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Difference between revisions of "Breast pathology"
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=Where to start= | =Where to start= | ||
{{Main|Short_power_list#Breast_pathology|Long_power_list#Breast_pathology}} | {{Main|Short_power_list#Breast_pathology|Long_power_list#Breast_pathology}} | ||
The following | The following is a starting point for understanding routine breast pathology & some of challenges in breast pathology: | ||
The key to breast pathology is. | The key to breast pathology is the myoepithelial cell. | ||
**A benign gland has two cell layers - myoepithelial and epithelial. | |||
**The luminal cell is epithelial | |||
**The basal cells is myoepithelial | |||
***The myoepithelial layer is hard to see at times. | |||
***IHC can aid in visualizing the myoepithelial layer. | |||
***The immunostains used in breast pathology for the myoepithelial layer include: CK5/6, SMA, p63, calponin | |||
==Questions to Ask== | |||
*Is it normal or close to normal | |||
**Are you familiar with normal/altered but benign/physiologic changes in the breast | |||
**Do the changes observed explain the biopsy (are you sure you are seeing the radiographic lesion?) | |||
**Have you found the microcalcifications? | |||
*Is it a neoplastic but benign. | |||
**Are you familiar with the common benign breast neoplasms? | |||
**Do you know the morphologic criteria for a benign breast gland? | |||
**Do you know how to use IHC to confirm a benign process? | |||
*Is it an in situ carcinoma? | |||
**Are you familiar with DCIS and LCIS and their variants? | |||
**Do you know the morphologic criteria for in situ carcinoma? | |||
**Do you know how to use ICH to confirm an in situ carcinoma? | |||
**Do you know how to report an in situ carcinoma? | |||
*Is it invasive carcinoma? | |||
**Do you know the morphologic features of typical invasive breast carcinoma? | |||
**Do you know the subtypes? | |||
**Do you understand the implications of some of the medullary/medullary-like subtype (especially in a young patient)? | |||
**Do you know the morphologic criteria for an invasive gland? | |||
**Do you know how to use IHC to confirm invasion? | |||
**Do you know how to use IHC for prognostication? | |||
**Do you understand the implications of triple negativity? | |||
**Do you know how to report a breast carcinoma? | |||
==Important Differential Diagnoses== | |||
===Papillary Lesions=== | |||
*Nipple adenoma | |||
*Intraductal papilloma | |||
*Papillary ductal carcinoma in situ | |||
*Intracystic papillary carcinoma | |||
*Intracystic papillary carcinoma with an invasive component | |||
*Invasive papillary carcinoma | |||
===Basaloid Lesions=== | |||
*Adenoid Cystic Carcinoma of the Breast | |||
*Intracystic Papillary Breast Carcinoma, Solid Variant | |||
*Invasive Papillary Breast Carcinoma, Solid Variant | |||
*Medullary Breast Carcinoma | |||
*Medullary-like Breast Carcinoma | |||
**Know when to start a discussion about BRCA mutations, triple negativity and the 'basal-like molecular phenotype'. | |||
===Spindle Cell Lesions=== | |||
*Metaplastic Breast Carcinoma | |||
*Treated Breast Carcinoma | |||
*Mammary Myofibroblastoma | |||
*Phyllodes Tumor - stromal component | |||
*Desmoid Fibromatosis | |||
*Nodular Fasciitis | |||
== Additional resources == | == Additional resources == | ||
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*''FEHUT'' = florid epithelial hyperplasia of the usual type. | *''FEHUT'' = florid epithelial hyperplasia of the usual type. | ||
*''extent'' refers to the size of the abnormal cell population within the papillary lesion. | *''extent'' refers to the size of the abnormal cell population within the papillary lesion. | ||
=Malignant lesions= | =Malignant lesions= | ||