Page 548 - Concise Pathology for Exam Preparation ( PDFDrive )

19 The Breast 533

Pathogenesis

Tumour cells from underlying ductal carcinoma migrate up into the lactiferous duct and
invade the epidermis producing a skin lesion without invading the basement membrane.

Gross Morphology
• Skin of nipple and areola is fissured, ulcerated with or without nipple discharge.
• Inflammatory oedema and hyperaemia are seen in the surrounding tissue.
• Underlying palpable mass is present in 50–60% cases of Paget disease.

Microscopic Features
• Histological hallmark is involvement of epidermis by malignant cells (Paget cells).
• Paget cells are large with abundant clear or lightly stained cytoplasm and nuclei with
prominent nucleoli.
• Cells contain mucin and are positive for epithelial membrane antigens (EMA), c-erb-B2
and low molecular weight keratins.
Prognosis depends on the extent of underlying carcinoma.

MALE BREAST

Q. Write briefly on gynaecomastia.
Ans. Gynaecomastia is defined as enlargement of the male breast. It may be unilateral or
bilateral and has the following salient features:
• Presents mostly as a subareolar swelling.
• Causes include idiopathic, hyperestrinism (cirrhosis and functioning testicular tumours),
drugs like anabolic steroids, cimetidine, omeprazole, antipsychotics and Klinefelter
syndrome.
• Morphological features include proliferation of dense collagenous connective tissue and
marked hyperplasia of the ductal and myoepithelial cells. Lobule formation is rare.
• Proliferation of dense collagenous connective tissue.
• Marked hyperplasia of the ductal and myoepithelial cells.
• Lobule formation is rare.

Q. Write briefly on male breast cancer.

Ans. Salient features of male breast cancer
• Incidence is 1% that of females.
• Risk factors are similar to those in women; 3–8% associated with Klinefelter syndrome
and decreased testicular function.
• Usually present between sixth and seventh decades with a subareolar mass and nipple
discharge (breast epithelium in males restricted to large ducts near areola.
• Associated with BRCA2 and BRCA1 mutations.
• Eighty-one percent are ER-positive; prognostic factors and pathology are similar to
female breast cancer.

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