Chapter 5 Breast Pathology Benign and Malignant Disease

TDLU (carcinoma)

 Fibrous tissue
 Connective tissue
 Larger ducts
(sarcoma)

 Epithelial hyperplasia
 Atypical (epithelial) hyperplasia
 Carcinoma in situ
 Metastases

Silicon
Saline

 Subglandular or retromammary placement
 Subpectoral or retropectoral placement

Linguine

 Elevation of nipple
 Removal of glandular
tissue

 Round
 Oval
 Lobulated

 Lobulated
 Irregular
 Spiculated

 Circumscribed
 Obscured
 Microlobulated

 Microlobulated
 Indistinct
 Spiculated

 Low density: Tends to indicate
benign lesion
 High density: Tends to indicate
malignant lesions

Radiolucent
Radiolucent and radiopaque combined
Low-density radiopaque

 Carcinoma
 Abscess
 Galactocele—calcified
 Hematoma—calcified
 Skin cyst

 Thin capsule—curved
radiolucent line(ring) around
the lesion

often (not always)

 Central tumor (Distinct central mass) withradiating structures
 Spicules reaching the skin or muscle may cause localized skin thickening or skin dimpling, e.g., IDC

 No solid, dense, or distinct central mass
radial scar-was considered “high risk” often now considered benign but often still excised

Radiolucent
Radiolucent and radiopaque combined
Low-density radiopaque

 Carcinoma
 Abscess
 Galactocele—calcified
 Hematoma—calcified
 Skin cyst

Thin capsule—curved radiolucent line(ring) around the lesion
often (not always) represent a benign lesion

Halo Sign

Skin Lesions

Radiolucent
Radiolucent and radiopaque
Low density
Spherical or ovoid
Halo sign
Capsule

High-density
Smooth or lobulated

IDC-invasive ductal carcinoma

Liposarcoma

Central tumor with radiating structures

Distinct central mass
Spicules reaching the skin or muscle may cause localized skin thickening or skin dimpling

No solid, dense, or distinct central mass
radial scar-was considered “high risk” often now considered benign but often still excised”

the indenting or
tenting of the breast parenchyma

glandular tissue in one portion of the breast that is not present in a similar position in the contralateral breast

asymmetric fibroglandular breast tissue seen on both the CC and MLO views

cover a
larger portion of the breast, typically more than one quadrant.

Asymmetry

Cystic changes
Dermal calcification
Calcified fibroadenoma
Sutural

Density
Distribution
Change over time
Number
Morphology

Skin calcifications
Vascular calcifications
Coarse calcifications—“pop-corn like”
Linear rod-like
Round calcifications - punctuate if they are smaller than 0.5 mm in diameter
Large rod-like calcifications
Rim calcifications/”eggshell”
Dystrophic calcifications
Milk of calcium
Sutural calcifications

Skin Calcifications

Vascular Calcifications
distinctive parallel lines

Coarse Calcifications
Popcorn like

Linear rod-like calcifications

Round, puntuate calcifications
are more likely to be malignant

Rim calcifications/”eggshell”

Dystrophic calcifications
often associated with surgery

Milk of calcium

Sutural calcifications

Coarse heterogeneous
Amorphous or indistinct

Coarse heterogeneous
they can also be associated with malignancy

Amorphous calcifications are of
intermediate concern and can be
malignant or benign

Fine linear or branching - casting- type calcifications
Pleomorphic

Fine linear or branching calcifications
casting- type calcifications, forming a “cast”
around the ducts.

Pleomorphic calcifications
very fine calcifications
appear similar to shattered glass or crushed stones

Pleomorphic calcifications

Fine linear or branching calcification
Amorphous or indistinct calcifications
Pleomorphic calcifications
Coarse heterogenous or granular calcifications

Simple Cyst
Galactocele
Fibroadenoma
Lipoma
Hamartoma - Fibroadenolipoma
Papilloma
Duct Ectasia
Hematoma
Abscess
Fat Necrosis/Oil cyst
Lymph Nodes
Gynecomastia-male
Radial Scar-no central mass

Simple Cyst

Galactocele

Fibroadenoma

Lipoma

Abscess

Hematoma

Duct Ectasia-green, brown discharge

Papilloma

Hamartoma

Fat Necrosis/Oil cyst

Lymph Nodes

Gynecomastia-male

Radial Scar

calcifications that can vary in size from 0.5 to 1 mm

Calcifications as a result of increased cellular activity

Ductal Ectasia

Hemangioma

Intraductal Papilloma - Small wart-like
bloody/serous nipple discharge

Microscopic analysis of organ and body tissues

Analysis of cells

 Entire breast or localized
 Peau d’orange appearance
 Associated with increased density
 Caused by benign or malignant
changes
Normal skin is 0.5–2 mm thick

Microhematoma

Radiation treatment

Inflammatory carcinoma
Obstruction of the lymphatic

 Ductal—90% of all breast cancers
 Lobular—5%–10% of all breast cancers

DCIS-DUCTAL CARCINOMA IN SITU

confined to the ducts
Most common non-invasive breast cancer
contain microcalcifications
Best detected with mammography

Ductal Carcinoma In Situ (DCIS)

LCIS- Lobular Carcinoma In Situ
Incidental finding on biopsy

LCIS- Lobular carcinoma In-situ (incidental finding)
ALH- Atypical Lobular Hyperplasia
ADH- Atypical Ductal Hyperplasia
Papilloma with Atypia
Radial Scar- more recently considered benign
Phyllodes Tumor

tissue (broken through the basement membrane)
Most common invasive breast cancer-75%

 Most frequently missed breast cancer
 Often multifocal, multicentric, bilateral
 Difficult to detect on imaging
 Single file pattern

Inflammatory
Infiltrating medullary
Colloid comedo
Tubular
Mucinous
Papillary carcinoma
Paget’s disease

Most common in younger women, Japanese and African Americans
<35yrs of age

Colloid (mucinous) Carcinoma

in older women
Nipple discharge

does not arise from TDLU, but from stroma
leaf-like

Lymphoma
Metastases to the Breast

Mastitis
Seroma, Hematoma
Abscess
Inflammatory Carcinoma
Paget’s Disease-

Puerperal(Lactating)Mastitis
Plasma Cell Mastitis

Most common type
Bacterial (staphylococcus)due to cracked nipple entry,inflamed ducts;milk stasis

Cellular not bacterial

IDC