Breast Pathology in Clinical Practice

Description

This book provides a concise, step-by-step guide to accurate microscopic diagnosis for clinicians who deal with patients with breast lesions. The emphasis is on a practical approach to dealing with breast biopsies and reaching a diagnosis. It outlines the procedures used for the microscopic diagnosis of various breast lesions and the significance of the nomenclature and terms used in pathology reports, including those dealing with uncommon or rare lesions. Ample illustrations of the lesions discussed are included, particularly those dealing with uncommon and border-line lesions. There is a special emphasis on breast cancer and on the fact that not all breast cancers are the same. The different ways by which breast cancers are classified are discussed including recent classifications which lead to personalized therapy.  The book is aimed at pathologists of all grades who deal with breast biopsies including those in training. It would be also useful for practicing and trainee surgeons and oncologists as well as other health professionals dealing with patients with breast diseases and scientists carrying out research on breast problems.   Contents 1: Introduction References 2: Core Biopsy The Patient The Lesion The Doctor The Needle Type of Biopsies The Sample The Request Form The Laboratory The Pathologist The Multi-disciplinary Team Meeting (MDT) References 3: Reporting Core Biopsies: Benign (B2) Lesions Introduction: Is the Lesion Benign or Malignant? Benign Lesions That Do Not Usually Need Further Intervention (B2 Lesions) Fibroadenoma Special Types of Fibroadenomas Hamartoma Fibrocystic Change Ductal Hyperplasia Differentiating Regular Hyperplasia (B2) from Atypical Hyperplasia (B3) and Low Grade DCIS (B5a) Columnar Cell Change and Columnar Cell Hyperplasia Sclerosing Adenosis and Apocrine Adenosis Duct Ectasia Granulomatous Mastitis Other Inflammatory Conditions Other Less Common Benign Conditions References 4: Reporting Core Biopsies: Benign Lesions That Usually Need Further Intervention (B3 Lesions) Introduction Atypical Epithelial Hyperplasia (ADH) Flat Epithelial Atypia (FEA) In Situ Lobular Neoplasia Radial Scar/Complex Sclerosing Lesions Intraduct Papillomas Cellular Fibro-Epithelial Lesions Spindle Cell Lesions Mucocele Like Lesions Microglandular Adenosis Benign and Atypical Vascular Lesions Granular Cell Tumour Collagenous Spherulosis Epithelial Myoepithelial Benign Lesions General Remark: Risk of Malignancy in Benign Breast Lesions Discovered During Mammography References 5: Reporting Core Biopsies: Lesions That Are Highly Suspicious of Malignancy (B4) or Definitely Malignant (B5) B4 Lesions B5 Lesions B5a (Non-invasive Lesions) In Situ Carcinoma Ductal Carcinoma In Situ (DCIS) Incidence of Metastasis and Death After Diagnosing DCIS Lobular Carcinoma In Situ (LCIS) Paget’s Disease of the Nipple Intracystic and Solid Papillary Carcinomas Invasive Lesions (B5b) Primary Invasive Breast Carcinoma Morphological Types Invasive Ductal Carcinoma Pleomorphic Invasive Ductal Carcinoma Invasive Lobular Carcinoma Invasive Tubular Carcinoma Invasive Cribriform Carcinoma Invasive Mucinous Carcinoma Lympho-Epithelioma-Like Carcinoma Invasive Apocrine Carcinoma Invasive Papillary Carcinoma Invasive Micropapillary Carcinoma Neuroendocrine Tumours of the Breast Glycogen-Rich Clear Cell Carcinoma Lipid-Rich Carcinoma Triple Negative Invasive Breast Carcinoma Grading of Primary Invasive Breast Carcinoma Other Additional Features That Should Be Mentioned in the Core Biopsy Report ER and PR Assessment HER2 Assessment [75] Other Immunohistological Studies Molecular Classification of Breast Carcinoma Complete Removal of Lesions Primary Sarcomas of the Breast Angiosarcoma Mammary Sarcoma with CD10 Expression (Fig. 5.60) Stromal Sarcoma Primary Osteogenic Sarcoma Lymphoma (Fig. 5.61) Metastatic Carcinoma in the Breast References 6: Dealing with the Excised Specimen Introduction Vacuum Assisted Excision Other Excision Biopsies Wire Guided Biopsies Wide Local Excision Biopsies and Therapeutic Mammoplasties Cavity Wall, Margins, Shaves and Tumour Bed Biopsies Re-excision Biopsies Lumpectomy Specimens Mastectomy Specimens Axillary Lymph Node Specimens Core Biopsy Sentinel Node Biopsies Axillary Lymph Node Clearance Examination of Breast Tissue After Neo-adjuvant Chemotherapy Steps of Gross Examination References 7: Reporting Excised Cancer Specimens Introduction Un-expected Invasive Carcinoma, Micro-invasion and Pseudo-Invasion DCIS in Association with Invasive Carcinoma Tumour Size Complete Removal of Lesions by Core/Vacuum Biopsy Presence or Absence of Lympho-Vascular Invasion Presence of Changes Indicating the Site of Previous Core/Vacuum Biopsy Presence of Necrosis, Fibrosis, Elstosis, Microcalcification and Lymphocytic Infiltration Multifocal Breast Carcinomas Has the Tumour Been Completely Excised? Axillary Lymph Node Status Benign Epithelial Inclusions in Axillary Lymph Nodes Additional Immunohistochemical Stains Reporting Excised Breast Carcinoma After Neo-adjuvant Chemotherapy Gene Expression Profiling Pathological Staging of Breast Carcinoma The Traditional TNM Pathological Staging of Breast Carcinoma [40] The Modified Pathologic Prognostic Staging References 8: Phyllodes Tumour and Selected Benign Breast Lesions Phyllodes Tumour Uncommon Breast Adenomas Pseudoangiomatous Stromal Hyperplasia Diabetic Mastopathy Silicon Mastitis and Breast Implant Associated Anaplastic Large Cell Lymphoma Fat Necrosis Fibromatosis Myofibroblastoma Nodular Fasciitis Ectopic Breast Tissue References 9: Women at Higher Risk of Developing Breast Cancer and the Concept of Risk-Based Breast Screening Introduction Women at Higher Risk of Developing Breast Cancer Uptake of Preventive Therapy in the UK References 10: Male Breast Biopsies Introduction Gynaecomastia Male Breast Carcinoma References Index