Patient Education |  Physician Guidelines |  Treatment Index News |  TransMed |  E-Mail |  Disclaimer Invasive Carcinoma I - Breast

Dr. Yao-Shi Fu

Department of Pathology

Providence Saint Joseph Medical Center

Burbank, California

I. INTRODUCTION

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.

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%

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).

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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.

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D. Tumor Necrosis and Hemorrhage

These are common in large tumors (Slide 5).

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E. Skin Retraction, Ulcer and Infiltration by Tumor

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