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{{familytree | | | | | SP | | SS | | DE | | SF | | FC |SP=Equal spacing,<br>punched-out|SS=Streaming, periph. <br>slit-like spaces.|DE=Discohesive cells,<br>expanded gl.|SF=Single cells<br>or single file|FC=Fibrovascular<br>cores}} |
{{familytree | | | | | |!| | | |!| | | |!| | | |!| | | |!| |}} |
{{familytree | | | | | DL | | FEHUT | | LL | | LC | | PL |DL=Ductal lesion|FEHUT=[[FEHUT]]|LL=Lobular lesion|LC=[[Invasive lobular carcinoma|Lobular carcinoma]]|PL=[[Breast pathology#Papillary lesions|Papillary lesions]]}} |
{{familytree | | | |,|-|^|-|.| | | |,|-|^|-|.| | | | | | | |}} |
{{familytree | | | TL | | OL | | LTF | | GTF | | | | | | |TL=Two cell layers|OL=One cell layer|LTF=<50% of gl.|GTF=>50% of gl.}} |
{{familytree | | | |!| | | |!| | | |!| | | |!| | | | | | | |}} |
{{familytree | | | DNI | | DC | | ALH | | LCIS | | | | | | |DNI=Ductal non-inv.<br>neoplasm|DC=[[Invasive ductal carcinoma of the breast|Ductal carcinoma]]|ALH=[[ALH]]|LCIS=[[LCIS]]}} |
{{familytree | |,|-|^|-|.| | | | | | | | | | | | | | | | | |}} |
{{familytree | LE | | SE | | | | | | | | | | | | | | | | |LE=Large extent|SE=Small extent}} |
{{familytree | |!| | | |!| | | | | | | | | | | | | | | | | |}} |
{{familytree | DCIS | | ADH | | | | | | | | | | | | | | | | |DCIS=[[DCIS]]|ADH=[[ADH]]}} |
{{familytree/end}} |
Notes: |
*The largest challenge is: differentiating between the first two categories on level 2, i.e. ''equal spacing' vs. ''streaming''. |
*The ''fibrovascular cores'' must arise from a tuft, i.e. if they are arising directly from the wall of glands only it is likely ''papillary DCIS''. |
===Papillary lesions=== |
<!-- |
DDX - PAPILLARY BREAST LESIONS |
--> |
{{familytree/start}} |
{{familytree | | | | | | | | | | | P | | | | | | |P='''Papillary lesions'''}} |
{{familytree | | | | | |,|-|-|-|-|-|^|-|-|-|-|-|.| |}} |
{{familytree | | | | | MP | | | | | | | | | |MA |MP=Myoepithelial cells<br>'''present'''|MA=Myoepithelial cells<br>'''absent'''}} |
{{familytree | |,|-|-|-|^|-|-|-|.| | | | | | | |!| |}} |
{{familytree | D | | | | | | E | | | | | | F |D=Unremarkable<br>papillae|E=Atypia ''or'' arch. abnorm.<br>''or'' cellular proliferation|F=Neoplastic cells<br>present}} |
{{familytree | |!| | | |,|-|-|-|+|-|-|-|.| | | |!| |}} |
{{familytree | G | | H | | I | | J | | K |G=[[intraductal papilloma of the breast|Benign<br>intraductal<br>papilloma]]|H=High grade atypia|I=Low grade atypia<br>''or'' abnorm. arch.|J=''Only'' cellular<br>proliferation|K=[[Encapsulated papillary carcinoma of the breast|Intracystic<br> (encapsulated)<br>papillary ca.]]}... |
{{familytree | | | | | |!| | | |!| | | |!| | | | | |}} |
{{familytree | | | | | L | | |!| | | N | | | | |L=[[DCIS]] in<br>papilloma|N=[[FEHUT]] in<br>papilloma}} |
{{familytree | | | | | | | |,|-|^|-|.| | | | | | | |}} |
{{familytree | | | | | | | P | | Q | | | | | | |P=>3 mm extent|Q=<3 mm extent}} |
{{familytree | | | | | | | |!| | | |!| | | | | | | |}} |
{{familytree | | | | | | | R | | S | | | | | | |R=DCIS in<br>papilloma|S=[[ADH]] in<br>papilloma}} |
{{familytree/end}} |
Notes: |
*Adapted from ''Mulligan & O'Malley''.<ref>{{cite journal |author=Mulligan AM, O'Malley FP |title=Papillary lesions of the breast: a review |journal=Adv Anat Pathol |volume=14 |issue=2 |pages=108–19 |year=2007 |month=March |pmid=17471117 |doi=10.1097/PAP.0b013e318032508d |url=}}</ref> |
*The most important decision is the first one: myoepithelial cells present vs. absent. |
*''abnorm. arch.'' = abnormal architecture present. |
*''DCIS'' = ductal carcinoma in situ. |
*''FEHUT'' = florid epithelial hyperplasia of the usual type. |
*''extent'' refers to the size of the abnormal cell population within the papillary lesion. |
=Malignant lesions= |
==Non-invasive breast cancer== |
{{main|Non-invasive breast cancer}} |
This includes the ''in situ'' lesions - ''DCIS'' and ''LCIS''. |
==Invasive breast cancer== |
{{main|Invasive breast cancer}} |
This is includes descriptions of the usual types... and the not so common ones. |
=Common benign lesions= |
The breast has lots of benign things. Unlike the prostate, the where benign is called ''benign'', everything has a name. It is more common among breast pathologists to sign-out things like: ''apocrine metaplasia'' (benign), ''columnar cell change'' (benign), and ''florid epithelial hyperplasia of the usual type (FEHU... |
==Mild epithelial hyperplasia== |
===General=== |
*No increased risk of malignancy. |
**Often ''not'' reported - as it has no clinical signficance. |
*Has to be separated from ''[[moderate epithelial hyperplasia]]'' / ''[[florid epithelial hyperplasia]]''. |
===Microscopic=== |
Features:<ref>{{Ref BP|159-160}}</ref> |
*Breast glands with three ''or'' four cell layers above the basement membrane. |
*Variable cells. |
Note: |
*No nuclear atypia. |
DDx: |
*[[Flat epithelial atypia]]. |
*[[Moderate epithelial hyperplasia]] / [[florid epithelial hyperplasia]]. |
*[[Atypical ductal hyperplasia]]. |
==Apocrine metaplasia== |
{{Main|Apocrine metaplasia of the breast}} |
==Duct ectasia== |
*Dilation of large ducts secondary to luminal obstruction by inspissated secretions |
*Presentation |
**~age 40-50, possibly with cheesy nipple discharge |
*Pathology |
**Duct lumen dilated and containing foamy macrophages |
**Necrosis/shedding of epithelium |
**If duct rupture: chronic and granulomatous inflammation of periductal region |
**Fibrotic thickening of duct wall |
<gallery> |
Image:Breast DuctEctasia LP PA.JPG|Breast - Duct Ectasia - low power (SKB) |
Image:Breast DuctEctasia MP2 PA.JPG|Breast - Duct Ectasia - low power (SKB) |
Image:Breast DuctEctasia MP PA.JPG|Breast - Duct Ectasia - medium power (SKB) |
</gallery> |
==Fibrocystic change== |
{{Main|Breast fibrocystic changes}} |
*[[AKA]] ''fibrocystic changes'' (abbreviated ''FCC''). |
==Columnar cell change== |
{{Main|Columnar cell change of the breast}} |
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