BREAST CANCER: PATHOLOGY, COMMON

SITES OF METASTASIS, STAGING AND RIDA ARIF

GRADING, PROGNOSIS, BIOMARKERS

CASE: UNLUCKY LUMP
BREAST CANCER: TYPES

(SATTAR, 2013)
DUCTAL CARCINOMA IN
SITU (DCIS)
• Malignant proliferation of cells in ducts with no
invasion of the BM
• Does not usually produce a mass as it is growing
inside the ducts
• Often detected as calcifications on mammography
• Important subtype: Comedo type characterized by
high grade cells with necrosis and dystrophic
calcifications in center
• PAGET DISEASE OF THE BREAST: DCIS that
extends up the duct to involve the skin of the nipple

(SATTAR, 2013)
• Invasive carcinoma that forms duct-
like structures in a desmoplasmic
stroma
• Presents as a mass on physical exam
or mammography; may cause
dimpling or nipple retraction
• Tubular: well-differentiated tubules
without myoepithelial cells; good
prognosis
• Mucinous: tumor cells floating in a
mucous pool; good prognosis
• Medullary: large, high grade cells
growing in sheets with lymphocytes
and plasma cells; increased incidence
in BRCA 1 carriers & good prognosis INVASIVE DUCTAL
• Inflammatory: carcinoma in dermal
lymphatics, presents as inflamed
CARCINOMA
swollen breasts; poor prognosis

(SATTAR, 2013)
 LOBULAR CARCINOMA IN INVASIVE LOBULAR
SITU CARCINOMA
• Malignant proliferation of cells in • Invasive carcinoma that
lobules with no invasion of the BM characteristically grows in a single-file
pattern
• Characterized by dyscohesive cells
lacking E-cadherin adhesion protein • No duct formation due to lack to E-
cadherin
• Often multifocal and bilateral

(SATTAR, 2013)
COMMON
SITES OF
METASTASIS
(VRANIC, 2019)
STAGING AND GRADING

(CANCER SOCIETY NZ, 2019)

(PATHOLOGY.JHU.EDU, 2019)
PROGNOSIS
Based on the TNM staging:
• Metastasis is the most important
factor, but most patients present
before metastasis
• Spread to axillary lymph nodes is
the most useful factor; sentinel
lymph node biopsy is done

(SATTAR, 2013)
 • They predict response to treatment; most important
include estrogen receptor (ER), progesterone receptor
(PR), HER2/neu gene amplification status
• Presence of ER and PR is associated with response to
PREDICTIVE antiestrogenic drugs (tamoxifen)
FACTORS/BIOMARKERS • HER2/neu amplification is associated with response to
trastuzumab (antibody directed against HER2
receptor)
• Triple negative tumors are negative for ER, PR,
HER2/neu and have a poor prognosis

(SATTAR, 2013)
REFERENCES
• Sattar, H. (2013). Fundamentals of pathology.
• Pathology.jhu.edu. (2019). Staging & Grade. [online] Available at:
https://pathology.jhu.edu/breast/my-results/staging-grade/ [Accessed 13 Feb.
2019].
• Cancer Society NZ. (2019). Staging breast cancer. [online] Available at:
https://auckland-northland.cancernz.org.nz/cancer-information/cancer-types/breast-
cancer/staging/?divisionId=17&centreId=2 [Accessed 13 Feb. 2019].
• Vranic, S. (2019). Pathology of the breast.