PATHOLOGY OF BREAST

FIBROADENOMA TUMOR PHYLLOIDES KARSINOMA INVASIF (infiltratif) PAGET’S DISEASE OF THE NIPPLE
WHO FIBROEPITHELIAL TUMOUR EPITHELIAL TUMOUR TUMOUR OF THE NIPPLE
classification
DEFINISI Tumor jinak : Kelainan epitel dan True fibroepithelial neoplasm. Kelainan No special type (NST)  79% karsinoma malignant glandular epithelial cells within the
stroma intralobular payudara. epitel dan stroma. invasif  malignant invasive epithelial squamous epithelium of the nipple.
lesion from terminal duct lobular unit. It is invariably associated with an underlying
Subklasifikasi : Jinak, bordeline (derajat ductal carcinoma in situ (DCIS), either alone or
rendah/low grade lesion), derajat associated with invasive carcinoma.
tinggi/high grade lesion
UMUR 20-30 tahun Any age, most common women in their Frekuensi meningkat sesuai peningkatan 26-88 tahun
50s. Rarely in young women. umur. Jarang pada orang tanpa riwayat
keluarga.
FAKTOR Terapi sulih hormon, kontrasepsi oral, Umur, riwayat keluarga, hiperplasia
RISIKO
imunosupresi, abnormalitas genetik. atipikal, radiasi, hormon, gen  BRCA 1
& BRCA 2.
>95% keganasan payudara adalah
adenokarsinoma yang muncul
pertamakali pada sistem duktus/lobular
sebagai karsinoma in situ, pada saat
deteksi klinis sudah menembus membran
basalis dan invasi stroma.
CLINICAL - Mobile, Tidak nyeri - Mobile - Hampir selalu sebagai massa - Normal or mild erythema or
FEATURES
- Benjolan payudara jelas - Massa jelas yang teraba saat palpasi eczematous weeping and crusting
- Bisa asimtomatik dan - Tumbuh cepat - Ca yang lebih besar: terfiksasi ke - ulcerated
impalpable. - Mirip FA  curiga TP bila dinding dada, “dimpling” kulit.
ukuran > 4cm&tumbuh cepat - Retraksi putting
- Lymphedema, penebalan kulit,
peau d’orange.
- Massa tidak jelas, bisa
menempel pada kulit atau otot.
RADIOLOGIC - Massa jelas - Massa jelas - Spiculated mass - Penebalan nipple
FEATURES
- Ada/tidak mikrokalsifikasi - Internal hyperechoic striation - Mikrokalsifikasi - Underlying calcifications/mass lesion
- Massa hipoekoik homogen. within hypoechoic lesion
(hipoekoik=seperti lemak)
TX & - Pembedahan Eksisi tanpa - Pembedahan eksisi dengan - Pembedahan eksisi pada small - Determined by the extent and grade of
prognosis
jaringan disekitarnya. jaringan non lesi disekitarnya. grade 1 carcinoma. the associated carcinoma
(jika massa besar dan keinginan pasien) (10 mm) - Terapi adjuvan : manipulasi
- Mayoritas benigna hormon, kemoterapi,
- Metastasis dilaporkan terjadi radioterapi
pada sebagian kecil tumor
maligna.
MAKROSKOPI - Batas tegas, kenyal, putih, - Batas tegas - Batas irreguler, beberapa tegas
S
elastis, jaringan lemak disekitar. - Tidak berkapsul - Konsistensi firm hingga hard,
 - No true capsule Round or
ovoid, often gray,
- 1-3 cm (rarely up to 20 cm)
MIKROSKOPIS - Nodul berbatas tegas
- (Anak panah): tampak lesi,
dimana lobus sekretorius
diantara edematosa stroma
yang ringan (tampak pucat).
- (panah): duktuli tampak
terkompresi oleh proliferasi
stroma.
(A, B) Intracanalicular growth pattern
showing compressed duct structures as
slitlike spaces, surrounded by stroma
with a somewhat whorled appearance.
(C, D) Pericanalicular growth pattern
TP jinak :  fibroadenomatoid lesion
with an intracanalicular pattern
Mikroskopis :
- Tunggal atau multinodular beberapa konsistensi lunak.
- Jika dibelah : padat, menonjol, - Saat dipotong  grating sound
abu abu sampai tengguli (seperti memotong water
- Fokus-fokus degenerasi, chesnut)
nekrosis, dan infark  tampak
hemoragik atau seperti gelatin
(biasa pada TP ganas, bisa pd
jinak jika luas)
- Biphasic with clefts lined with a - Malignant glandular cells are seen
bilayer of epithelial and within the squamous epithelium
myoepithelial within a cellular - These cells may be seen singly in all
stroma. layers of the epidermis or they may
- leaflike pattern cluster in the basal layers
- Cytologically, they are large with
pleomorphic nuclei and abundant
eosinophilic cytoplasm
- mitosis jarang  1-2 per 10 lbp
- ekspansi stromal dan
selularitas tampak seragam
(bisa heterogen)
- derajat proliferasi epitelial
biasanya masih sesuai dengan
Gene expression in NST :
tampilan stroma.
showing stromal proliferation
surrounding disorganized epithelial
tubular structures
- Batas jelas atau invasif
- 2-5 mitosis per 10 lbp
- Selularitas stroma berderajat
sedang, terdistribusi secara
heterogen diantara area
hiposelular.

Leaf like contour dari pertumbuhan

intrakanalikuli yang berlebihan

Peningkatan selularitas stroma

ASSESMENT OF BREAST LUMPS

- A breast lump might be defined as a discrete mass palpably separate from surrounding tissue and invariably of
different consistency.
- An experienced breast examiner can usually make a distinction between a definite breast lump and a generally
lumpy breast.
- As a rule, all breast lumps require assessment.

- Assessment of a breast lump includes clinical examination, imaging, and some form of biopsy (fine needle aspiration
[FNA], core needle biopsy, or occasionally, excisional biopsy).
- There is a trend toward performing ultrasound for all lumps, with mammography reserved for women over 40 years
in whom clinical assessment or ultrasound findings are suspicious or uncertain.