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Invasive Carcinoma I - Breast

 
INVASIVE BREAST CARCINOMA - PATHOLOGY
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.

Infiltrating Ductal Carcinoma
Not otherwise specified type (75%)
Special variants (20%)
  tubular
  mucinous
  papillary
  medullary
  metaplastic carcinomas
  metaplastic carcinomas
  inflammatory
  others
Infiltrating Lobular Carcinoma (5%)
  Classic
  Signet-ring
  Solid
  Pleomorphic

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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