Breast lumps pathophysiology: Difference between revisions

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Diagnostic Subtypes
Diagnostic Subtypes
!Diagnostic subtypes
! style="background:#4479BA; color: #FFFFFF;" align="center" + | Diagnostic Subtypes
![[Breast cancer]] [[relative risk]]
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Breast cancer relative risk
|-
|-
|Non-proliferative disease
| style="background:#DCDCDC;" align="center" + |Non-proliferative disease
|1.17
| style="background:#F5F5F5;" +|1.17
|-
|-
|Proliferative disease without [[atypia]]
| style="background:#DCDCDC;" align="center" + |Proliferative disease without [[atypia]]
|1.76
| style="background:#F5F5F5;" + |1.76
|-
|-
|Benign breast disease
| style="background:#DCDCDC;" align="center" + |Benign breast disease
|2.07
| style="background:#F5F5F5;" + |2.07
|-
|-
|Atypical [[hyperplasia]]
| style="background:#DCDCDC;" align="center" + |Atypical [[hyperplasia]]
|3.93
| style="background:#F5F5F5;" + |3.93
|}
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Histologic Subtypes
Histologic Subtypes
!Histological subtypes
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Histological subtypes
![[Relative risk|Breast cancer relative risk]]
!style="background:#4479BA; color: #FFFFFF;" align="center" + |Relative risk|Breast cancer relative risk  
|-
|-
|Adenosis
| style="background:#DCDCDC;" align="center" + |Adenosis
|2.00
| style="background:#F5F5F5;" + |2.00
|-
|-
|Atypical ductal [[hyperplasia]]
| style="background:#DCDCDC;" align="center" + |Atypical ductal [[hyperplasia]]
|3.28
| style="background:#F5F5F5;" + |3.28
|-
|-
|Atypical [[lobular]] [[hyperplasia]]
| style="background:#DCDCDC;" align="center" + |Atypical [[lobular]] [[hyperplasia]]
|3.92
| style="background:#F5F5F5;" + |3.92
|-
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|[[Cysts]]
| style="background:#DCDCDC;" align="center" + |[[Cysts]]
|1.55
| style="background:#F5F5F5;" + |1.55
|-
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|[[Fibroadenoma]]
| style="background:#DCDCDC;" align="center" + |[[Fibroadenoma]]
|1.41
| style="background:#F5F5F5;" + |1.41
|-
|-
|[[Papilloma]]
| style="background:#DCDCDC;" align="center" + |[[Papilloma]]
|2.06
| style="background:#F5F5F5;" + |2.06
|}
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Histological findings of breast lumps
Histological findings of breast lumps
!Breast lumps
!style="background:#4479BA; color: #FFFFFF;" align="center" + |Breast lumps
!Histological findings
!style="background:#4479BA; color: #FFFFFF;" align="center" + |Histological findings
|-
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|Atypical [[hyperplasia]]<ref name="pmid7560165">{{cite journal| author=Lakhani SR, Collins N, Stratton MR, Sloane JP| title=Atypical ductal hyperplasia of the breast: clonal proliferation with loss of heterozygosity on chromosomes 16q and 17p. | journal=J Clin Pathol | year= 1995 | volume= 48 | issue= 7 | pages= 611-5 | pmid=7560165 | doi= | pmc=502709 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7560165  }}</ref>
| style="background:#DCDCDC;" align="center" + |Atypical [[hyperplasia]]<ref name="pmid7560165">{{cite journal| author=Lakhani SR, Collins N, Stratton MR, Sloane JP| title=Atypical ductal hyperplasia of the breast: clonal proliferation with loss of heterozygosity on chromosomes 16q and 17p. | journal=J Clin Pathol | year= 1995 | volume= 48 | issue= 7 | pages= 611-5 | pmid=7560165 | doi= | pmc=502709 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7560165  }}</ref>
|
| style="background:#F5F5F5;" + |
* Clonal neoplastic proliferations is present.
* Clonal neoplastic proliferations is present.
|-
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|[[Atypical AVNRT|Atypical]] [[Ductal carcinoma|ductal]] [[hyperplasia]] (ADH)<ref name="pmid11474285">{{cite journal| author=Ely KA, Carter BA, Jensen RA, Simpson JF, Page DL| title=Core biopsy of the breast with atypical ductal hyperplasia: a probabilistic approach to reporting. | journal=Am J Surg Pathol | year= 2001 | volume= 25 | issue= 8 | pages= 1017-21 | pmid=11474285 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11474285  }}</ref>
| style="background:#DCDCDC;" align="center" + |[[Atypical AVNRT|Atypical]] [[Ductal carcinoma|ductal]] [[hyperplasia]] (ADH)<ref name="pmid11474285">{{cite journal| author=Ely KA, Carter BA, Jensen RA, Simpson JF, Page DL| title=Core biopsy of the breast with atypical ductal hyperplasia: a probabilistic approach to reporting. | journal=Am J Surg Pathol | year= 2001 | volume= 25 | issue= 8 | pages= 1017-21 | pmid=11474285 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11474285  }}</ref>
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| style="background:#F5F5F5;" + |
* Localized intraductal proliferations,having some microscopic features of [[ductal carcinoma in situ]] (DCIS), usually associated with [[calcification]], duct spaces consist of complex proliferation of monotonous luminal-type cells by creating bridging feature.
* Localized intraductal proliferations,having some microscopic features of [[ductal carcinoma in situ]] (DCIS), usually associated with [[calcification]], duct spaces consist of complex proliferation of monotonous luminal-type cells by creating bridging feature.
* Differentiation of ADH from DCIS : ADH has less [[cytological]] [[atypia]] than DCIS.
* Differentiation of ADH from DCIS : ADH has less [[cytological]] [[atypia]] than DCIS.
* Distribution in severe ADH is restricted to less than 3 contiguous ducts and less than 0.2 cm in size.
* Distribution in severe ADH is restricted to less than 3 contiguous ducts and less than 0.2 cm in size.
|-
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|[[Lobular]] [[neoplasia]]<ref name="pmid2986821">{{cite journal| author=Page DL, Dupont WD, Rogers LW, Rados MS| title=Atypical hyperplastic lesions of the female breast. A long-term follow-up study. | journal=Cancer | year= 1985 | volume= 55 | issue= 11 | pages= 2698-708 | pmid=2986821 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2986821  }}</ref>
| style="background:#DCDCDC;" align="center" + |[[Lobular]] [[neoplasia]]<ref name="pmid2986821">{{cite journal| author=Page DL, Dupont WD, Rogers LW, Rados MS| title=Atypical hyperplastic lesions of the female breast. A long-term follow-up study. | journal=Cancer | year= 1985 | volume= 55 | issue= 11 | pages= 2698-708 | pmid=2986821 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2986821  }}</ref>
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| style="background:#F5F5F5;" + |
* Associated to decrease expression or missing expression of E-cadherine, [[lobular]] [[neoplasia]] is considered to be as incidental findings in during [[microcalcification]] evaluation.
* Associated to decrease expression or missing expression of E-cadherine, [[lobular]] [[neoplasia]] is considered to be as incidental findings in during [[microcalcification]] evaluation.
|-
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|[[Atypical AVNRT|Atypical]] [[lobular]] [[hyperplasia]] (ALH)<ref name="pmid24639339">{{cite journal| author=Middleton LP, Sneige N, Coyne R, Shen Y, Dong W, Dempsey P et al.| title=Most lobular carcinoma in situ and atypical lobular hyperplasia diagnosed on core needle biopsy can be managed clinically with radiologic follow-up in a multidisciplinary setting. | journal=Cancer Med | year= 2014 | volume= 3 | issue= 3 | pages= 492-9 | pmid=24639339 | doi=10.1002/cam4.223 | pmc=4101740 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24639339  }}</ref>
| style="background:#DCDCDC;" align="center" + |[[Atypical AVNRT|Atypical]] [[lobular]] [[hyperplasia]] (ALH)<ref name="pmid24639339">{{cite journal| author=Middleton LP, Sneige N, Coyne R, Shen Y, Dong W, Dempsey P et al.| title=Most lobular carcinoma in situ and atypical lobular hyperplasia diagnosed on core needle biopsy can be managed clinically with radiologic follow-up in a multidisciplinary setting. | journal=Cancer Med | year= 2014 | volume= 3 | issue= 3 | pages= 492-9 | pmid=24639339 | doi=10.1002/cam4.223 | pmc=4101740 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24639339  }}</ref>
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| style="background:#F5F5F5;" + |
* ALH is containing monomorphic cells and distend into lobular acini and adjacent terminal ducts.
* ALH is containing monomorphic cells and distend into lobular acini and adjacent terminal ducts.
* Differentiation between ALH and [[lobular carcinoma in situ]] (LCIS) associated with quantitative degrees about lobules and architecture feature.
* Differentiation between ALH and [[lobular carcinoma in situ]] (LCIS) associated with quantitative degrees about lobules and architecture feature.
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|[[Apocrine]] proliferative lesions<ref name="pmid16720843">{{cite journal| author=Guray M, Sahin AA| title=Benign breast diseases: classification, diagnosis, and management. | journal=Oncologist | year= 2006 | volume= 11 | issue= 5 | pages= 435-49 | pmid=16720843 | doi=10.1634/theoncologist.11-5-435 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16720843  }}</ref>
| style="background:#DCDCDC;" align="center" + |[[Apocrine]] proliferative lesions<ref name="pmid16720843">{{cite journal| author=Guray M, Sahin AA| title=Benign breast diseases: classification, diagnosis, and management. | journal=Oncologist | year= 2006 | volume= 11 | issue= 5 | pages= 435-49 | pmid=16720843 | doi=10.1634/theoncologist.11-5-435 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16720843  }}</ref>
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| style="background:#F5F5F5;" + |
* [[Apocrine]] [[atypia]] is described by a 3-fold variation in nuclear size or by cribriform structures with nuclear [[atypia]], associated with sclerosing adenosis or complex [[sclerosing]] lesion.
* [[Apocrine]] [[atypia]] is described by a 3-fold variation in nuclear size or by cribriform structures with nuclear [[atypia]], associated with sclerosing adenosis or complex [[sclerosing]] lesion.
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|Columnar cell lesions (CCL)<ref name="pmid12717115">{{cite journal| author=Schnitt SJ, Vincent-Salomon A| title=Columnar cell lesions of the breast. | journal=Adv Anat Pathol | year= 2003 | volume= 10 | issue= 3 | pages= 113-24 | pmid=12717115 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12717115  }}</ref>
| style="background:#DCDCDC;" align="center" + |Columnar cell lesions (CCL)<ref name="pmid12717115">{{cite journal| author=Schnitt SJ, Vincent-Salomon A| title=Columnar cell lesions of the breast. | journal=Adv Anat Pathol | year= 2003 | volume= 10 | issue= 3 | pages= 113-24 | pmid=12717115 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12717115  }}</ref>
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| style="background:#F5F5F5;" + |
* CCL has heterogeneous set of lesions distinguished by reduplication and microcystic changes in lobular acini, elevated [[estrogen]] receptor expression, increased proliferative rate, associated with [[sclerosing adenosis]], clacification and pleomorphic appearnace.
* CCL has heterogeneous set of lesions distinguished by reduplication and microcystic changes in lobular acini, elevated [[estrogen]] receptor expression, increased proliferative rate, associated with [[sclerosing adenosis]], clacification and pleomorphic appearnace.
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|[[Papillary]] lesions<ref name="pmid18716096">{{cite journal| author=Muttarak M, Lerttumnongtum P, Chaiwun B, Peh WC| title=Spectrum of papillary lesions of the breast: clinical, imaging, and pathologic correlation. | journal=AJR Am J Roentgenol | year= 2008 | volume= 191 | issue= 3 | pages= 700-7 | pmid=18716096 | doi=10.2214/AJR.07.3483 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18716096  }}</ref>
| style="background:#DCDCDC;" align="center" + |[[Papillary]] lesions<ref name="pmid18716096">{{cite journal| author=Muttarak M, Lerttumnongtum P, Chaiwun B, Peh WC| title=Spectrum of papillary lesions of the breast: clinical, imaging, and pathologic correlation. | journal=AJR Am J Roentgenol | year= 2008 | volume= 191 | issue= 3 | pages= 700-7 | pmid=18716096 | doi=10.2214/AJR.07.3483 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18716096  }}</ref>
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| style="background:#F5F5F5;" + |
* Arborescent fibrovascular stalk lined to the myoepithelium are present.
* Arborescent fibrovascular stalk lined to the myoepithelium are present.
|-
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|Radical scars and complex sclerosing lesions<ref name="pmid22268202">{{cite journal| author=Krishnamurthy S, Bevers T, Kuerer H, Yang WT| title=Multidisciplinary considerations in the management of high-risk breast lesions. | journal=AJR Am J Roentgenol | year= 2012 | volume= 198 | issue= 2 | pages= W132-40 | pmid=22268202 | doi=10.2214/AJR.11.7799 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22268202  }}</ref>
| style="background:#DCDCDC;" align="center" + |Radical scars and complex sclerosing lesions<ref name="pmid22268202">{{cite journal| author=Krishnamurthy S, Bevers T, Kuerer H, Yang WT| title=Multidisciplinary considerations in the management of high-risk breast lesions. | journal=AJR Am J Roentgenol | year= 2012 | volume= 198 | issue= 2 | pages= W132-40 | pmid=22268202 | doi=10.2214/AJR.11.7799 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22268202  }}</ref>
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| style="background:#F5F5F5;" + |
* Radial scars are [[tumor]] like lesions with stellate nidus of dense elastotic [[collagen]], surrounding with [[epithelial]] elements and [[sclerosing adenosis]].
* Radial scars are [[tumor]] like lesions with stellate nidus of dense elastotic [[collagen]], surrounding with [[epithelial]] elements and [[sclerosing adenosis]].
* Complex sclerosing lesions are kind of radial scars larger than 1 cm which has distorted glandular tissue.
* Complex sclerosing lesions are kind of radial scars larger than 1 cm which has distorted glandular tissue.
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|[[Fibroadenoma]]<ref name="pmid16034008">{{cite journal| author=Hartmann LC, Sellers TA, Frost MH, Lingle WL, Degnim AC, Ghosh K et al.| title=Benign breast disease and the risk of breast cancer. | journal=N Engl J Med | year= 2005 | volume= 353 | issue= 3 | pages= 229-37 | pmid=16034008 | doi=10.1056/NEJMoa044383 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16034008  }}</ref>
| style="background:#DCDCDC;" align="center" + |[[Fibroadenoma]]<ref name="pmid16034008">{{cite journal| author=Hartmann LC, Sellers TA, Frost MH, Lingle WL, Degnim AC, Ghosh K et al.| title=Benign breast disease and the risk of breast cancer. | journal=N Engl J Med | year= 2005 | volume= 353 | issue= 3 | pages= 229-37 | pmid=16034008 | doi=10.1056/NEJMoa044383 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16034008  }}</ref>
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| style="background:#F5F5F5;" + |
* Consist of  disposed compressed glands within collagenous stroma.
* Consist of  disposed compressed glands within collagenous stroma.
* Complex [[Fibroadenoma|fibroadenomas]]: containing [[sclerosing  adenosis]], calcifications, [[papillary]] [[hyperplasia]].
* Complex [[Fibroadenoma|fibroadenomas]]: containing [[sclerosing  adenosis]], calcifications, [[papillary]] [[hyperplasia]].
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|[[Phyllodes tumor]]<ref name="pmid19329316">{{cite journal| author=Karim RZ, Gerega SK, Yang YH, Spillane A, Carmalt H, Scolyer RA et al.| title=Phyllodes tumours of the breast: a clinicopathological analysis of 65 cases from a single institution. | journal=Breast | year= 2009 | volume= 18 | issue= 3 | pages= 165-70 | pmid=19329316 | doi=10.1016/j.breast.2009.03.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19329316  }}</ref>
| style="background:#DCDCDC;" align="center" + |[[Phyllodes tumor]]<ref name="pmid19329316">{{cite journal| author=Karim RZ, Gerega SK, Yang YH, Spillane A, Carmalt H, Scolyer RA et al.| title=Phyllodes tumours of the breast: a clinicopathological analysis of 65 cases from a single institution. | journal=Breast | year= 2009 | volume= 18 | issue= 3 | pages= 165-70 | pmid=19329316 | doi=10.1016/j.breast.2009.03.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19329316  }}</ref>
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| style="background:#F5F5F5;" + |
* Prominent and hypercellular [[stromal]] feature expanded to [[epithelial]] of tumor.
* Prominent and hypercellular [[stromal]] feature expanded to [[epithelial]] of tumor.
* Classified to [[benign]], borderline, and [[malignant]] on the basis of [[stromal]] [[mitotic]] rate, [[cytology]] and degree of [[stromal]] overgrowth.
* Classified to [[benign]], borderline, and [[malignant]] on the basis of [[stromal]] [[mitotic]] rate, [[cytology]] and degree of [[stromal]] overgrowth.
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|Pseudoangiomatous [[Stromal]] [[Hyperplasia]]<ref name="pmid15569209">{{cite journal| author=Hoda SA, Rosen PP| title=Observations on the pathologic diagnosis of selected unusual lesions in needle core biopsies of breast. | journal=Breast J | year= 2004 | volume= 10 | issue= 6 | pages= 522-7 | pmid=15569209 | doi=10.1111/j.1075-122X.2004.21412.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15569209  }}</ref>
| style="background:#DCDCDC;" align="center" + |Pseudoangiomatous [[Stromal]] [[Hyperplasia]]<ref name="pmid15569209">{{cite journal| author=Hoda SA, Rosen PP| title=Observations on the pathologic diagnosis of selected unusual lesions in needle core biopsies of breast. | journal=Breast J | year= 2004 | volume= 10 | issue= 6 | pages= 522-7 | pmid=15569209 | doi=10.1111/j.1075-122X.2004.21412.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15569209  }}</ref>
|
| style="background:#F5F5F5;" + |
* Composed of dense [[collagen]], slit like spaces resulting from [[fibroblast]] proliferation resembling blood vessels in the [[stroma]] between [[lobular]] units.
* Composed of dense [[collagen]], slit like spaces resulting from [[fibroblast]] proliferation resembling blood vessels in the [[stroma]] between [[lobular]] units.
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|[[Sclerosing adenosis]]<ref name="pmid21572066">{{cite journal| author=Ferrara A| title=Benign breast disease. | journal=Radiol Technol | year= 2011 | volume= 82 | issue= 5 | pages= 447M-62M | pmid=21572066 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21572066  }}</ref>
| style="background:#DCDCDC;" align="center" + |[[Sclerosing adenosis]]<ref name="pmid21572066">{{cite journal| author=Ferrara A| title=Benign breast disease. | journal=Radiol Technol | year= 2011 | volume= 82 | issue= 5 | pages= 447M-62M | pmid=21572066 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21572066  }}</ref>
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| style="background:#F5F5F5;" + |
* Increase in [[lobular]] acini number, enriched in [[myoepithelial cells]].
* Increase in [[lobular]] acini number, enriched in [[myoepithelial cells]].
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== Gross pathology ==
== Gross pathology ==
{| class="wikitable"
{| class="wikitable"
!Gross findings
!style="background:#4479BA; color: #FFFFFF;" align="center" + |Gross findings
!Gross pathology
!style="background:#4479BA; color: #FFFFFF;" align="center" + |Gross pathology
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|
|style="background:#DCDCDC;" align="left" + |
* Fibrotic capsule and infiltrated the surrounding tissue<ref name="pmid19946485">{{cite journal| author=Gashi-Luci LH, Limani RA, Kurshumliu FI| title=Invasive ductal carcinoma within fibroadenoma: a case report. | journal=Cases J | year= 2009 | volume= 2 | issue=  | pages= 174 | pmid=19946485 | doi=10.1186/1757-1626-2-174 | pmc=2783130 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19946485  }} </ref>
* Fibrotic capsule and infiltrated the surrounding tissue<ref name="pmid19946485">{{cite journal| author=Gashi-Luci LH, Limani RA, Kurshumliu FI| title=Invasive ductal carcinoma within fibroadenoma: a case report. | journal=Cases J | year= 2009 | volume= 2 | issue=  | pages= 174 | pmid=19946485 | doi=10.1186/1757-1626-2-174 | pmc=2783130 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19946485  }} </ref>
* Gray-white color and moderately increased consistency
* Gray-white color and moderately increased consistency
|[[File:FibroAdenoma of the breast.JPG|thumb|none|300px|Gross feature of fibroadenoma [https://commons.wikimedia.org/wiki/File:FibroAdenoma_of_the_breast.JPG Source: Netha Hussain , from Wikimedia Commons]]]
|style="background:#F5F5F5;" + |[[File:FibroAdenoma of the breast.JPG|thumb|none|300px|Gross feature of fibroadenoma [https://commons.wikimedia.org/wiki/File:FibroAdenoma_of_the_breast.JPG Source: Netha Hussain , from Wikimedia Commons]]]
|-
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|style="background:#DCDCDC;" align="left" + |
* Stellate area of cancer 2cm in diameter
* Stellate area of cancer 2cm in diameter
* Felt as a hard mobile mass  
* Felt as a hard mobile mass  
* Histology as a moderately well differentiated duct carcinoma
* Histology as a moderately well differentiated duct carcinoma
|[[File:800px-Breast cancer.JPG|thumb|none|300px| Gross image of breast cancer [https://commons.wikimedia.org/wiki/File:Breast_cancer.JPG Source: John Hayman , from Wikimedia Commons]]]
|style="background:#F5F5F5;" + |[[File:800px-Breast cancer.JPG|thumb|none|300px| Gross image of breast cancer [https://commons.wikimedia.org/wiki/File:Breast_cancer.JPG Source: John Hayman , from Wikimedia Commons]]]
|}
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{| class="wikitable"
{| class="wikitable"
|+
|+
!Pathologic findings
!style="background:#4479BA; color: #FFFFFF;" align="center" + | Pathologic findings
!Microscopic image
!style="background:#4479BA; color: #FFFFFF;" align="center" + |Microscopic image
|-
|-
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|style="background:#DCDCDC;" align="left" + |
* [[Phyllodes tumor]] is a tumor of the intralobular breast [[stroma]]<br>and it may be benign or malignant with large slit-like spaces.<br>It is a type of [[fibroepithelial tumor]].
* [[Phyllodes tumor]] is a tumor of the intralobular breast [[stroma]]<br>and it may be benign or malignant with large slit-like spaces.<br>It is a type of [[fibroepithelial tumor]].
|[[File:800px-Phyllodes tumour - very low mag.jpg|thumb|none|300px|Histopathologic image of Phyllodes tumor [https://commons.wikimedia.org/wiki/File:Phyllodes_tumour_-_very_low_mag.jpg Source: Nephron, from Wikimedia Commons]]]
|style="background:#F5F5F5;" + |[[File:800px-Phyllodes tumour - very low mag.jpg|thumb|none|300px|Histopathologic image of Phyllodes tumor [https://commons.wikimedia.org/wiki/File:Phyllodes_tumour_-_very_low_mag.jpg Source: Nephron, from Wikimedia Commons]]]
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|style="background:#DCDCDC;" align="left" + |
* Sclerosing adenosis microscopic pathology has increased numbers of small<br>breast acini with collapsed lumens, [[fibrosis]] surrounds the acini,<br>considered as benign lesion with increased risk of [[breast cancer]].
* Sclerosing adenosis microscopic pathology has increased numbers of small<br>breast acini with collapsed lumens, [[fibrosis]] surrounds the acini,<br>considered as benign lesion with increased risk of [[breast cancer]].
|[[File:Microscopic feature of Sclerosing adenosis.jpg|thumb|none|300px|Histopathologic image of sclerosing adenosis [https://commons.wikimedia.org/wiki/File:Sclerosing_adenosis_--_intermed_mag.jpg Source: Nephron, from Wikimedia Commons]]]
|style="background:#F5F5F5;" + |[[File:Microscopic feature of Sclerosing adenosis.jpg|thumb|none|300px|Histopathologic image of sclerosing adenosis [https://commons.wikimedia.org/wiki/File:Sclerosing_adenosis_--_intermed_mag.jpg Source: Nephron, from Wikimedia Commons]]]
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|style="background:#DCDCDC;" align="left" + |
* [[ADH]], based on a molecular basis, is a low-grade [[DCIS]] with localized<br>[[proliferation]].
* [[ADH]], based on a molecular basis, is a low-grade [[DCIS]] with localized<br>[[proliferation]].
|[[File:Atypical ductal hyperplasia.jpg|thumb|none|300px|Histopathologic image of atypical ductal hyperplasia [https://commons.wikimedia.org/wiki/File:Atypical_ductal_hyperplasia_-_high_mag.jpg Source: Nephron, from Wikimedia Commons]]]
|style="background:#F5F5F5;" + |[[File:Atypical ductal hyperplasia.jpg|thumb|none|300px|Histopathologic image of atypical ductal hyperplasia [https://commons.wikimedia.org/wiki/File:Atypical_ductal_hyperplasia_-_high_mag.jpg Source: Nephron, from Wikimedia Commons]]]
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Latest revision as of 20:42, 29 July 2020

Breast lumps Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shadan Mehraban, M.D.[2]

Overview

Breast development is influenced by different hormones such as estrogen, progesterone, prolactin, and estradiol. The pathophysiology of breast lumps depends on the histological subtypes. Histological findings of breast lumps are different from each other which lead to diagnosis. It is thought that breast lumps are the result of hormonal events and genetic mutations. Estrogen and progesterone may increase risk of benign proliferative disease to 74% and benign breast lesion in post-menopausal women receiving estrogen with or without progesteron for more than 8 years raise by 1.7 fold. Gene mutations are classified into 3 categories based on cancer risk such as BRCA1, BRCA2, TP53 considered as high risk mutations, Homozygous ataxia-telangiectasia, somatic mutation in CHEK2, BRIP1, PALB2 moderate risk mutations, and low risk genes mutation are not determined yet.

Pathophysiology

Physiology

Histological changes of breast

Histological changes of breast undergo continuous changes throughout the life:[4]

  • Fibrocystic disease
    • Histological apperance change from predominance of ducts, lobules to fibrous change, and cyst formation
    • Fibrocystic changes are not associated with breast cancer
  • Diagnostic subtypes and histologic subtypes are described according to their relative risk for cancer as below:[7]
Diagnostic Subtypes
Diagnostic Subtypes Breast cancer relative risk
Non-proliferative disease 1.17
Proliferative disease without atypia 1.76
Benign breast disease 2.07
Atypical hyperplasia 3.93
Histologic Subtypes
Histological subtypes Relative risk|Breast cancer relative risk
Adenosis 2.00
Atypical ductal hyperplasia 3.28
Atypical lobular hyperplasia 3.92
Cysts 1.55
Fibroadenoma 1.41
Papilloma 2.06
Histological findings of breast lumps
Breast lumps Histological findings
Atypical hyperplasia[8]
  • Clonal neoplastic proliferations is present.
Atypical ductal hyperplasia (ADH)[9]
  • Localized intraductal proliferations,having some microscopic features of ductal carcinoma in situ (DCIS), usually associated with calcification, duct spaces consist of complex proliferation of monotonous luminal-type cells by creating bridging feature.
  • Differentiation of ADH from DCIS : ADH has less cytological atypia than DCIS.
  • Distribution in severe ADH is restricted to less than 3 contiguous ducts and less than 0.2 cm in size.
Lobular neoplasia[10]
  • Associated to decrease expression or missing expression of E-cadherine, lobular neoplasia is considered to be as incidental findings in during microcalcification evaluation.
Atypical lobular hyperplasia (ALH)[11]
  • ALH is containing monomorphic cells and distend into lobular acini and adjacent terminal ducts.
  • Differentiation between ALH and lobular carcinoma in situ (LCIS) associated with quantitative degrees about lobules and architecture feature.
Apocrine proliferative lesions[12]
  • Apocrine atypia is described by a 3-fold variation in nuclear size or by cribriform structures with nuclear atypia, associated with sclerosing adenosis or complex sclerosing lesion.
Columnar cell lesions (CCL)[13]
  • CCL has heterogeneous set of lesions distinguished by reduplication and microcystic changes in lobular acini, elevated estrogen receptor expression, increased proliferative rate, associated with sclerosing adenosis, clacification and pleomorphic appearnace.
Papillary lesions[14]
  • Arborescent fibrovascular stalk lined to the myoepithelium are present.
Radical scars and complex sclerosing lesions[15]
  • Radial scars are tumor like lesions with stellate nidus of dense elastotic collagen, surrounding with epithelial elements and sclerosing adenosis.
  • Complex sclerosing lesions are kind of radial scars larger than 1 cm which has distorted glandular tissue.
Fibroadenoma[16]
Phyllodes tumor[17]
Pseudoangiomatous Stromal Hyperplasia[18]
Sclerosing adenosis[19]

Pathogenesis

Genetics

Associated Conditions

  • There are no other associated conditions with breast lumps.

Gross pathology

Gross findings Gross pathology
  • Fibrotic capsule and infiltrated the surrounding tissue[33]
  • Gray-white color and moderately increased consistency
Gross feature of fibroadenoma Source: Netha Hussain , from Wikimedia Commons
  • Stellate area of cancer 2cm in diameter
  • Felt as a hard mobile mass
  • Histology as a moderately well differentiated duct carcinoma
Gross image of breast cancer Source: John Hayman , from Wikimedia Commons

Microscopic Pathology

Pathologic findings Microscopic image
Histopathologic image of Phyllodes tumor Source: Nephron, from Wikimedia Commons
  • Sclerosing adenosis microscopic pathology has increased numbers of small
    breast acini with collapsed lumens, fibrosis surrounds the acini,
    considered as benign lesion with increased risk of breast cancer.
Histopathologic image of sclerosing adenosis Source: Nephron, from Wikimedia Commons
Histopathologic image of atypical ductal hyperplasia Source: Nephron, from Wikimedia Commons

References

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  2. Hughes LE, Mansel RE, Webster DJ (1987). "Aberrations of normal development and involution (ANDI): a new perspective on pathogenesis and nomenclature of benign breast disorders". Lancet. 2 (8571): 1316–9. PMID 2890912.
  3. Santen RJ. Benign Breast Disease in Women. [Updated 2018 May 25]. In: De Groot LJ, Chrousos G, Dungan K, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK278994/
  4. Love, Susan M.; Sue Gelman, Rebecca; silen, William (1982). "Fibrocystic Disease of the Breast — A Nondisease?". New England Journal of Medicine. 307 (16): 1010–1014. doi:10.1056/NEJM198210143071611. ISSN 0028-4793.
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  6. 6.0 6.1 Huh SJ, Oh H, Peterson MA, Almendro V, Hu R, Bowden M; et al. (2016). "The Proliferative Activity of Mammary Epithelial Cells in Normal Tissue Predicts Breast Cancer Risk in Premenopausal Women". Cancer Res. 76 (7): 1926–34. doi:10.1158/0008-5472.CAN-15-1927. PMC 4873436. PMID 26941287.
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  14. Muttarak M, Lerttumnongtum P, Chaiwun B, Peh WC (2008). "Spectrum of papillary lesions of the breast: clinical, imaging, and pathologic correlation". AJR Am J Roentgenol. 191 (3): 700–7. doi:10.2214/AJR.07.3483. PMID 18716096.
  15. Krishnamurthy S, Bevers T, Kuerer H, Yang WT (2012). "Multidisciplinary considerations in the management of high-risk breast lesions". AJR Am J Roentgenol. 198 (2): W132–40. doi:10.2214/AJR.11.7799. PMID 22268202.
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  26. Hicks DG, Kulkarni S (2008). "HER2+ breast cancer: review of biologic relevance and optimal use of diagnostic tools". Am J Clin Pathol. 129 (2): 263–73. doi:10.1309/99AE032R9FM8WND1. PMID 18208807.
  27. O'Connell P, Pekkel V, Fuqua SA, Osborne CK, Clark GM, Allred DC (1998). "Analysis of loss of heterozygosity in 399 premalignant breast lesions at 15 genetic loci". J Natl Cancer Inst. 90 (9): 697–703. PMID 9586667.
  28. Sharif S, Moran A, Huson SM, Iddenden R, Shenton A, Howard E; et al. (2007). "Women with neurofibromatosis 1 are at a moderately increased risk of developing breast cancer and should be considered for early screening". J Med Genet. 44 (8): 481–4. doi:10.1136/jmg.2007.049346. PMC 2597938. PMID 17369502.
  29. Seal S, Thompson D, Renwick A, Elliott A, Kelly P, Barfoot R; et al. (2006). "Truncating mutations in the Fanconi anemia J gene BRIP1 are low-penetrance breast cancer susceptibility alleles". Nat Genet. 38 (11): 1239–41. doi:10.1038/ng1902. PMID 17033622.
  30. Wong MW, Nordfors C, Mossman D, Pecenpetelovska G, Avery-Kiejda KA, Talseth-Palmer B; et al. (2011). "BRIP1, PALB2, and RAD51C mutation analysis reveals their relative importance as genetic susceptibility factors for breast cancer". Breast Cancer Res Treat. 127 (3): 853–9. doi:10.1007/s10549-011-1443-0. PMID 21409391.
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