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*Pathology Outlines - Breast Malignant [http://pathologyoutlines.com/breastmalignant.html] | *Pathology Outlines - Breast Malignant [http://pathologyoutlines.com/breastmalignant.html] | ||
*WebPathology - Breast [http://www.webpathology.com/atlas_map.asp?section=9] | *WebPathology - Breast [http://www.webpathology.com/atlas_map.asp?section=9] | ||
=Normal= | |||
==Resting== | |||
*Glands -- normally has two cell layers (like the [[prostate]]). | |||
**Myoepithelial cells | |||
***Frequently spindle-like, often hard to see. | |||
**Secretory cells. | |||
*Stroma: | |||
**Not cellular. | |||
**Not myxoid. | |||
May be present: | |||
*Calcification: | |||
**Purple globs (with concentric rings) on H&E = calcium phosphate. | |||
***Q. How to remember? A. '''P'''urple = '''P'''hosphate. | |||
**Calcium oxalate visible with (light) polarization - not assoc. with malignancy. | |||
**Often in the lumen of a gland, may be in the stroma. | |||
**Calcific material typically has a well-demarcated border +/- "sharp corners". | |||
**Radiologists can pick-up calcs (calcifications) that are approximately 100 micrometers; if "calcs" is on the requisition one needs to find calcs this size.<ref>MUA. 1 October 2010.</ref> | |||
***The large calcs seen on radiology are approximately 1/5 - 1/6 the size of a HPF, if the field of view (FOV) is ~0.55 mm (as is the case with 22 mm-10x eye pieces and a 40x objective). | |||
Image: | |||
*[http://www.breastpathology.info/Images/calcs/FatNec1_700.jpg Breast with calcifications (breastpathology.info)]. | |||
Notes: | |||
*The architecture is more important than the cytologic features in the diagnosis of malignancy in the breast;<ref>RS. 4 May 2010.</ref> low grade tumours have distorted architecture but normal/near normal cytology. | |||
==Lactational changes== | |||
*[[AKA]] secretory change, [[AKA]] lactational adenoma, [[AKA]] lactating adenoma <ref>URL: [Breast_pathology#Lactational_changes Breast_pathology#Lactational_changes. Accessed on: 3 October 2011.</ref> | |||
===General=== | |||
*Lactational adenoma generally arises in during or in the few weeks after pregnancy. | |||
*May be present focally in non-pregnant females. | |||
*"Lactational adenoma"- circumscribed mass displacing the normal breast architecture (hyperplasia plus functional/physiologic change) | |||
*"Lactational change"- normal breast tissue architecture preserved (functional/physiologic change). | |||
ASIDE: | |||
*Some believe ''lactational change'' and ''secretory change'' aren't the same... | |||
**Lactational change = only in lactation. | |||
**Secretory change = other times. | |||
*This hair splitting is clinically irrelevant-- both are benign. Also, experts use the terms interchangeably.<ref name=pmid2879437>{{Cite journal | last1 = Tavassoli | first1 = FA. | last2 = Yeh | first2 = IT. | title = Lactational and clear cell changes of the breast in nonlactating, nonpregnant women. | journal = Am J Clin Pathol | volume = 87 | issue = 1 | pages = 23-9 | month = Jan | year = 1987 | doi = | PMID = 2879437 }} | |||
</ref> | |||
===Microscopic=== | |||
Features:<ref>URL: [http://flylib.com/books/en/2.953.1.9/1/ http://flylib.com/books/en/2.953.1.9/1/]. Accessed on: 6 August 2011.</ref> | |||
*Glands dilated. | |||
*Increased number of lobules. | |||
**Relative decrease in intralobular and extralobular stroma. | |||
*Luminal cells enlarged. | |||
**Vacuolated cytoplasm. | |||
**Hobnail morphology - hang into the lumen. | |||
*Myoepithelial cells indistinct - after second trimester. | |||
*Lactational "adenoma" may undergo infarction - Imagine what an infarcted lactational adenoma could look like in a FNA specimen! | |||
DDx: | |||
*[[Secretory carcinoma of the breast]]. | |||
====Images==== | |||
<gallery> | |||
Image:Lactational_change_-_low_mag.jpg | Lactational change - low mag. (WC/Nephron) | |||
Image:Lactational_change_-_high_mag.jpg | Lactational change - high mag. (WC/Nephron) | |||
Image:Breast LactationalChange MP CTR.jpg|Breast - Lactational Change - medium power (SKB) | |||
Image:Breast LactationalChange HP CTR.jpg|Breast - Lactational Change - high power (SKB) | |||
Image:Breast LactationalAdenoma MP CTR.jpg|Breast - Lactational adenoma - medium power (SKB) | |||
Image:Breast LactationalAdenoma HP CTR.jpg|Breast - Lactational adenoma - high power (SKB) | |||
Image:Breast LactationalAdenoma LP SNP.jpg|Breast - Lactational adenoma - low power (SKB) | |||
Image::Breast LactationalAdenoma MP SNP.jpg|Breast - Lactational adenoma - high power (SKB) | |||
Image:Breast LactatingAdenoma (4) PA.JPG|Breast - Lactational adenoma - low power (SKB) | |||
Image:Breast LactationalAdenoma MP SNP.jpg|Lactational adenoma - high power - in this example, the epithelium is flattened with clear bubbly cytoplasm (SKB) | |||
Image:Breast LactatingAdenoma HP PA.JPG|Breast - Lactational adenoma - high power - shows snouting and decapitation secretion. (SKB) | |||
</gallery> | |||
www: | |||
*[http://www.gfmer.ch/selected_images_v2/detail_list.php?cat1=2&cat2=9&cat3=0&cat4=3&stype=n Lactational changes (gfmer.ch)]. | |||
*[http://www.webpathology.com/image.asp?case=320&n=7 Lactational changes in an angiosarcoma of the breast (webpathology.com)]. | |||
*[http://www.lab.anhb.uwa.edu.au/mb140/CorePages/FemaleRepro/femalerepro.htm#LabMamm Lactating breast (uwa.edu.au)]. | |||
==Major Pathologic Patterns== | ==Major Pathologic Patterns== |
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