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Tumor of the breast

1The percentage of breast pathology

22The percentage of breast malignancy according to the quadrantQuadrant PercentageUpper outer quadrant50%Lower outer quadrant10%Central portion20%Upper inner quadrant10%Lower inner quadrant10%33

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5Diagnostic methodsImmagingmammography & ultrasoundFine needle aspiration cytologyCore biopsy6Mammogram Uses a series of X-rays to show images of breast tissue The American Cancer Society recommended for > 40 yAmerican Cancer Society screening guidelines:- 20s or 30s every three years- > 40 y or older one annually

77Benign tumorFibroadenomaDuct papillomaAdenomaConnective tissue tumor8 Fibroadenoma

MacroscopicWell circumscribed & lobulated1 4 cm in diameterCut surface: solid, firm

Microscopic Admixture of stromal & glandular epithelial pro liferation9

10Breast cancer20% of all cancers in woman (Ind : 2 nd rank)Occur in pre & post menopausal womanCommonest cause of death in 35 55 age group Prognosis is good if detected at early stage

11Breast cancerAetiological mechanismOverexposure to estrogens & underexposure to progesterone importantSome tumors contain ER & PR & respond to hormone manipulationNo good evidence for viral involvement12Histological Types13Histologic TypeFrequency(%)Infiltrating Ductal Carcinoma63.6Infiltrating Lobular Carcinoma5.9Infiltrating Ductal & Lobular Ca1.6Medullary Carcinoma2.8Mucinous (colloid) Carcinoma2.1Comedocarcinoma1.4Paget's Disease1.0Histological Types13

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Peau dorangeNipple retractionNipple eczema16Signs & Symptoms

1717Skin retraction

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19Major prognostic factorInvasive / insitu diseaseDistant metastases (lungs,bones,liver)Lymph node metastases (axillary LN!!)Tumor sizeLocally advancedInflammatory ca20

21Minor prognostic factorHistologic subtypeTumor gradeEstrogen & progesterone receptorHER 2/neuLymphovascular invasionProliferative rateDNA content22Ductal invasive carcinomaMacroscopicirregular/stellate outline/nodularIll defined edgeCut surface : gray white+yellow streaks MicroscopicTumor cells aranged in cords,cluster,trabeculae cytoplasm often abundant & eosinophilic nuclei regular /pleomor phic

23Predictive marker

ERHER 2HER 224

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DCIS

LOBULAR CA

MEDULARY CA

MUCINOUS CA

TUBULAR CA

Chart10.40.30.130.10.07

Sheet1Dis%Fibrocystic disease40%No disease30%Miscellanous Benign13%Cancer10%Fibroadenoma7%

Sheet100000

Sheet2

Sheet3