Talk:Breast pathology

From Libre Pathology
Jump to: navigation, search

Case with everything

Microscopic

  1. The sections show breast tissue with a partially fibrous breast stroma, and glands with columnar cells, apocrine snouts and moderate, focal nuclear atypia in which nucleoli are easy to identify at the intermediate power objective. The glandular cells layer up to three cells thick. There are also glands with a columnar cell morphology and apocrine snouts, and dilated glands with flat and benign appearing epithelium. There is a focus of breast glands with a columnar cell morphology and apocrine snouts, with pale periglandular stroma. Focal microcalcifications, approximately 50-80 micrometers in size, are seen in benign breast glands.
  1. The section small blood vessel-like channels in a dense, abundant interlobular stromal tissue. There are also glands with a columnar cell morphology and apocrine snouts, and dilated glands with flat and benign appearing epithelium.

Final diagnosis

  1. Left breast, lumpectomy:
    • Flat epithelial atypia.
    • Columnar cell change.
    • Fibrocytic change.
    • Focal fibroadenomatoid change.
    • Microcalcifications in benign breast glands.
  2. Left breast, lumpectomy:
    • Pseudoangiomatous stromal hyperplasia.
    • Columnar cell change.
    • Fibrocystic change.

Fibroadenoma

Microscopic

Thank you for the consult.

The sections show a well-circumscribed breast nodule that separates from the surrounding fibrous tissue. It has a pale pink staining, dense, cellular stroma that consists of cells with bland nuclear features. The epithelial component consists of a variable cell population with nuclei that are small and round to oval and do not have an easy-to-identify nucleolus. There are more than three cells above the basement membrane. Mitotic activity is seen focally. No atypical mitoses are identified.

The surrounding breast parenchyma has focal cystic glandular dilation and epithelium with a columnar cell morphology and apocrine snouts. There is a small focus of glands without significant mitotic activity, an increased epithelial component with slit-like spaces, and nuclei that are small and round to oval.

Final diagnosis

Breast, right, excisional biopsy for a nodule:
Fibroadenoma with epithelial hyperplasia.
Fibrocystic changes.
Columnar cell change.

Phyllodes

Microscopic

The specimen consists of a close excision lumpectomy.

The sections show a moderately well-circumscribed fibroepithelial lesion, that focally has an irregular interface to the surround breast tissue. It has long slit-like spaces that together give the a leaf-like appearance. The stromal component is mitotically active (10 mitoses / 2.376 mm^2 ) and has moderate nuclear atypia. There is no stromal overgrowth. The epithelial component of the lesion has no nuclear atypia and is not mitotically active. The surgical margin is 0.1 cm from the lesion.

The surrounding breast parenchyma has a small focus of glands without significant mitotic activity, an increased epithelial component -- with more than three cells to the basement membrane, and nuclei that are small and round to oval. There is also focal cystic glandular dilation and epithelium with a columnar cell morphology and apocrine snouts. Calcifications are found in benign breast glands.

The focally irregular interface between the lesion and surrounding breast tissue, and the mitotic rate is concerning for an aggressive (phyllodes) tumour; however other features that typically accompany a malignant behaviour (stromal overgrowth, marked stromal cell nuclear atypia) are absent.

Final

DIAGNOSIS:
Breast, left, (close excision) lumpectomy:
Phyllodes tumour with:
Marked cellular proliferation, and Focally irregular interface to surround breast tissue – suggest re-excision of lumpectomy cavity.