Pathology of breast – Case based

Tutorial / Practical

Department of Pathology
 Case – 1
Nipple discharge

• A 45 year old woman presents with a right

nipple discharge for 6 weeks.
 Case – 1
Nipple discharge

1. What are the clinical features (signs /

symptoms) that you would elicit in this
patient ?
2. List the likely causes for her clinical
presentation?
 Case – 1 continue
• USS of her breast shows a solid mural nodule
within a dilated duct and mammography
detects rounded or ovoid well circumscribed
subareolar mass
• This lump is removed surgically and histology
of this lump is shown in the photomicrograph
 Describe the histology of this
photomicrographs

What is the diagnosis?

 Case 2

A 55 year old woman presents with a firm

irregular painless mass in the lower lateral
quadrant of the left breast. It is not freely
mobile.
 Case 2

1. What is the most likely underlying cause ?

2. What other clinical features would you look
for ?
3. Briefly discuss the pathological basis for each
of the clinical features you mentioned.
 Case - 2 (Hard irregular fixed painless breast
lump)

1. List other causes that would give rise to

similar features (Firm/ hard irregular
immobile mass).
 Case - 2

1. What are the investigations you would

undertake in this patient?
 Case 2
Tru cut biopsy performed on this mass, is
provided – Describe the features.
 Case - 2
2. Fine needle aspiration cytology performed on
the axillary lymph node, is provided – Describe
the features.
 Case 2
• Below given is the conclusion of her breast biopsy
report
Invasive carcinoma - No special type
Provisional tumour grade - Nottingham Grade III
ER – Negative (0/8)
PR – Negative (0/8)
Her 2 – Positive (+3)
• Briefly discuss the prognostic factors included in
this report
• How do you classify this breast carcinoma depend
on hormone receptor status and molecular profile
 Case - 2

• List the possible histological types of breast

carcinoma and describe their histological
features
 Case – 3 (Painless mobile mass)
1. A 24 year old woman presents with a freely
mobile, well defined, 20mm in diameter
mass in the upper medial quadrant of the
left breast. She is worried because her
mother died of breast cancer 5 years back.
• Question –
– Is the history of her mothers death due to breast
carcinoma important ?
– If so how will you reassure this patient?
 Case – 3
1. The macroscopic picture of the lump is
provided. What is the most likely lesion?
 Case - 3
• Compare it with these macroscopic pictures
 Case - 3
1. The photomicrograph of a Fine needle
aspiration sample of the lesion is provided –
Describe the key features.
 Case - 3

1. List the benign tumours of the breast.

2. Describe their microscopic features
 Case – 4
Lactating mother
• A 38 year old female (P2 C1) develops a
painful enlargement of the left breast during
the 2nd week of lactation.
• She is found to have an ill defined breast lump
in the right breast.
• What are the histological changes that occur
in the breast during pregnancy and lactation?
 Case – 4 (Lactational changes of the breast)

1. What are the likely causes for this patients

symptoms ?
 Case - 4

• What are the possible causes for generalized

enlargement of the breast ?
 Case - 5
• A 48-year-old lady presented to surgical clinic
with right side eczymatous breast lesion
involving the nipple.
• On examination she also had blood-stained
nipple discharge, lump and axillary
lymphadenopathy on the same side.
Case -5
 Case -5
1. What is the most likely diagnosis?
2. Briefly describe how did you arrive at the
above diagnosis with the given information?
3. List the specimens that can be send to
histopathology laboratory from this patient.
4. Describe the pathological features of the
breast lesions of this patient