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Difference between revisions of "Breast pathology"
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→Stromal lesions of the breast: tweak, subdivide
m (→Fibroadenoma: word about stromal lesions) |
(→Stromal lesions of the breast: tweak, subdivide) |
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*"Hyaline <nowiki>[pink stuff on H&E]</nowiki> is the key."<ref>RS. May 2010.</ref> | *"Hyaline <nowiki>[pink stuff on H&E]</nowiki> is the key."<ref>RS. May 2010.</ref> | ||
=Stromal lesions of the breast | =Stromal lesions= | ||
This section (below) covers stromal lesions of the breast, which vary from benign to malignant. The most common is (the benign) fibroadenoma. | |||
Non-breast stromal lesions are | Non-breast stroma stromal lesions are covered in the ''[[soft tissue lesions]]'' article. [[Angiosarcoma]] (dealt with in the ''[[vascular tumours]]'' article) is the most common (non-breast stroma) sarcoma of the breast, and classically arises after treatment for a breast carcinoma. | ||
==Fibroadenoma== | ==Fibroadenoma== | ||
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===Microscopic=== | ===Microscopic=== | ||
Features (not otherwise specified): | Features (fibroadenoma not otherwise specified): | ||
*Myxoid stroma -- most '''important feature'''. | *Myxoid stroma -- most '''important feature'''. | ||
**Stroma is white/pale on H&E -- normal stroma is pink on H&E. | **Stroma is white/pale on H&E -- normal stroma is pink on H&E. | ||
*Compression of glandular elements -- commonly seen. | *Compression of glandular elements -- commonly seen. | ||
DDx: | |||
*Phyllodes tumour. | |||
**Stroma is more cellular than in fibroadenoma. | |||
**May have mitoses. | |||
**"Stromal overgrowth" large area where there is a 'loss of glands'. | |||
**Patients with phyllodes tumour are usually older than those with fibroadenoma. | |||
*Sarcoma. | |||
Note: | |||
*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. | |||
====Juvenile variant==== | |||
Features (juvenile variant): | Features (juvenile variant): | ||
*"Looks more malignant": | *"Looks more malignant": | ||
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**More cellular. | **More cellular. | ||
Note: | |||
*The ''juvenile variant'', as the name suggests, is typically found in younger patients. | *The ''juvenile variant'', as the name suggests, is typically found in younger patients. | ||
====Phyllodes tumour vs. fibroadenoma==== | ====Phyllodes tumour vs. fibroadenoma==== | ||
Histology of phyllodes: | |||
* More cellular. | * More cellular. | ||
* More mitoses. | * More mitoses. | ||
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* Long/large slit-like spaces - '''key feature'''. | * Long/large slit-like spaces - '''key feature'''. | ||
** Small foci of long slit-like space may exist -- how much... no definition. | ** Small foci of long slit-like space may exist -- how much... no definition. | ||
Epidemiology: | |||
* Phyllodes = older patients (usually) | * Phyllodes = older patients (usually) | ||
Tx: | Tx: | ||
* Wide excision | * Wide excision for phyllodes vs. local excision for fibroadenoma. | ||
Ref.: <ref>{{Ref PBoD|1150}}</ref> | Ref.: <ref>{{Ref PBoD|1150}}</ref> | ||
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==Pseudoangiomatous stromal hyperplasia== | ==Pseudoangiomatous stromal hyperplasia== | ||
*Often abbreviated ''PASH''. | *Often abbreviated ''PASH''. | ||
===General=== | |||
*Benign lesion. | *Benign lesion. | ||
*Thought to arise due to myofibroblast abnormality - though not well understood.<ref name=pmid7872425>{{cite journal |author=Powell CM, Cranor ML, Rosen PP |title=Pseudoangiomatous stromal hyperplasia (PASH). A mammary stromal tumor with myofibroblastic differentiation |journal=Am. J. Surg. Pathol. |volume=19 |issue=3 |pages=270–7 |year=1995 |month=March |pmid=7872425 |doi= |url=}}</ref> | *Thought to arise due to myofibroblast abnormality - though not well understood.<ref name=pmid7872425>{{cite journal |author=Powell CM, Cranor ML, Rosen PP |title=Pseudoangiomatous stromal hyperplasia (PASH). A mammary stromal tumor with myofibroblastic differentiation |journal=Am. J. Surg. Pathol. |volume=19 |issue=3 |pages=270–7 |year=1995 |month=March |pmid=7872425 |doi= |url=}}</ref> | ||