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Abstract

This chapter reviews the clinical, macroscopic, microscopic, and molecular features as well as the differential diagnosis of the most common breast lesions seen in a routine surgical pathology practice. We review the reporting requirements, components of histologic grading, axillary lymph node status, testing for predictive markers (estrogen and progesterone receptor and HER2), as well as the molecular genetics of breast cancer, including the “intrinsic” subtypes. We include a quick review of metastases to the breast and the TNM classification of breast cancer. Applicable ancillary testing modalities and tables and photomicrographs are included to facilitate the use of this chapter as a quick reference guide to the surgical pathology of the breast.

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  • Adeniran A, Al-Ahmadie H, Mahoney MC, Robinson-Smith TM. Granular cell tumor of the breast: a series of 17 cases and review of the literature. Breast J. 2004;10:528–31.

    Article  PubMed  Google Scholar 

  • Allegra CJ, Aberle DR, Ganschow P, et al. National Institutes of Health State-of-the-Science Conference statement: diagnosis and management of ductal carcinoma in situ September 22–24, 2009. J Natl Cancer Inst. 2010;102:161–9.

    Article  PubMed  Google Scholar 

  • Alvarado Cabrero I, Carrera Alvarez M, Pérez Montiel D, Tavassoli FA. Metastases to the breast. Eur J Surg Oncol. 2003;29:854–5.

    Article  CAS  PubMed  Google Scholar 

  • Alvarado-Cabrero I, Tavassoli FA. Neoplastic and malignant lesions involving or arising in a radial scar: a clinicopathologic analysis of 17 cases. Breast J. 2000;6:96–102.

    Article  PubMed  Google Scholar 

  • Ashton MA, Lefkowitz M, Tavassoli FA. Epithelioid stromal cells in lymphocytic mastitis—a source of confusion with invasive carcinoma. Mod Pathol. 1994;7:49–54.

    CAS  PubMed  Google Scholar 

  • Bagaria SP, Ray PS, Sim MS, et al. Personalizing breast cancer staging by the inclusion of ER, PR, and HER2. JAMA Surg. 2014;149:125–9.

    Article  PubMed  Google Scholar 

  • Bhargava R, Esposito NN, Dabbs DJ. Intracystic papillary carcinomas of the breast are more similar to in situ carcinomas than to invasive carcinoma. Am J Surg Pathol. 2011;35:778–9.

    Article  PubMed  Google Scholar 

  • Boldt V, Stacher E, Halbwedl I, et al. Positioning of necrotic lobular intraepithelial neoplasias (LIN, grade 3) within the sequence of breast carcinoma progression. Genes Chromosomes Cancer. 2010;49:463–70.

    CAS  PubMed  Google Scholar 

  • Borst MJ, Ingold JA. Metastatic patterns of invasive lobular versus invasive ductal carcinoma of the breast. Surgery. 1993;114:637–42.

    CAS  PubMed  Google Scholar 

  • Bratthauer GL, Tavassoli FA. Lobular intraepithelial neoplasia: previously unexplored aspects assessed in 775 cases and their clinical implications. Virchows Arch. 2002;440:134–8.

    Article  PubMed  Google Scholar 

  • Bratthauer GL, Tavassoli FA. Assessment of lesions coexisting with various grades of ductal intraepithelial neoplasia of the breast. Virchows Arch. 2004;444:340–4.

    Article  PubMed  Google Scholar 

  • Bratthauer GL, Moinfar F, Stamatakos MD, et al. Combined e-cadherin and high molecular weight CK immunoprofile differentiates lobular, ductal, and hybrid mammary intraepithelial neoplasias. Hum Pathol. 2002;33:620–7.

    Article  CAS  PubMed  Google Scholar 

  • Bratthauer GL, Miettinen M, Tavassoli FA. Cytokeratin immunoreactivity in lobular intraepithelial neoplasia. J Histochem Cytochem. 2003;51:1527–31.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Burga AM, Fadare O, Lininger RA, Tavassoli FA. Invasive carcinomas of the male breast: a morphologic study of the distribution of histologic subtypes and metastatic patterns in 778 cases. Virchows Arch. 2006;449:507–12.

    Article  PubMed Central  PubMed  Google Scholar 

  • Carney JA, Tookey BC. Myxoid fibroadenoma and allied conditions (myxomatosis) of the breast. Am J Surg Pathol. 1991;15:713–21.

    Article  CAS  PubMed  Google Scholar 

  • Chaudary MA, Millis RR, Lane EB, Miller NA. Paget’s disease of the nipple: a ten year review including clinical, pathological and immunohistochemical findings. Breast Cancer Res Treat. 1986;8:139–46.

    Article  CAS  PubMed  Google Scholar 

  • Clement PB, Young RH, Azzopardi JG. Collagenous spherulosis of the breast. Am J Surg Pathol. 1987;11:411–7.

    Article  CAS  PubMed  Google Scholar 

  • Cornejo KM, Kandil D, Khan A, Cosar EF. Theranostic and molecular classification of breast cancer. Arch Pathol Lab Med. 2014;138:44–56.

    Article  PubMed  Google Scholar 

  • de Boer M, van Dijck JA, Bult P, Borm GF, Tjan-Heijnen VC. Breast cancer prognosis and occult lymph node metastases, isolated tumor cells, and micrometastases. J Natl Cancer Inst. 2010;102:410–25.

    Article  PubMed  Google Scholar 

  • Devouassoux-Shisheboran M, Schammel MD, Man YG, Tavassoli FA. Fibromatosis of the breast: age-correlated morphofunctional features of 33 cases. Arch Pathol Lab Med. 2000;124:276–80.

    CAS  PubMed  Google Scholar 

  • DiConstanzo D, Rosen PP, Gareen I, Franklin S, Lesser M. Prognosis of infiltrating lobular carcinoma: an analysis of “classical” and variant tumors. Am J Surg Pathol. 1990;14:12–23.

    Article  Google Scholar 

  • Dowlatashahi K, Fan M, Snider HC, Habib FA. Lymph node micrometastases from breast carcinoma: reviewing the dilemma. Cancer. 1997;80:1188–97.

    Article  Google Scholar 

  • Dupont WD, Page DL. Risk factors for breast cancer in women with proliferative disease. N Engl J Med. 1985;312:146–51.

    Article  CAS  PubMed  Google Scholar 

  • Elston CW, Ellis IO. Pathological prognostic factors in breast cancer, I: the value of histological grade in breast cancer: experience from a large study with long-term follow-up. Histopathology. 1991;19:403–10.

    Article  CAS  PubMed  Google Scholar 

  • Esserman LJ, Thompson Jr IM, Reid B. Overdiagnosis and overtreatment in cancer: an opportunity for improvement. JAMA. 2013;310:797–8.

    Article  CAS  PubMed  Google Scholar 

  • Fadare O, Tavassoli FA. Clinical and pathologic aspects of basal-like breast cancers. Nat Clin Pract Oncol. 2008;5:149–59.

    Article  PubMed  Google Scholar 

  • Fadare O, Dadmanesh F, Alvarado-Cabrero I, et al. Lobular intraepithelial neoplasia [lobular carcinoma in situ] with comedo-type necrosis: a clinicopathologic study of 18 cases. Am J Surg Pathol. 2006;30:1445–53.

    Article  PubMed  Google Scholar 

  • Farshid G, Moinfar F, Meredith DJ, Peiterse S, Tavassoli FA. Spindle cell ductal carcinoma in situ. An unusual variant of ductal intra-epithelial neoplasia that simulates ductal hyperplasia or a myoepithelial proliferation. Virchows Arch. 2001;439:70–7.

    Article  CAS  PubMed  Google Scholar 

  • Fisher ER, Costantino J, Fisher B, et al. Pathologic findings from the National Surgical Adjuvant Breast Project (NSABP) protocol B-17: five year observations concerning lobular carcinoma in situ. Cancer. 1996;78:1403–16.

    Article  CAS  PubMed  Google Scholar 

  • Ghofrani M, Tapia B, Tavassoli FA. Discrepancies in the diagnosis of intraductal proliferative lesions of the breast and its management implications: results of a multinational survey. Virchows Arch. 2006;449:609–16.

    Article  PubMed Central  PubMed  Google Scholar 

  • Giuliano AE, McCall L, Beitsch P, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: the American College of Surgeons Oncology Group Z0011 randomized trial. Ann Surg. 2010;252:426–32.

    PubMed  Google Scholar 

  • Going JJ, Andersen TJ, Wilkinson S. Granulomatous lobular mastitis. J Clin Pathol. 1987;40:535–40.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Goodman S, O’Connor A, Kandil D, Khan A. The ever-changing role of sentinel lymph node biopsy in the management of breast cancer. Arch Pathol Lab Med. 2014;138:57–64.

    Article  PubMed  Google Scholar 

  • Green I, McCormick B, Cranor M, Rosen PP. A comparative study of pure tubular and tubulolobular carcinoma of the breast. Am J Surg Pathol. 1997;21:653–7.

    Article  CAS  PubMed  Google Scholar 

  • Guo T, Zhang L, Chang NE, Singer S, Maki RG, Antonescu CR. Consistent MYC and FLT4 gene amplification in radiation-induced angiosarcoma but not in other radiation-associated atypical vascular lesions. Genes Chromosomes Cancer. 2011;50:25–33.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Hall FM. Identification, biopsy, and treatment of poorly understood premalignant, in situ, and indolent low grade cancers: are we becoming victims of our own success? Radiology. 2010;254:655–9.

    Article  PubMed  Google Scholar 

  • Hammond ME, Hayes DF, Dowsett M, et al. American Society of Clinical Oncology/College of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. Arch Pathol Lab Med. 2010;134:907–22.

    PubMed Central  PubMed  Google Scholar 

  • Hoda SA, Rosen PP. Observations on the pathologic diagnosis of selected unusual lesions in needle core biopsies of breast. Breast J. 2004;10:522–7.

    Article  PubMed  Google Scholar 

  • Holland R, Connolly J, Gelman R, et al. The presence of an extensive intraductal component following limited excision correlates with prominent residual disease in the remainder of the breast. J Clin Oncol. 1990;8:113–8.

    CAS  PubMed  Google Scholar 

  • Jensen RA, Page DL, Dupont WD, Roggers LW. Invasive breast cancer risk in women with sclerosing adenosis. Cancer. 1989;64:1977–83.

    Article  CAS  PubMed  Google Scholar 

  • Johnson RE, Murad MH. Gynecomastia: pathophysiology, evaluation, and management. Mayo Clin Proc. 2009;84:1010–5.

    Article  PubMed Central  PubMed  Google Scholar 

  • Jones MW, Tavassoli FA. Coexistence of nipple duct adenoma and breast carcinoma: a clinicopathologic study of five cases and review of the literature. Mod Pathol. 1995;8:633–6.

    CAS  PubMed  Google Scholar 

  • Jones MW, Norris HJ, Snyder RC. Infiltrating syringomatous adenoma of the nipple: a clinical and pathological study of 11 cases. Am J Surg Pathol. 1989;13:197–201.

    Article  CAS  PubMed  Google Scholar 

  • Koenig C, Dadmanesh F, Bratthauer GL, Tavassoli FA. Carcinoma arising in microglandular adenosis: an immunohistochemical analysis of 20 intraepithelial and invasive neoplasms. Int J Surg Pathol. 2000;8:303–15.

    Article  PubMed  Google Scholar 

  • Lammie GA, Millis RR. Ductal adenoma of the breast—a review of fifteen cases. Hum Pathol. 1989;20:903–8.

    Article  CAS  PubMed  Google Scholar 

  • Leidy J, Khan A, Kandil D. Basal-like breast cancer: update on clinicopathologic, immunohistochemical, and molecular features. Arch Pathol Lab Med. 2014;138:37–43.

    Article  CAS  PubMed  Google Scholar 

  • Linnel F, Ostberg G, Söderström J, Andersson I, Hildell J, Ljungqvist U. Breast hamartomas: an important entity in mammary pathology. Virchows Arch A Pathol Anat Histol. 1979;383:253–64.

    Article  Google Scholar 

  • Magro G. Mammary myofibroblastoma: a tumor with a wide morphologic spectrum. Arch Pathol Lab Med. 2008;132:1813–20.

    PubMed  Google Scholar 

  • Maitra A, Tavassoli FA, Albores-Saavedra J, et al. Molecular abnormalities associated with secretory carcinomas of the breast. Hum Pathol. 1999;30:1435–40.

    Article  CAS  PubMed  Google Scholar 

  • Martel M, Barron-Rodriguez P, Tolgay Ocal I, Dotto J, Tavassoli FA. Flat DIN 1 (Flat epithelial atypia) on core needle biopsy: 63 cases identified retrospectively among 1,751 core biopsies performed over an 8-year period (1992–1999). Virchows Arch. 2007;451:883–91.

    Article  PubMed  Google Scholar 

  • Moinfar F, Man YG, Bratthauer GL, Ratschek M, Tavassoli FA. Genetic abnormalities in mammary ductal intraepithelial neoplasia-flat type (“clinging ductal carcinoma in situ”): a simulator of normal mammary epithelium. Cancer. 2000;88:2072–81.

    Article  CAS  PubMed  Google Scholar 

  • Oberman HA. Breast lesions in the adolescent female. Pathol Annu. 1979;14:175–201.

    PubMed  Google Scholar 

  • Oberman HA. Metaplastic carcinoma of the breast: a clinicopathologic study of 29 patients. Am J Surg Pathol. 1987;11:918–29.

    Article  CAS  PubMed  Google Scholar 

  • Page DL, Salhany KE, Jensen RA, Dupont WD. Subsequent breast cancer risk after biopsy with atypia in a breast papilloma. Cancer. 1996;78:258–66.

    Article  CAS  PubMed  Google Scholar 

  • Parham DM, Fisher C. Angiosarcomas of the breast developing postradiotherapy. Histopathology. 1997;31:189–95.

    Article  CAS  PubMed  Google Scholar 

  • Prat A, Perou CM. Deconstructing the molecular portraits of breast cancer. Mol Oncol. 2011;5:5–23.

    Article  CAS  PubMed  Google Scholar 

  • Provenzano E, Brown JP, Pinder SE. Pathological controversies in breast cancer: classification of ductal carcinoma in situ, sentinel lymph nodes and low volume metastatic disease and reporting of neoadjuvant chemotherapy specimens. Clin Oncol. 2013;25:80–92.

    Article  CAS  Google Scholar 

  • Rasmussen BB. Human mucinous carcinomas of the breast and their lymph node metastases: a histological review of 247 cases. Pathol Res Pract. 1985;180:377–82.

    Article  CAS  PubMed  Google Scholar 

  • Rosen PP, Fineberg S. Cutaneous angiosarcoma and atypical vascular lesions of the skin and breast after radiation therapy for breast carcinoma. Am J Clin Pathol. 1994;102:757–63.

    PubMed  Google Scholar 

  • Salarieh A, Sneige N. Breast carcinoma arising in microglandular adenosis: a review of the literature. Arch Pathol Lab Med. 2007;131:1397–9.

    PubMed  Google Scholar 

  • Santen RJ, Mansel R. Benign breast disorders. N Engl J Med. 2005;353:275–85.

    Article  CAS  PubMed  Google Scholar 

  • Sastre-Garau X, Jouve M, Asselain B, et al. Infiltrating lobular carcinoma of the breast: clinicopathologic analysis of 975 cases with reference to data on conservative therapy and metastatic patterns. Cancer. 1996;77:113–20.

    Article  CAS  PubMed  Google Scholar 

  • Schwartz IS, Strauchen AJ. Lymphocytic mastopathy: an autoimmune disease of the breast? Am J Clin Pathol. 1990;93:725–30.

    CAS  PubMed  Google Scholar 

  • Seal MD, Chia SK. What is the difference between triple-negative and basal breast cancers? Cancer J. 2010;16:12–6.

    Article  CAS  PubMed  Google Scholar 

  • Silver SA, Tavassoli FA. Pleomorphic carcinoma of the breast: clinicopathological analysis of 26 cases of an unusual high grade phenotype of ductal carcinoma. Histopathology. 2000;36:505–14.

    Article  CAS  PubMed  Google Scholar 

  • Silverstein MJ, Gierson ED, Colburn WJ, et al. Can intraductal breast carcinoma be excised completely by local excision? Cancer. 1994;73:2985–9.

    Article  CAS  PubMed  Google Scholar 

  • Tan PH, Tse GM, Bay BH. Mucinous breast lesions: diagnostic challenges. J Clin Pathol. 2008;61:11–9.

    Article  CAS  PubMed  Google Scholar 

  • Tavassoli FA. Myoepithelial lesions of the breast: myoepitheliosis, adeno-myoepithelioma, and myoepithelial carcinoma. Am J Surg Pathol. 1991;15:554–68.

    Article  CAS  PubMed  Google Scholar 

  • Tavassoli FA. Mammary intraepithelial neoplasia: a translational classification system for the intraductal epithelial proliferations. Breast J. 1997;3:48–58.

    Article  Google Scholar 

  • Tavassoli FA. Ductal carcinoma in situ: introduction of the concept of ductal intraepithelial neoplasia. Mod Pathol. 1998;11:140–54.

    CAS  PubMed  Google Scholar 

  • Tavassoli FA. Ductal intraepithelial neoplasia of the breast. Virchows Arch. 2001;438:221–7.

    Article  CAS  PubMed  Google Scholar 

  • Tavassoli FA. Breast pathology: rationale for adopting the ductal intraepithelial neoplasia (DIN) classification. Nat Clin Pract Oncol. 2005;2:116–7.

    Article  PubMed  Google Scholar 

  • Tavassoli FA. Correlation between gene expression profiling-based molecular and morphologic classification of breast cancer. Int J Surg Pathol. 2010a;18:167S–9.

    Article  PubMed  Google Scholar 

  • Tavassoli FA. Lobular neoplasia: evolution of its significance and morphologic spectrum. Int J Surg Pathol. 2010b;18:174S–7.

    Article  PubMed  Google Scholar 

  • Tavassoli FA, Norris HJ. Microglandular adenosis of the breast: a clinicopathologic study of 11 cases with ultrastructural observations. Am J Surg Pathol. 1983;7:731–7.

    Article  CAS  PubMed  Google Scholar 

  • Tavassoli FA, Norris HJ. A comparison of the results of long-term follow-up for atypical intraductal hyperplasia and intraductal hyperplasia of the breast. Cancer. 1990;65:518–29.

    Article  CAS  PubMed  Google Scholar 

  • Tavassoli FA, Norris HJ. Intraductal apocrine carcinoma: a clinicopathologic study of 37 cases. Mod Pathol. 1994;7:813–8.

    CAS  PubMed  Google Scholar 

  • Tornos C, Silva EG, el-Naggar A, Pritzker KP. Calcium oxalate crystals in breast biopsies: the missing microcalcifications. Am J Surg Pathol. 1990;14:961–8.

    Article  CAS  PubMed  Google Scholar 

  • Tse GM, Tan PH, Cheung HS, Chu WC, Lam WW. Intermediate to highly suspicious calcification in breast lesions: a radio-pathologic correlation. Breast Cancer Res Treat. 2008;110:1–7.

    Article  PubMed  Google Scholar 

  • Ueng SH, Mezzetti T, Tavassoli FA. Papillary neoplasms of the breast: a review. Arch Pathol Lab Med. 2009;133:893–907.

    PubMed  Google Scholar 

  • Vuitch MF, Rosen PP, Erlandson RA. Pseudoangiomatous hyperplasia of the mammary stroma. Hum Pathol. 1986;17:185–91.

    Article  CAS  PubMed  Google Scholar 

  • Wargotz ES, Norris HJ, Austin RM, Enzinger FM. Fibromatosis of the breast: a clinical and pathological study of 28 cases. Am J Surg Pathol. 1987a;11:38–45.

    Article  CAS  PubMed  Google Scholar 

  • Wargotz ES, Weiss SW, Norris HJ. Myofibroblastoma of the breast: sixteen cases of a distinctive benign mesenchymal tumor. Am J Surg Pathol. 1987b;11:493–502.

    Article  CAS  PubMed  Google Scholar 

  • Welch HG, Black WC. Overdiagnosis in cancer. J Natl Cancer Inst. 2010;102:605–13.

    Article  PubMed  Google Scholar 

  • Wells CA, El-Ayat GA. Non-operative breast pathology: apocrine lesions. J Clin Pathol. 2007;60:1313–20.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Wetterskog D, Lopez-Garcia MA, Lambros MB, et al. Adenoid cystic carcinomas constitute a genomically distinct subgroup of triple-negative and basal-like breast cancers. J Pathol. 2012;226:84–96.

    Article  CAS  PubMed  Google Scholar 

  • Wheeler DT, Tai LH, Bratthauer GL, Waldner DL, Tavassoli FA. Tubulolobular carcinoma of the breast: an analysis of 27 cases of a tumor with a hybrid morphology and immunoprofile. Am J Surg Pathol. 2004;28:1587–93.

    Article  PubMed  Google Scholar 

  • Wolff AC, Hammond ME, Hicks DG, et al. Recommendations for human epidermal growth factor receptor 2 testing in breast cancer: American Society of Clinical Oncology/College of American Pathologists clinical practice guideline update. Arch Pathol Lab Med. 2014;138:241–56.

    Article  PubMed Central  PubMed  Google Scholar 

  • Yang X, Kandil D, Cosar EF, Khan A. Fibroepithelial tumors of the breast: pathologic and immunohistochemical features and molecular mechanisms. Arch Pathol Lab Med. 2014;138:25–36.

    Article  PubMed  Google Scholar 

  • Zaloudek C, Oertel YC, Orenstein JM. Adenoid cystic carcinoma of the breast. Am J Clin Pathol. 1984;81:297–307.

    CAS  PubMed  Google Scholar 

  • Zhao L, Yang X, Khan A, Kandil D. Diagnostic role of immunohistochemistry in the evaluation of breast pathology specimens. Arch Pathol Lab Med. 2014;138:16–24.

    Article  PubMed  Google Scholar 

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Correspondence to Fattaneh A. Tavassoli MD .

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Ghofrani, M., Tavassoli, F.A. (2016). Breast. In: Cheng, L., Bostwick, D. (eds) Essentials of Anatomic Pathology. Springer, Cham. https://doi.org/10.1007/978-3-319-23380-2_29

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