E136
 Axillary veins

Venous Drainage Internal thoracic veins

Intercostal veins (2nd, 3rd, 4th veins)

Vascular Abnormalities of the Breast: Arterial and Venous Disorders, Vascular Masses, and Mimic Lesions with Radiologic-Pathologic Correlation. Robert A. Jesinger, Grant E. Lattin,
Jr, Elizabeth A. Ballard, Scott M. Zelasko, and Leonard M. Glassman. RadioGraphics 2011 31:7, E117-E136
 75% pectoral axillary subclavian
Subareolar
lymph lymph lymphatic
lymphatic plexus
Lymph nodes nodes trunks

Drainage Subareolar lymphatic parasternal lymph bronchomediastinal

plexus nodes lymphatic trunks
25%
 HISTOLOGY
Epithelium and Stroma
Ducts and lobules are lined by 2
cell types
• Myoepithelial cell lying on the
Basal membrane
• Epithelial cells lines the lumen
Stroma
1. Interlobular stroma
2. Intralobular stroma
ACKERMAN, 2018
Nonpregnant women, the gland is quiescent and undifferentiated, and its duct
system is inactive.
Di Fiore atlas of histology 11th 2008
During pregnancy, alveoli proliferate at the ends of the ducts and prepare
for the secretion of milk
DI FIORE ATLAS OF HISTOLOGY 11TH
2008
During lactation, alveoli are fully differentiated, and milk secretion is abundant.

Di Fiore atlas of histology 11th 2008

BREAST PATHOLOGY
MICROSCOPIC

datia
Langhans cell

Caseous
Necrosis

Epithelioid
cells
TUBERCULOUS MASTITIS

Clinical Features :
- May present with abscess, fistula or mass
- Usually unilateral
Gross Description :
Multiple sinuses or fistulas ; may have focal discoloration
or mass

Microscopic :
Granulomas with Langhans giant cells and caseous necrosis
(often), epithelioid cell between normal breast ductuli gland.
 Fibroadenoma
BENIGN TUMORS Phyllodes Tumor
 FIBROADENOMA MAMMAE

Clinical Palpable breast Size

Manifestation: mass, firm, but
Young Woman yet Mobile 0,5 cm to 3 cm

There are no No Pain

significant May be discomfort
enlargement of the feelings during the
mass periode
 MACROSCOPIC
Massa

Massa
MICROSCOPIC

Myxoid degeneration Hyaline degeneration

Epithelial cells lines the mammary gland ductules
MICROSCOPIC

Myxoid degeneration
Epithelial cells lines the mammary gland ductules
FIBROADENOMA

Most common benign breast tumor in young woman

(early years after menarche 16-25 years)

WHO definition – Discrete benign tumor showing evidence

of connective tissue and epithelial proliferation

Etiology is unknown, thought to be due to hormonal

influence

Good prognostic after total excision

PHYLLODES TUMOR

https://www.elsevier.es/es-revista-revista-senologia-patologia-mamaria--131-articulo-giant-phyllodes-tumour-case-S0214158217300208
PHYLLODES TUMOR

Occurs in middle-aged and older women

can certainly occur in young adults and even in adolescents

Commonly presents with firm, asymptomatic, mobile

breast mass
Large tumor (up to 20 cm) can cause skin ulceration and pain
MACROSCOPIC

Gross Appearance of
Phyllodes Tumor:

Typical Phyllodes tumor is

round, relatively well
circumscribed and firm.

The cut surface is solid and

grey-white and shows the
cleft-like spaces.
PHYLLODES TUMOR
• Microscopis:
• Leaf-like (phyllodal) epithelial
pattern formed by an
exaggerated intracanalicular
pattern
• Subepithelial condensation with
increased stromal cellularity
adjacent to epithelium
• Graded into benign, borderline
and malignant histologic grades
MICROSCOPIC

cleft-like spaces
hypercellular
stroma
PHYLLODES TUMOR -> MALIGNANT

• Macroscopic:

Areas of necrosis, cystic

degeneration, and
hemorrhage may be
present
MALIGNANT BREAST TUMORS

Epithelial Non-Epithelial
• Ductal Carcinoma In Situ • Malignant Pyhllodes
• Invasive Carcinoma: • Malignant Lymphoma
• Invasive Ductal • etc
• Invasive Lobular
• Invasive Papillary
• etc
INVASIVE BREAST CARCINOMA

• An infiltrative malignant epithelial proces resembling

cells lining ducts – most common breast carcinoma
• Invasive carcinoma of no special type majority 70-80%
cases of breast cancer
• Most of these cancers exhibit marked increase in dense,
fibrous tissue stroma giving tumour a hard consistency
(schirrous carcinoma)
MOLECULAR CLASSIFICATION

Based on Immunohistochemistry examination

(Estrogen Receptor (ER), Progesterone Receptor (PR), CerbB2/Her2Neu, Ki67)

• Luminal A
• Luminal B
• Her2 type
• Triple Negative
INVASIVE BREAST
CARCINOMA
Macroscopic:
• Firm to hard, irregular
border
• Less frequently –well-
circumscribed border,
softer consistency
• May be gritty on cut
• When cut/scraped 
central pinpoint foci or
streaks of chalky-white
elastic stroma and
occasional small foci of
calcification
MICROSCOPIC

Malignant cells group

INVASIVE BREAST
CARCINOMA

Microscopic:
• Malignant tumour cells
arranged in cords,
solid nest, tubules, or
mixture of all these
invading the stroma
• perineural, vascular and
lymphatic invasion
NUCLEAR GRADE

Nucleoli / Anak inti

MITOTIC RATE