PATHOLOGY OF THE BREAST PROLIFERATIVE BREAST DISEASE WITHOUT

ATYPIA
FIBROADENOMA MAMMAE(FAM) Commonly detected as:
a. Benign neoplasm, composed of 1. Mammographic densities
epithelial and stromal elements 2. Calcifications, or
(originate from the terminal duct 3. As incidental findings in specimens from
lobular unit/TDLU) biopsies
b. Ages: 20-35 years
Typically > 1 lesion
Diagnosis
Manifestasi klinis Characterized by:
Round, elastic/rubbery, soliter/ multiple, firm, Proliferation of ductal epithelium and/or
freely moveable, upper lateral quadrant >> stroma, without cytologic or architectural
Macroscopic features
Encapsulated, gray white
Morphology:
BENIGN EPITHELIAL LESIONS 1. Epithelial Hyperplasia
NON-PROLIFERATIVE BREAST CHANGES 2. Sclerosing Adenosis
(FIBROCYSTICCHANGES) 3. Complex Sclerosing
a. Very common morphologic 4. Lesion Papillomas
b. Clinician: mean “lumpy bumpy” breasts
on palpation SCLEROSING ADENOSIS
c. Radiologist: a dense breast with cysts Diagnosis
d. Pathologist: Microscopic
1. Benign histologic findings a. Acini compressed and distorted by
2. Not associated with an increased dense stroma
cancer risk b. Calcifications within some of the
e. These lesions distinguish from lumens
“proliferative” changes, which are c. Involved terminal duct lobular unit
associated with an increased risk of (TDLU) is enlarged
breast cancer d. The acini are arranged in a ‘swirling
pattern’ → outer border is well
Morphologic changes: circumscribed
1.Cystic change Often with apocrine metaplasia
2.Fibrosis INTRADUCTAL PAPILLOMA
Cysts rupture → releasing secretory a. A central fibrovascular core extends
material to adjacent stroma → chronic from the wall of a duct
inflammation and fibrosis (palpable b. The papillae arborize within the lumen
firmness) and lined by myoepithelial and luminal
3.Adenosis cells
a.Defined: an increase number of acini
per lobule PROLIFERATIVE BREAST DISEASE WITH ATYPIA
b.Normal physiologic: occurs during ATYPICAL DUCTAL HYPERPLASIA
pregnancy a. A duct filled with mixed population of
c.Non-pregnant women: can occur as a cells consisting of:
focal change 1. Oriented columnar cells at the
periphery
 2. Rounded cells within the central
portion Etiologi
b. Although some of the spaces are round
and regular, the peripheral spaces are
irregular and slitlike
c. These features are highly atypical, but
fall short of a diagnosis of DCIS(Ductal
Carcinoma In Situ)
ATYPICAL LOBULAR HYPERPLASIA
a. Population of monomorphic small,
round, loosely cohesive cells partially fill
a lobule
b. Some intracellular lumens can be seen.
c. Although morphologically identical to
the cells of LCIS, the extent of
involvement is not suf ficient for this
diagnosis
Signs and Symptoms
CARCINOMA OF THE BREAST
a. Genetic Factor: History of breast cancer
in 1st line degree relatives (mother,
sister, daughter)
b. Mutations of:
1. p53 tumor suppressor gene
2. BRCA 1 gene (breast ca 1) located at
chromosome 17 (17q21)
3. BRCA 2 gene located on
chromosome 13q12
c. Hormonal status (increased risk):
1. Early menarch
2. Late menopause and
3. Older age at first term pregnancy
d. Environmental (high fat intake)
e. Radiation
f. Fibrocystic change
g. Previous cancer of the breast
a. Palpable mass (55%)
b. 60% located in UO quadran
c. Skin change (color/dimpling/peau
d’orange/ulceration)
d. Nipple retraction, nipple discharge
e. Axillary mass
f. 85% occurs after 40, 75% after 50