BREAST HISTOLOGY

NORMAL
LOBULE
ACINUS
DUCT
INTER-INTRALOBULAR STROMA
Breast luminal and epithelial cell
Double layers
Myoepithelial are
the outer layer of
luminal (flattened
nuclei)
Luminal cell seen
medially (bigger
nuclei)
Lumen in the middle
Squamous metaplasia of lactiferrous duct
*No squamous metaplasia of lactiferrous duct
FAT NECROSIS
 NON PROLIFERATIVE
FIBROSIS
ADENOSIS
CYST
Breast fibrosis
adenosis:increase number of acini per lobule, normal in pregnancy, can be focal finding in non pregnant breast.acini are often enlarge but not distorted,
line by columnar epith that can exhibit atypia
fibrosis:can occur secondary to ruptured cyst or inflammation
cyst:lobular dilatation and unfolding and they coalesce to form large lesion
Apocrine Metaplasia is a reversible transformation of cells to an apocrine phenotype. It is common in the breast in the context of fibrocystic change. It is
seen in women mostly over the age of 50 years. Metaplasia happens when there is an irritation to the breast (breast cyst). Apocrine-like cells form in a
lining of developing microcysts, due to the pressure buildup within the lumen. The pressure build up is caused by secretions
Apocrine metaplasia
PROLIFERATIVE DSS W/OUT ATYPIA
STROMA
EPITHELIAL
Radial scars are spiculated masses characterized microscopically by a sclerotic appearing (i.e. scar like) center with peripheral
entrapped normal breast ducts and lobules. is a benign breast lesion that can radiologically mimic malignancy BUT

It is not associated with an increased risk of breast cancer.

Ass w fibrovascular core within dilated duct
ATYPICAL DUCTAL HYPERPLASIA
ATYPICAL DUCTAL HYPERPLASIA
DUCTAL HYPERPLASIA
ATYPICAL LOBULAR HYPERPLASIA
ATYPICAL LOBULAR HYPERPLASIA
 ATYPICAL LOBULAR HYPERPLASIA
Definition

A proliferative lobular process that exhibits cytologic features of lobular carcinoma in situ but does not fulfil the
requirements for extent of involvement

Alternate / historical names

Lobular neoplasia
Diagnostic Criteria

Same cytologic features as LCIS

May be classic or pleomorphic
Classic: uniform, small, round, discohesive cells, has been subdivided as:
Type A - small completely bland cells
Type B - slightly larger, slightly irregular, small nucleoli
Pleomorphic: larger, sometimes irregular nuclei, often with prominent nucleoli
May exhibit pagetoid spread into ducts
No lobular unit completely fulfils the extent of involvement required for LCIS
No lobular units show complete filling of all the acini, OR
Even if all filled, fewer than half of the acini in the lobule expanded
There is no category of non-atypical lobular hyperplasia
 Breast carcinoma
Non-invasive epithelial cancers
- LCIS
- DCIS (papillary, cribriform, solid and comedo types)

Invasive epithelial cancers

- Invasive lobular carcinoma
-classic
- solid
- pleiomorphic

- invasive ductal carcinoma

- IDC, NOS (50-70%)
- Tubular carcinoma (2-3%)
- Mucinous or colloid carcinoma (2-3%)
- Medullary carcinoma (5%)
- Invasive cribriform carcinoma (1-3%)
- Invasive papillary carcinoma (1-2%)

-Mixed connective and epithelial tumours

- Phyllodes tumours
- Angiosarcoma
- Sarcoma
 DCIS
DEFINITION:
Proliferation of malignant epithelial cells that has not breached the
myoepithelial layer of the ductolobular system.
GRADE from 1 - 3.
Grade 1: monomorphic cells with inconspicious nuclei and diffuse chromatin
Grade 2: Not 1 or 3
Grade 3: large nucleii, pleiomorphism and irregular chromatin

4 morphologic types:
- papillary, cribriform, comedo, solid

As the cells grow they tend to undergo central necrosis leading to

calcifications.
DCIS-cribiform
DCIS-cribiform
DCIS-solid
 LCIS
LCIS affects the terminal duct lobular unit.
Proliferation of monomorphic, evenly spaced
cells, that are loosely connective - resembles
"marbles in a bag".
Can exhibit pleiomorphic characteristics,
confers higher risk of malignancy.
NB LCIS is not seen as a premalignant lesion
but does play significant role as a risk factor.
Lobular carcinoma in
situ
the breast lobule, filled with bland pink cells.
There is an intact basement membrane around
the lobular acini.
LCIS
 Paget disease
skin with surface
strands of keratin. Within the epidermis of the skin there are atypical ductal
epithelial cells,
Paget dss
 INVASIVE DUCTAL CARCINOMA
-is a term use for all carcinoma that cannot subclassified into
one specialized type
-Majority 70-80% fall into this group
-usu ass w DCIS
-produce desmoplastic response (replaced normal breast fat and
form a hard palpable mass
-histo: ranging from well developed tubule tumor consisting of
sheets of anaplastic cell. Tumor margin is irregular,invasion to
lymphovascular space
-1/3 overexpress HER2/NEU
-2/3 express estrogen/progestron receptor
Invasive ductal carcinoma
INVASIVE LOBULAR CARCINOMA

-has a much lower incidence than infiltrating ductal carcinoma,

-less than 20% of cases of invasive breast cancer.
-2/3 ass w LCIS
-characterized histologically by the Indian file arrangement of small tumor
cells.
-Staining for E-cadherin can add in distinguishing lobular carcinoma from
invasive ductal carcinoma.
-Studies have illustrated a link between cadherin (CDH1) gene and invasive
lobular breast cancers, with approximately 50 % of this subtype of breast cancer
containing E-cadherin mutations.
-has unique pattern of mets ( spread to CSF,serosal surface,ovary, uterus)
-almost all express hormon receptor
-HER2/NEU overexpression is rare
Invasive lobular carcinoma
Indian file
Colloid carcinoma
Luminal A (40-55%) eg: Tubular, lobular
and low grade IDC (GOOD
PROGNOSIS)

Luminal B (15-20%) eg: Grade 2 IDC,

micropapillary Ca

HER2/neu (7-12%) eg: High grade IDC

(POOR PROGNOSIS)

Basal-like / triple negative (13-25%) eg:

High grade IDC, medullary, metaplastic
Ca (POOR PROGNOSIS)
 Good prognosis
Less than 2 cm
Without LN involvement
Non invasice DCIS and LCIS
ER and PR positivity
Lack of aneuploidy
fibroadenoma
fibroadenoma
Philloides tumour