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Invasive Carcinoma I - Breast
|INVASIVE BREAST CARCINOMA - PATHOLOGY|
Infiltrating (invasive) breast carcinoma differs from intraductal carcinoma (ductal carcinoma in situ) by the presence of stromal invasion, through which tumor cells spread not only locally but also regionally and distantly via vascular lymphatic space.
Invasive carcinoma are divided into two major types: ductal and lobular. The majority (75%) of infiltrating ductal carcinomas fall into the not otherwise specified category. The remaining 20% are special variants, which have distinct morphology and prognosis. The remaining 5% are infiltrating lobular carcinomas, including classic type and variants.
|Infiltrating Ductal Carcinoma|
|Not otherwise specified type (75%)|
|Special variants (20%)|
|Infiltrating Lobular Carcinoma (5%)|
II. GROSS PATHOLOGY
A. Tumor Size
Tumor size is closely related to lymph node metastasis and prognosis (Palmer et al; Rosen et al, 1989).
TUMOR SIZE LYMPH NODE METASTASIS Tumors 1 cm or less 14-26% Tumors 1.1 to 2.0 cm 33% Tumors 10 cm or greater 78%
|TUMOR SIZE IN T1 TUMORS||20-YEAR RECURRENCE FREE SURVIVAL|
|Tumor 1 cm or less||86 %|
|Tumor 1.1 to 2.0 cm||69%|
B. Tumor Borders
About one third of infiltrating carcinomas have pushing, smooth borders, and, when small, they may be misconstrued as benign lesions (Slides 1 and 2). The remaining two-thirds have infiltrative, poorly circumscribed, irregular borders (Slide 3). Tumor cells extend into the adjacent breast and fibroadipose tissue in a radiating pattern creating stellate, white streaks seen on gross examination and mammographic images (Slide 4).
C. Tumor Characters
Most tumors have gray-white to tan color and firm consistency. The latter results from fibroblastic proliferation (desmoplastic reaction), elastosis, and hyalinization of the stroma. Involvement of fascial tissue by fibrous reaction causes skin retraction.
D. Tumor Necrosis and Hemorrhage
These are common in large tumors (Slide 5).
E. Skin Retraction, Ulcer and Infiltration by Tumor
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