Page 539 - Concise Pathology for Exam Preparation ( PDFDrive )

524 SECTION II Diseases of Organ Systems

thelium leading to obliteration of the lumina of the glands so that they appear as solid
cords of cells, closely mimicking an invasive carcinoma). Identification of the myo-
epithelial cells is an important clue to indicate the benign nature of the lesion.
(c) Complex sclerosing lesion: Complex sclerosing lesion may be a part of sclerosing
adenosis, papillomatosis or radial sclerosing lesion (radial sclerosing lesion closely
mimics invasive carcinoma, radiologically and pathologically; and is composed of a
central nidus of glands entrapped in a hyalinized stroma).
(d) Papillomas: Grow within ducts and are composed of fibrovascular cores lined by
luminal and myoepithelial cells; may be large duct papillomas (solitary and located in
lactiferous sinuses) or small duct papillomas (multiple and located in the deeper
ducts). Usually present with nipple discharge.

Proliferative Breast Disease With Atypia
(a) In some cases, the cells lining ducts show monomorphic hyperplasia and form a
regularly spaced pattern (atypical ductal hyperplasia).
(b) Atypical lobular hyperplasia is a term used to describe a hyperplasia that resembles
lobular carcinoma in situ, but in which the cells do not fill or distend more than 50%
of the acini within a lobule. Atypical lobular hyperplasia is associated with increased
risk of invasive carcinoma.

Relationship Between Benign Epithelial Breast Lesions and
Invasive Carcinoma

• Nonproliferative breast disease includes fibrosis, cystic change, apocrine metaplasia,
mild hyperplasia, duct ectasia, adenosis and fibroadenoma; associated with minimal or
no increased risk.
• Slightly increased risk (1.5–2 times) is noted with moderate or florid hyperplasia with-
out atypia, papillomatosis, sclerosing adenosis, radial sclerosing lesion and fibroadenoma
with complex features.
• Significantly increased risk (4–5 times) is noted with atypical hyperplasia (ductular
or lobular).
• A family history of breast cancer may increase the risk in all categories, eg, atypical hyper-
plasia (ductular or lobular), associated with a family history may increase the risk ten-fold.

Q. Write briefly on stromal tumours of breast.

Ans. There are two main stromal tumours of breast—fibroadenoma and phyllodes
tumour, both of which arise from the intralobular stroma.

Fibroadenoma Breast (FA)
Salient Features
• It is the commonest benign neoplasm of the female breast, thought to arise as a result
of an absolute or relative increase in oestrogen activity.
• A biphasic tumour of stromal origin, it has both the stromal (neoplastic) and epithelial
(nonneoplastic) components.
• FA occurs within the reproductive age group with a peak incidence in the third decade,
when it presents as a palpable, well-defined, freely mobile mass, which bulges above the
breast surface.
• FA is known to regress and calcify after menopause; it sometimes shows features overlapping
with fibrocystic disease, when it is labelled fibroadenomatoid change.
• FAs almost never become malignant.
Gross Morphology

• Discrete spherical nodule 1–10 cm in diameter (more than 10 cm, labelled as giant
fibroadenoma).
• Freely mobile, sharply circumscribed and easily enucleated.

mebooksfree.com