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Breast Pathology. Helge Stalsberg MD University Hospital of North Norway. Major classes of breast disease. Benign breast disease. Normal breast. Invasive carcinoma. Carcinoma in situ. Normal breast. Lobule and duct. Lobule. Benign Breast disease : Elements of fibrocystic disease.

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Breast Pathology


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    1. Breast Pathology Helge Stalsberg MD University Hospital of North Norway

    2. Major classes of breast disease Benign breast disease Normal breast Invasive carcinoma Carcinoma in situ

    3. Normal breast Lobule and duct Lobule

    4. Benign Breastdisease:Elements offibrocysticdisease Ductal hyper-plasia Cyst Apo-crine meta-plasia Sclero-sing adenosis

    5. Benign breast disease: Intraductal papilloma Fibro-adenoma

    6. Carcinoma in situ Ductal carcinoma in situ. DCIS Lobular carcinoma in situ. LCIS

    7. The distribution of carcinoma in situ Ductal carcinoma in situ Lobular carcinoma in situ

    8. Invasive carcinoma: The pathology report • The definite diagnosis • The local/regional extent of the disease • Data relevant to prognosis • Data relevant for the choice of treatment

    9. The Pathology report, Ca. resection MAIN DIAGNOSIS: • Local resection (lumpectomy) of breast with invasive ductal carcinoma OTHER FEATURES: • TUMOR SIZE: 3 cm • LOCATION: Upper inner quadrant, right breast • TUMOR GRADE: 2 • RESECTION MARGINS, MINIMUM DISTANCE TO TUMOR: 4 mm from dorsal margin, 32 mm from ventral margin • TUMOR INVASION OF SKIN, MUSCLE, PAGET’S DISEASE OF THE NIPPLE: Absent. • VASCULAR INVASION: Present • DCIS: Present DCIS GRADE: 3 DCIS MIN. DIST. TO RESECTION MARGIN: 1 mm to dorsal margin • NO. OF LYMPH NODES EXAMINED: 13 • NO. OF LYMPH NODES WITH TUMOR: 5 • HORMONE RECEPTOR STATUS: Positive for estrogen receptor Negative for progesteron receptor • Her-2 STATUS: Negative (2+ by immunohistochemistry, negative by FISH) • pTNM CLASSIFICATION: pT1N2Mx • EXTRA-TUMORAL BREAST: Fibrocystic disease

    10. The Pathology report MAIN DIAGNOSIS: • Local resection (lumpectomy) of breast with invasive ductal carcinoma OTHER FEATURES: • TUMOR SIZE: 3 cm • LOCATION: Upper inner quadrant, right breast • TUMOR GRADE: 2 • RESECTION MARGINS, MINIMUM DISTANCE TO TUMOR: 4 mm from dorsal margin, 32 mm from ventral margin • TUMOR INVASION OF SKIN, MUSCLE, PAGET’S DISEASE OF THE NIPPLE: Absent. • VASCULAR INVASION: Present • DCIS: Present DCIS GRADE: 3 DCIS MIN. DIST. TO RESECTION MARGIN: 1 mm to dorsal margin • NO. OF LYMPH NODES EXAMINED: 13 • NO. OF LYMPH NODES WITH TUMOR: 5 • HORMONE RECEPTOR STATUS: Positive for estrogen receptor Negative for progesteron receptor • Her-2 STATUS: Negative (2+ by immunohistochemistry, negative by FISH) • pTNM CLASSIFICATION: pT1N2Mx • EXTRA-TUMORAL BREAST: Fibrocystic disease

    11. Types of invasive carcinoma Ductal Ductal Lobular Tubular Mucinous Medullary

    12. Inflammatory carcinoma • The diagnosis is based on clinical features:Diffuse erythema, peau d’orange, tenderness, induration, warmth, enlargement • And carcinoma confirmed by biopsy:In most cases an invasive ductal carcinoma grade 3 with tumor in dermal lymphatics

    13. The Pathology report MAIN DIAGNOSIS: • Local resection (lumpectomy) of breast with invasive ductal carcinoma OTHER FEATURES: • TUMOR SIZE: 3 cm • LOCATION: Upper inner quadrant, right breast • TUMOR GRADE (1-3): 2 • RESECTION MARGINS, MINIMUM DISTANCE TO TUMOR: 4 mm from dorsal margin, 32 mm from ventral margin • TUMOR INVASION OF SKIN, MUSCLE, PAGET’S DISEASE OF THE NIPPLE: Absent. • VASCULAR INVASION: Present • DCIS: Present DCIS GRADE: 3 DCIS MIN. DIST. TO RESECTION MARGIN: 1 mm to dorsal margin • NO. OF LYMPH NODES EXAMINED: 13 • NO. OF LYMPH NODES WITH TUMOR: 5 • HORMONE RECEPTOR STATUS: Positive for estrogen receptor Negative for progesteron receptor • Her-2 STATUS: Negative (2+ by immunohistochemistry, negative by FISH) • pTNM CLASSIFICATION: pT1N2Mx • EXTRA-TUMORAL BREAST: Fibrocystic disease

    14. Tumor grading

    15. Tumor grades Grade 1 Grade 3

    16. The Pathology report MAIN DIAGNOSIS: • Local resection (lumpectomy) of breast with invasive ductal carcinoma OTHER FEATURES: • TUMOR SIZE: 3 cm • LOCATION: Upper inner quadrant, right breast • TUMOR GRADE: 2 • RESECTION MARGINS, MINIMUM DISTANCE TO TUMOR: 4 mm from dorsal margin, 32 mm from ventral margin • TUMOR INVASION OF SKIN, MUSCLE, PAGET’S DISEASE OF THE NIPPLE: Absent. • VASCULAR INVASION: Present • DCIS: Present DCIS GRADE: 3 DCIS MIN. DIST. TO RESECTION MARGIN: 1 mm to dorsal margin • NO. OF LYMPH NODES EXAMINED: 13 • NO. OF LYMPH NODES WITH TUMOR: 5 • HORMONE RECEPTOR STATUS: Positive for estrogen receptor Negative for progesteron receptor • Her-2 STATUS: Negative (2+ by immunohistochemistry, negative by FISH) • pTNM CLASSIFICATION: pT1N2Mx • EXTRA-TUMORAL BREAST: Fibrocystic disease

    17. Orientation of the specimen

    18. Inking of resection margins

    19. The inked surface as seen in the microscopic slide

    20. Examination of resection margin Skin Inked margin Section 1 Section 2

    21. The Pathology report MAIN DIAGNOSIS: • Local resection (lumpectomy) of breast with invasive ductal carcinoma OTHER FEATURES: • TUMOR SIZE: 3 cm • LOCATION: Upper inner quadrant, right breast • TUMOR GRADE: 2 • RESECTION MARGINS, MINIMUM DISTANCE TO TUMOR: 4 mm from dorsal margin, 32 mm from ventral margin • TUMOR INVASION OF SKIN, MUSCLE, PAGET’S DISEASE OF THE NIPPLE: Absent. • VASCULAR INVASION: Present • DCIS: Present DCIS GRADE: 3 DCIS MIN. DIST. TO RESECTION MARGIN: 1 mm to dorsal margin • NO. OF LYMPH NODES EXAMINED: 13 • NO. OF LYMPH NODES WITH TUMOR: 5 • HORMONE RECEPTOR STATUS: Positive for estrogen receptor Negative for progesteron receptor • Her-2 STATUS: Negative (2+ by immunohistochemistry, negative by FISH) • pTNM CLASSIFICATION: pT1N2Mx • EXTRA-TUMORAL BREAST: Fibrocystic disease

    22. Vascular invasion Tumor tissue Lymphvessel

    23. The Pathology report MAIN DIAGNOSIS: • Local resection (lumpectomy) of breast with invasive ductal carcinoma OTHER FEATURES: • TUMOR SIZE: 3 cm • LOCATION: Upper inner quadrant, right breast • TUMOR GRADE: 2 • RESECTION MARGINS, MINIMUM DISTANCE TO TUMOR: 4 mm from dorsal margin, 32 mm from ventral margin • TUMOR INVASION OF SKIN, MUSCLE, PAGET’S DISEASE OF THE NIPPLE: Absent. • VASCULAR INVASION: Present • DCIS: Present DCIS GRADE (1-3): 3 DCIS MINIMUM DISTANCE TO RESECTION MARGIN: 1 mm to dorsal margin • NO. OF LYMPH NODES EXAMINED: 13 • NO. OF LYMPH NODES WITH TUMOR: 5 • HORMONE RECEPTOR STATUS: Positive for estrogen receptor Negative for progesteron receptor • Her-2 STATUS: Negative (2+ by immunohistochemistry, negative by FISH) • pTNM CLASSIFICATION: pT1N2Mx • EXTRA-TUMORAL BREAST: Fibrocystic disease

    24. The Pathology report MAIN DIAGNOSIS: • Local resection (lumpectomy) of breast with invasive ductal carcinoma OTHER FEATURES: • TUMOR SIZE: 3 cm • LOCATION: Upper inner quadrant, right breast • TUMOR GRADE: 2 • RESECTION MARGINS, MINIMUM DISTANCE TO TUMOR: 4 mm from dorsal margin, 32 mm from ventral margin • TUMOR INVASION OF SKIN, MUSCLE, PAGET’S DISEASE OF THE NIPPLE: Absent. • VASCULAR INVASION: Present • DCIS: Present DCIS GRADE: 3 DCIS MIN. DIST. TO RESECTION MARGIN: 1 mm to dorsal margin • NO. OF LYMPH NODES EXAMINED: 13 • NO. OF LYMPH NODES WITH TUMOR: 5 • HORMONE RECEPTOR STATUS: Positive for estrogen receptor Negative for progesteron receptor • Her-2 STATUS: Negative (2+ by immunohistochemistry, negative by FISH) • pTNM CLASSIFICATION: pT1N2Mx • EXTRA-TUMORAL BREAST: Fibrocystic disease

    25. Axillary lymph nodes Breast cancer spreads through lymphatic channels to axillary lymph nodes. When axillary content is removed, all nodes are searched and embedded for microscopy

    26. Micrometastasis Micrometastasis spotted in otherwise negative sentinel node

    27. Tumor deposits in lymph node

    28. The Pathology report MAIN DIAGNOSIS: • Local resection (lumpectomy) of breast with invasive ductal carcinoma OTHER FEATURES: • TUMOR SIZE: 3 cm • LOCATION: Upper inner quadrant, right breast • TUMOR GRADE: 2 • RESECTION MARGINS, MINIMUM DISTANCE TO TUMOR: 4 mm from dorsal margin, 32 mm from ventral margin • TUMOR INVASION OF SKIN, MUSCLE, PAGET’S DISEASE OF THE NIPPLE: Absent. • VASCULAR INVASION: Present • DCIS: Present DCIS GRADE: 3 DCIS MIN. DIST. TO RESECTION MARGIN: 1 mm to dorsal margin • NO. OF LYMPH NODES EXAMINED: 13 • NO. OF LYMPH NODES WITH TUMOR: 5 • HORMONE RECEPTOR STATUS: Positive for estrogen receptor Negative for progesteron receptor • Her-2 STATUS: Negative (2+ by immunohistochemistry, negative by FISH) • pTNM CLASSIFICATION: pT1N2Mx • EXTRA-TUMORAL BREAST: Fibrocystic disease

    29. Immunohistochemistry:Estrogenreceptor Negative: No benefit from hormone therapy Positive: Will benefit from hormone therapy

    30. The Pathology report MAIN DIAGNOSIS: • Local resection (lumpectomy) of breast with invasive ductal carcinoma OTHER FEATURES: • TUMOR SIZE: 3 cm • LOCATION: Upper inner quadrant, right breast • TUMOR GRADE: 2 • RESECTION MARGINS, MINIMUM DISTANCE TO TUMOR: 4 mm from dorsal margin, 32 mm from ventral margin • TUMOR INVASION OF SKIN, MUSCLE, PAGET’S DISEASE OF THE NIPPLE: Absent. • VASCULAR INVASION: Present • DCIS: Present DCIS GRADE: 3 DCIS MIN. DIST. TO RESECTION MARGIN: 1 mm to dorsal margin • NO. OF LYMPH NODES EXAMINED: 13 • NO. OF LYMPH NODES WITH TUMOR: 5 • HORMONE RECEPTOR STATUS: Positive for estrogen receptor Negative for progesteron receptor • Her-2 STATUS: Negative • pTNM CLASSIFICATION: pT1N2Mx • EXTRA-TUMORAL BREAST: Fibrocystic disease

    31. ImmunohistochemistryHer-2 Her-2 positive. Will benefit from Herceptin therapy

    32. The Pathology report MAIN DIAGNOSIS: • Local resection (lumpectomy) of breast with invasive ductal carcinoma OTHER FEATURES: • TUMOR SIZE: 3 cm • LOCATION: Upper inner quadrant, right breast • TUMOR GRADE: 2 • RESECTION MARGINS, MINIMUM DISTANCE TO TUMOR: 4 mm from dorsal margin, 32 mm from ventral margin • TUMOR INVASION OF SKIN, MUSCLE, PAGET’S DISEASE OF THE NIPPLE: Absent. • VASCULAR INVASION: Present • DCIS: Present DCIS GRADE: 3 DCIS MIN. DIST. TO RESECTION MARGIN: 1 mm to dorsal margin • NO. OF LYMPH NODES EXAMINED: 13 • NO. OF LYMPH NODES WITH TUMOR: 5 • HORMONE RECEPTOR STATUS: Positive for estrogen receptor Negative for progesteron receptor • Her-2 STATUS: Negative (2+ by immunohistochemistry, negative by FISH) • pTNM CLASSIFICATION: pT1N2Mx • EXTRA-TUMORAL BREAST: Fibrocystic disease

    33. The Pathology report MAIN DIAGNOSIS: • Local resection (lumpectomy) of breast with invasive ductal carcinoma OTHER FEATURES: • TUMOR SIZE: 3 cm • LOCATION: Upper inner quadrant, right breast • TUMOR GRADE: 2 • RESECTION MARGINS, MINIMUM DISTANCE TO TUMOR: 4 mm from dorsal margin, 32 mm from ventral margin • TUMOR INVASION OF SKIN, MUSCLE, PAGET’S DISEASE OF THE NIPPLE: Absent. • VASCULAR INVASION: Present • DCIS: Present DCIS GRADE: 3 DCIS MIN. DIST. TO RESECTION MARGIN: 1 mm to dorsal margin • NO. OF LYMPH NODES EXAMINED: 13 • NO. OF LYMPH NODES WITH TUMOR: 5 • HORMONE RECEPTOR STATUS: Positive for estrogen receptor Negative for progesteron receptor • Her-2 STATUS: Negative (2+ by immunohistochemistry, negative by FISH) • pTNM CLASSIFICATION: pT1N2Mx • EXTRA-TUMORAL BREAST: Fibrocystic disease

    34. Is Breast pathology in Ghana similar to that in the industralized countries ? A comparisonofnon-inflammatorypathology diagnoses in Ghana (KATH) and Norway (UNN)

    35. The relative frequency of major pathology diagnoses in breast specimens from KATH and UNN 2006-2009

    36. The relative frequency of main types of invasive breast carcinoma 2006-2009

    37. Tumor grade inCore biopsies of Breast cancerPreliminary data 2009 E. Adjei

    38. Hormone receptors inCore biopsies of Breast cancerPreliminary data 2009 E. Adjei

    39. Her-2 overexpression inCore biopsies of Breast cancerPreliminary data 2009 E.Adjei