Difference between revisions of "Breast biopsy or excision"
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− | | Fibroadenoma || 7% || Biphasic proliferation of both stromal and epithelial components, arranged into either a pericanalicular pattern (stromal proliferation around epithelial structures), or an intracanalicular pattern (stromal proliferation compressing the epithelial structures into clefts). Fibroadenomas characteristically display hypovascular stroma compared to malignant tumors.<ref name="WHO">{{cite book |editor=Tavassoli, F.A. |editor2=Devilee, P. |title=World Health Organization Classification of Tumours: Pathology & Genetics: Tumours of the breast and female genital organs |publisher=IARC Press |location=Lyon |year=2003 |isbn=978-92-832-2412-9 |url=}}</ref><ref name="POW">Pathology Outlines Website. [http://pathologyoutlines.com/breast.html#fibroadenoma] Accessed 12 February 2009.</ref><ref name="Rosen">{{cite book |author=Rosen, PP. |title=Rosen's Breast Pathology |isbn=978-0-7817-7137-5 |edition=3rd|year=2009 }}</ref> Furthermore, the epithelial proliferation appears in a single terminal ductal unit and has duct-like spaces surrounded by a fibroblastic stroma. The basement membrane is intact.<ref name="titleFibroadenoma of the breast">{{cite web |url=http://www.pathologyatlas.ro/fibroadenoma-breast-pathology.php |title=Fibroadenoma of the breast |access-date=2007-12-15 }}</ref> | + | | [[Fibroadenoma]] || 7% || Biphasic proliferation of both stromal and epithelial components, arranged into either a pericanalicular pattern (stromal proliferation around epithelial structures), or an intracanalicular pattern (stromal proliferation compressing the epithelial structures into clefts). Fibroadenomas characteristically display hypovascular stroma compared to malignant tumors.<ref name="WHO">{{cite book |editor=Tavassoli, F.A. |editor2=Devilee, P. |title=World Health Organization Classification of Tumours: Pathology & Genetics: Tumours of the breast and female genital organs |publisher=IARC Press |location=Lyon |year=2003 |isbn=978-92-832-2412-9 |url=}}</ref><ref name="POW">Pathology Outlines Website. [http://pathologyoutlines.com/breast.html#fibroadenoma] Accessed 12 February 2009.</ref><ref name="Rosen">{{cite book |author=Rosen, PP. |title=Rosen's Breast Pathology |isbn=978-0-7817-7137-5 |edition=3rd|year=2009 }}</ref> Furthermore, the epithelial proliferation appears in a single terminal ductal unit and has duct-like spaces surrounded by a fibroblastic stroma. The basement membrane is intact.<ref name="titleFibroadenoma of the breast">{{cite web |url=http://www.pathologyatlas.ro/fibroadenoma-breast-pathology.php |title=Fibroadenoma of the breast |access-date=2007-12-15 }}</ref> |
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Revision as of 10:21, 4 November 2019
Author:
Mikael Häggström [note 1]
Contents
Gross processing
Selection and trimming
- Determine total specimen size. Optionally, determine weight[1]
- Ink margins.Template:Ink note If sample orientations are marked, use different colors for different directions.[1]
- Palpate specimen for masses. Compare with radiograph if available[1]
- Make 3-4 mm thick slices.[1]
- Submit:[1]
- Entire specimen if it can fit in 3-5 slices.
- If larger, 1 slice per cm of tumor (minimum of 3 slices of tumor), including both center and periphery of tumor.
- Additional suspicious areas, including those indicated by mammography
See also: General notes on gross processing
Report
- Size of original tissue sample, preferably in 3 dimensions.
- Tumor properties, at least:
Staining
Usually H&E staining.
Routine immunohistochemistry usually include estrogen and progesterone receptors (ER, PR) and HER2.[2]
Microscopic evaluation
If tumor is found, determine:
- Tumor size
- Malignancy
- Distance from excision margin
Malignancy
The most important is to classify a sample as either of the following:
- Benign
- Carcinoma in situ
- Invasive cancer
Most common types
Finding | Relative incidence |
Histopathology | Image |
---|---|---|---|
Fibrocystic breast changes | 40% | ||
No disease | 30% | ||
Fibroadenoma | 7% | Biphasic proliferation of both stromal and epithelial components, arranged into either a pericanalicular pattern (stromal proliferation around epithelial structures), or an intracanalicular pattern (stromal proliferation compressing the epithelial structures into clefts). Fibroadenomas characteristically display hypovascular stroma compared to malignant tumors.[4][5][6] Furthermore, the epithelial proliferation appears in a single terminal ductal unit and has duct-like spaces surrounded by a fibroblastic stroma. The basement membrane is intact.[7] | |
Atypical ductal hyperplasia | 7%[8] | Epithelial proliferations which are not qualitatively or quantitatively abnormal enough to be classified as ductal carcinoma in situ.[8] | |
Other benign mammary dysplasias and neoplasms | 5% | ||
Breast cancer (in situ or invasive) | 10% | See next section. |
Breast cancer
Cancer type | Histopathology | Image |
---|---|---|
Invasive ductal carcinoma | Carcinomatous cells are seen below the basement membrane of lactiferous ducts. Otherwise, there are no specific histologic characteristics, essentially making it a diagnosis of exclusion.[9] | |
Ductal carcinoma in situ | Malignant epithelial cells confined to the ductal system of the breast, without invasion through the basement membrane.[10] | |
Invasive lobular carcinoma | The "classic" pattern is round or ovoid cells with little cytoplasm in a single-file infiltrating pattern, sometimes concentrically giving a targetoid pattern. |
- Further information: Evaluation of tumors
Notes
- ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.
Main page
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 Monika Roychowdhury. Grossing (histologic sampling) of breast lesions. Pathologyoutlines.com. Topic Completed: 1 August 2012. Revised: 19 September 2019
- ↑ "Immunohistochemical detection of estrogen and progesterone receptor and HER2 expression in breast carcinomas: comparison of cell block and tissue block preparations ". Int J Clin Exp Pathol 2 (5): 476–80. 2009. PMID 19294006.
- ↑ Mitchell, Richard Sheppard; Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson (2007). Robbins Basic Pathology (8th ed.). Philadelphia: Saunders. p. 739. ISBN 978-1-4160-2973-1.
- ↑ Tavassoli, F.A., ed (2003). World Health Organization Classification of Tumours: Pathology & Genetics: Tumours of the breast and female genital organs . Lyon: IARC Press. ISBN 978-92-832-2412-9.
- ↑ Pathology Outlines Website. [1] Accessed 12 February 2009.
- ↑ Rosen, PP. (2009). Rosen's Breast Pathology (3rd ed.). ISBN 978-0-7817-7137-5.
- ↑ . Fibroadenoma of the breast.
- ↑ 8.0 8.1 David J. Myers; Andrew L. Walls.. Atypical Breast Hyperplasia. StatPearls, National Center for Biotechnology Information. Last Update: February 15, 2019.
- ↑ Peter Abdelmessieh. Breast Cancer Histology. Medscape. Retrieved on 2019-10-04. Updated: May 24, 2018
- ↑ Siziopikou, Kalliopi P. (2013). "Ductal Carcinoma In Situ of the Breast: Current Concepts and Future Directions ". Archives of Pathology & Laboratory Medicine 137 (4): 462–466. doi: . ISSN 0003-9985.
Image sources