Difference between revisions of "Breast pathology"

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Breast pathology (view source)

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==Fibroadenoma==
==Fibroadenoma==
===General===
{{Main|Fibroadenoma}}
*Very common benign finding.
*The pathology is in the stroma; so, the lesion is really a misnomer by the naming rules.
**It ought to be called ''adenofibroma'' (as a few occasionally do<ref name=pmid15797289>{{Cite journal  | last1 = Guinebretière | first1 = JM. | last2 = Menet | first2 = E. | last3 = Tardivon | first3 = A. | last4 = Cherel | first4 = P. | last5 = Vanel | first5 = D. | title = Normal and pathological breast, the histological basis. | journal = Eur J Radiol | volume = 54 | issue = 1 | pages = 6-14 | month = Apr | year = 2005 | doi = 10.1016/j.ejrad.2004.11.020 | PMID = 15797289 }}</ref>), as the glandular component is benign and the stromal component lesional; there is [[no truth in names]] in pathology.
 
Management:
*Local excision -- without a large margin.
 
===Gross===
Features:<ref>{{Ref PCPBoD8|550}}</ref>
*Well-circumscribed.
*Rubbery - '''classic descriptor'''.
*Tan/white.
*+/-Lobulated appearance.
*+/-Slit-like spaces - short.
*+/-Calcification.
 
Images:
*[http://webpathology.com/image.asp?n=2&Case=276 Fibroadenoma - slit-like spaces (webpathology.com)].
*[http://webpathology.com/image.asp?case=276&n=3 Fibroadenoma - lobulated appearance (webpathology.com)].
*[http://www.surgical-tutor.org.uk/default-home.htm?tutorials/fibroadenoma.htm~right Fibroadenoma (surgical-tutor.org)].
 
===Microscopic===
Features:<ref name=Ref_BP110>{{Ref BP|110}}</ref>
*Abundant (intralobular) stroma - most '''key feature'''.
**Stroma is usually:
***White/pale, i.e. [[myxoid stroma|myxoid]], on H&E (normal stroma is pink).
****May be hyalinized (dark pink) if infarcted.
***Paucicellular - typical.
*Compression of glandular elements - very commonly seen.
**Glandular elements have at least two cell layers - epithelial and myoepithelial.
 
Notes:
#There is stuff about ''intracanalicular'' vs. ''pericanalicular''.<ref>URL: [http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970216-9 http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970216-9]. Accessed on: 16 March 2011.</ref>  It is irrelevant; there is no prognostic difference between the two.
#Do '''not''' comment on the margin - it is irrelevant.
 
DDx:
*[[Phyllodes tumour]] - long slit-like spaces (seen grossly), stroma is more cellular.
**+/-Mitoses,
**+/-"Stromal overgrowth" = large area where there is a 'loss of glands'.
*Sarcoma.
*[[Pseudoangiomatous stromal hyperplasia]].
**Small capillary-like structures in the stroma.
***Epithelial component often not compressed - as in fibroadenoma.
*[[Adenomyoepithelioma]] - for [[tubular adenoma of the breast]].
 
====Images====
<gallery>
Image:Breast fibradenoma (1).jpg | Fibroadenoma. (WC/KGH)
Image:Breast_fibradenoma_(2).jpg | Fibroadenoma. (WC/KGH)
</gallery>
www:
*[http://radiographics.rsna.org/content/27/suppl_1/S101/F40.expansion.html Infarcted fibroadenoma (rsna.org)].<ref name=pmid18180221>{{Cite journal  | last1 = Sabate | first1 = JM. | last2 = Clotet | first2 = M. | last3 = Torrubia | first3 = S. | last4 = Gomez | first4 = A. | last5 = Guerrero | first5 = R. | last6 = de las Heras | first6 = P. | last7 = Lerma | first7 = E. | title = Radiologic evaluation of breast disorders related to pregnancy and lactation. | journal = Radiographics | volume = 27 Suppl 1 | issue =  | pages = S101-24 | month = Oct | year = 2007 | doi = 10.1148/rg.27si075505 | PMID = 18180221 }}</ref>
*[http://www.imagingpathways.health.wa.gov.au/includes/images/image/fibroadenoma_he.jpg Fibroadenoma (gov.au)].<ref>URL: [http://www.imagingpathways.health.wa.gov.au/includes/dipmenu/image/image.html http://www.imagingpathways.health.wa.gov.au/includes/dipmenu/image/image.html]. Accessed on: 15 February 2012.</ref>
 
====Variants====
Four variants are described by the ''Washington Manual'':<ref name=Ref_WMSP262>{{Ref WMSP|262}}</ref>
#Juvenile.
#Complex.
#Myxoid.
#Cellular.
 
Considered a variant of fibroadenoma by many authorities:<ref name=Ref_BP116>{{Ref BP|116}}</ref>
*''[[Tubular adenoma of the breast]]''.
 
=====Juvenile fibroadenoma=====
*As the name suggests, is typically found in younger patients.
*Classic history: rapid growth.
 
Features (juvenile variant):<ref>URL: [http://www.breastpathology.info/fibro_variants.html#juvenile http://www.breastpathology.info/fibro_variants.html#juvenile]. Accessed on: 3 October 2011.</ref>
*Stromal and epithelial hyperplasia - '''key feature'''.
*+/-Tapering, thin micropapillae (''[[gynecomastoid hyperplasia]]'').<ref name=Ref_BP116>{{Ref BP|116}}</ref>
*Mitoses uncommon.
 
=====Myxoid fibroadenoma=====
*May be associated with ''[[Carney's complex]]''.
 
Features:
*[[Myxoid stroma]].
 
=====Cellular fibroadenoma=====
Features (cellular variant):
*Cellular.
*Mitoses.
 
=====Complex fibroadenoma=====
*Contain proliferative epithelium which outside and inside a fibroadenoma is associated with an increased risk of malignancy.
 
Features:<ref>URL: [http://www.breastpathology.info/fibro_variants.html#complex http://www.breastpathology.info/fibro_variants.html#complex]. Accessed on: 3 October 2011.</ref>
# [[Apocrine metaplasia]].
# Cysts > 3 mm.
# Calcification.
# [[Sclerosing adenosis]].
 
Memory devices:
*''FACS'': complex '''f'''ibroadenoma, '''a'''pocrine metaplasia, '''c'''alcs & '''c'''ysts, '''s'''clerosing adenosis.
*''CAMS'': '''c'''alcs, '''a'''pocrine metaplasia, '''m'''icrocysts, '''s'''clerosing adenosis.
 
=====Tubular adenoma of the breast=====
*Considered by many a variant of ''fibroadenoma''.
**[[IHC]] features of ''tubular adenoma of the breast'' and ''fibroadenoma'' are similar.<ref>{{Cite journal  | last1 = Maiorano | first1 = E. | last2 = Albrizio | first2 = M. | title = Tubular adenoma of the breast: an immunohistochemical study of ten cases. | journal = Pathol Res Pract | volume = 191 | issue = 12 | pages = 1222-30 | month = Dec | year = 1995 | doi =  | PMID = 8927570 }}</ref>
 
Features:<ref name=Ref_BP116>{{Ref BP|116}}</ref>
*Fibromyxoid stroma (like in a fibroadenoma).
*Small round glands.
 
Images:
*[http://www.webpathology.com/image.asp?case=277&n=1 Tubular adenoma of the breast (webpathology.com)].
<gallery>
Image:Tubular_Adenoma_of_Breast_(myosin_immunostain)_(4351463966).jpg | TA of the breast - myosin IHC. (WC)
</gallery>


==Phyllodes tumour==
==Phyllodes tumour==
Michael
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