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BREAST-PATHOLOGY-benign-proliferative-lesions.pdf
- 1. BREAST PATHOLOGY 3. Benign proliferative breast diseases
- 2. CONTENTS 1. Fibroadenoma 2. Adenoma 3. Intraductal papilloma 4. Adenosis 5. Fibrocystic breast disease
- 3. 1. FIBROADENOMA Introduction: ● Most common breast tumor especially in young women ● Biphasic tumor composed of proliferation of both epithelial and stromal components ● Variants: Juvenile fibroadenoma Myxoid fibroadenoma Complex fibroadenoma
- 4. 1. FIBROADENOMA Gross appearance: Firm, well circumscribed, ovoid mass with, slit-like spaces.
- 5. 1. FIBROADENOMA Microscopic appearance: Two recognized growth pattern in the glandular component Intracanalicular Pericanalicular Glands are compressed into linear branching structures Glands retain open lumens Both patterns can co-exist in the same lesion
- 6. 1. FIBROADENOMA Variants of fibroadenoma with unknown significance Morphologic variations such as hyalinization, calcification, metaplastic change are common. Some of the rare morphologic variations are squamous metaplastic change and apocrine metaplasia. Variants of fibroadenoma with clinical significance Myxoid fibroadenoma Cellular fibroadenoma
- 7. 1. FIBROADENOMA Differences between important variants of fibroadenoma Variants Juvenile Myxoid Cellular Complex Age Usually young but not always Young women Associated with carney complex Can occur at any age Usually older age Microscopic appearance Increased epithelial and stromal cellularity Epithelial >Stromal hyperplasia (Pericanalicular pattern) Abundant pale, blue-gray extracellular matrix material (myxoid) in the stroma Diffuse stromal hypercellularity Cysts > 3 mm, sclerosing adenosis, microcalcifications or papillary apocrine metaplasia Risk of breast carcinoma No increased risk Same as classic fibroadenoma Same as classic fibroadenoma Increased relative risk (1.5 - 2.0) Molecular MED12 exon 2 mutation Lack MED 12 (usually seen in classic fibroadenoma) Higher rates of mutation in PIK3CA and MAP3KI MED12 exon 2 mutation
- 8. 2. ADENOMA Types Tubular adenoma Lactating adenoma Apocrine adenoma Nipple adenoma
- 9. 2. ADENOMA Tubular adenoma: ● A type of ductal adenoma with tubular features has been found to be associated with the above-mentioned Carney syndrome. ● Needs to be differentiated from carcinoma. Lactating adenoma: ● Microscopically, proliferated glands are seen lined by actively secreting cuboidal cells. ● This lesion should be distinguished from the proliferative and secretory changes brought on by pregnancy in a preexisting fibroadenoma.
- 10. 2. ADENOMA Apocrine adenoma: ● This exceptionally rare lesion should be distinguished from fibrocystic disease with focally prominent apocrine changes and from well-differentiated apocrine carcinoma. Nipple adenoma: ● Occurs in the fifth decade, almost always unilateral. ● Retained myoepithelial layer ● Florid ductal hyperplasia, papilloma like pattern
- 11. 3. INTRADUCTAL PAPILLOMA ● Central intraductal papilloma: arises from large lactiferous ducts, usually solitary ● Peripheral intraductal papilloma: involves terminal duct lobular unit, usually multiple (papillomatosis) ● Frequently associated with usual type ductal hyperplasia and apocrine metaplasia, less frequently squamous, osseous or chondroid metaplasia may be seen ● Myoepithelial cell markers are positive in fibrovascular cores and at the periphery of the involved duct
- 12. 4. ADENOSIS Types Blunt duct adenosis Sclerosing adenosis Nodular adenosis and related lesions Microglandular and adenomyoepithelial adenosis
- 13. 4. ADENOSIS Blunt duct adenosis ● Very common, shows blunting of both epithelial and myoepithelial cells. Sclerosing duct adenosis ● Very common, shows blunting of both epithelial and myoepithelial cells. ● Increased risk of cancer of 1.5 - 2x. ● Myoepithelial cells may vary from being prominent to indistinct on routine H&E staining ● Myoepithelial cells are readily apparent via immunohistochemistry
- 14. 4. ADENOSIS Nodular adenosis ● Nodular adenosis combines features of blunt duct adenosis and sclerosing adenosis. Microglandular adenosis Typical microglandular adenosis Atypical microglandular adenosis ● Glands lined by single layer of cuboidal / flat cells with vacuolated / granular cytoplasm and bland nuclei ● Increased complexity including multilayered epithelium, fused glandular units, luminal bridging, cribriform architecture ● Mild cytologic atypia, hyperchromatic nuclei, prominent nucleoli, occasional mitotic figures
- 15. 4. ADENOSIS Microglandular adenosis ● Lumen consists of PAS-positive diastase resistant secretions ● Myoepithelial cells are absent, but immunohistochemistry with collagen IV can highlight basement membrane. ● Cells of microglandular adenosis express cytokeratins, S 100, cathepsin D and EGFR (Her 1) ● Associated carcinomas include adenoid cystic, secretory and squamous, matrix producing and triple negative, basal-like carcinomas.
- 16. 4. ADENOSIS Complex sclerosing lesion (Radial scar) ● Low power stellate configuration ● Myoepithelial cells are intact ● Imaging features include irregular spiculated mass with dense center frequently mimicking invasive carcinoma
- 17. 5. FIBROCYSTIC DISEASE Key microscopic features: Adenosis ,cysts and fibrosis Additional features: Columnar cell changes, Apocrine metaplasia
- 18. CONDITION RISK OF DEVELOPING BREAST CARCINOMA Sclerosing adenosis 1.5 to 2 fold Apocrine adenosis 1- 2 fold Complex sclerosing lesion (Radial scar) 1.5 to 2 fold Complex fibroadenoma 1.5 to 2 fold Proliferative fibrocystic disease 1.5 to 2 fold Microglandular adenosis is associated with 20-30 % increased risk of developing breast carcinoma