DISEASES OF THE
BREAST
Lecture Objectives
At the end of the lecture the student should be
able to:
1. Discuss the etiology/pathologic features of
different forms of benign non-neoplastic and
neoplastic breast disease.
2. List the benign breast diseases that increase a
patient’s risk of developing breast cancer and
classify these conditions by the degree of risk.
Lecture Objectives
At the end of the lecture the student should
be able to:
3. Outline other risk factors predisposing to breast
cancer & incidence/prevalence of breast cancer.
4. Classify breast cancer into histologic subtypes
and describe the pathologic features of each.
5. List the prognostic factors for breast cancer.
CLINICAL PRESENTATION
Palpable lump
Inflammatory mass
Nipple discharge
Non-palpable abnormality
METHODS OF DIAGNOSIS
FNAC
Incisional biopsy
Excisional biopsy
Image-guided
biopsy
Breast Disease Study
Clinical Findings
5%
15%
80%
Malignant Uncertain Benign
Major classes of breast disease
Normal breast Benign breast disease
Carcinoma in situ Invasive carcinoma
Normal breast
Lobule and duct Lobule
BENIGN BREAST
DISEASE
INFLAMMATION
Acute Mastitis
Most clinically important form of
mastitis
Breast-feeding cracks/fissures
in the nipples bacterial infection
(esp. Staph. aureus)
INFLAMMATION
Acute Mastitis
Usually unilateral—acute
inflammation in the breast can
lead to abscess formation
Treatment = surgical drainage
(often under general anesthesia)
and antibiotics
INFLAMMATION
Mammary Duct Ectasia
5th and 6th decades
Affects mainly large ducts
Periductal chronic inflammation
destruction and dilation of
the ducts with fibrosis
The underlying cause is unknown
INFLAMMATION
Mammary Duct Ectasia
Poorly defined periareolar mass; can be confused
clinically/radiologically with carcinoma
Can also present as a thick, cheesy nipple discharge +/- mass
Periductal fibrosis skin retraction
INFLAMMATION
Fat Necrosis
Uncommon lesion; may be a history
of trauma, prior surgical
intervention or radiation therapy
Characterized by a central focus of
necrotic fat cells with lipid-laden
macrophages and neutrophils
INFLAMMATION
Fat Necrosis
Chronic inflammation with lymphs and multinucleated giant
cells
Major clinical significance is its possible confusion with
carcinoma (e.g. fibrosis clinically palpable mass / Ca2+ seen
on mammography)
NON-PROLIFERATIVE
(“FIBROCYSTIC”) CHANGES
Most common breast disorder
Alterations present in most women
No associated risk of progression
or cancer
? Due to hormonal imbalances
NON-PROLIFERATIVE
(“FIBROCYSTIC”) CHANGES
Pathologic features:
Cystic change
Apocrine metaplasia
Adenosis
Fibrosis
Benign Breast disease:
Elements of fibrocystic disease
Cyst Ductal hyperplasia
Apocrine metaplasia Sclerosing adenosis
NON-PROLIFERATIVE
(“FIBROCYSTIC”) CHANGES
Usually diagnosed 20 to 40 years
Present as palpable lumps, nipple
discharge or mammographic
densities/calcifications
Often multifocal and bilateral
general “lumpiness”
PROLIFERATIVE DISEASE
WITHOUT ATYPIA
Epithelial Hyperplasia
↑ number of layers of cells lining
ducts and acini
Involved ducts and acini are
filled with overlapping,
proliferating cells
PROLIFERATIVE DISEASE
WITHOUT ATYPIA
Sclerosing Adenosis
Characterized by ↑ #acini +
stromal fibrosis within lobules
Can be assoc with calcifications
which may be detected on
mammography
ATYPICAL HYPERPLASIA
Epithelial hyperplasia characterized
atypical architectural and/or
cytologic features
Can affect ducts—atypical ductal
hyperplasia, or lobules—atypical
lobular hyperplasia
ATYPICAL HYPERPLASIA
Atypical features resemble but fall short of in-situ cancer
No diagnostic clinical or radiologic features
↑ Incidence with ↑use of screening mammography and ↑
number of breast biopsies
BENIGN TUMORS
Fibroadenoma
Most common benign tumor
Circumscribed lesion composed
of both proliferating glandular
and stromal elements
BENIGN TUMORS
Fibroadenoma
BENIGN TUMORS
Fibroadenoma
Patients usually present < 30 years
Classic presentation is that of a firm,
mobile lump (“breast mouse”)
Giant forms can occur, especially in
younger patients
BENIGN TUMOURS
Fibroadenoma
Can be associated with proliferative
changes in the adjacent breast tissue
Approx. 20% of lesions are complex
fibroadenomas —characterized by
certain specific histologic features
BENIGN TUMORS
Duct Papilloma
Benign papillary epithelial tumor;
occurs mainly in large ducts
Papillae are fibrovascular stalks lined
by layers of proliferating epithelial
and myoepithelial cells
Most patients present with a serous or
bloody nipple discharge
RELATIVE RISK FOR
INVASIVE BREAST
CANCER FOR BENIGN
BREAST LESIONS
RISK FOR INVASIVE BREAST
CANCER
No Increased Risk (NIR)
Mastitis
Fat necrosis
Mammary duct ectasia
Non-proliferative
(“fibrocystic”) disease
Fibroadenoma (simple)
RISK FOR INVASIVE BREAST
CANCER
Slightly ↑ Risk (SIR)
= ↑ Risk 1.5-2 Times
Moderate/florid hyperplasia
Sclerosing adenosis
Fibroadenoma (complex)
Duct papilloma
RISK FOR INVASIVE BREAST
CANCER
Moderately ↑Risk (MIR)
= ↑Risk 4-5 Times
Atypical ductal hyperplasia
Atypical lobular hyperplasia
CARCINOMA OF
THE BREAST
EPIDEMIOLOGY
Commonest malignancy in women worldwide:
Breast cancer 18%
Cervical cancer 15%
Colonic cancer 9%
Stomach cancer 8%
RISK FACTORS
Age
Incidence of breast cancer ↑ses
with age
Uncommon before age 25 years;
incidence ↑ses to the time of
menopause and then slows
RISK FACTORS
Family History
Approx 10% of breast cancer is due to
inherited genetic predisposition
A woman whose mother or sister has
had breast cancer is at ↑relative risk 2
to 3 times compared to other women
RISK FACTORS
Family History
At least two genes that predispose to
breast cancer have been identified—
BRCA 1 and BRCA 2
Mutations in these tumour-suppressor
genes also predispose affected women
to ovarian cancer
RISK FACTORS
Benign Breast Disease
Certain types of benign breast disease
History of Other Cancer
A history of cancer in the other breast
or a history of ovarian or endometrial
cancer
RISK FACTORS
Hormonal Factors
↑ levels of estrogen ↑risk:
Early age at menarche
Late age at menopause
Nulliparity
Late age at first child-birth
Obesity
RISK FACTORS
Environmental Factors
High fat intake
Excess alcohol consumption
Ionizing radiation
ETIOLOGY
The etiology of breast cancer in
most women is unknown
Most likely due to a combination
of risk factors i.e. genetic,
hormonal and environmental
factors
HISTOLOGIC
CLASSIFICATION
Breast Cancer
Ductal Lobular
DCIS IDC LCIS ILC
(15%) (75%) (5%) (5%)
Ductal Carcinoma In-situ
↑sed incidence with ↑sed use of
mammographic screening and
early cancer detection
50% screen-detected cancers
Can also produce palpable mass
Ductal Carcinoma In-situ
Characterized by proliferating
malignant cells within ducts that do
not breach the basement membrane
comedo (central
Different patterns e.g.
necrosis); cribiform (cells arranged
around “punched-out” spaces);
papillary and solid (cells fill spaces)
distribution of carcinoma in-situ
Ductal carcinoma Lobular carcinoma
Carcinoma in situ
Ductal carcinoma in situ. Lobular carcinoma in situ.
DCIS LCIS
Ductal Carcinoma In-situ
Different grades i.e. low, intermediate
and high grade—comedo DCIS is
classically high grade
Often multifocal—malignant
population can spread widely through
the duct system
Ductal Carcinoma In-situ
Women with DCIS are at risk of:
Recurrent DCIS following Rx
Invasive cancer (rel. risk 8 to 10
times) especially in the same
breast
Lobular Carcinoma In-situ
Relatively uncommon lesion
Malignant proliferation of small,
uniform epithelial cells within
the lobules
Also at marked ↑sed relative risk
for invasive cancer (8 to 10 times)
in either breast
Invasive Ductal Carcinoma
Commonest form of breast cancer especially in poorer
populations
↑sing incidence of screen–detected
cancer in developed countries
(usually smaller; much better
prognosis)
Invasive Ductal Carcinoma
Clinical presentation:
Hard, irregular palpable lump
Peau d’orange (lymphatic obstruction
thickening/dimpling of the skin)
Paget’s disease of the nipple
(ulceration/inflammation due to
intraductal spread to the nipple)
Invasive Ductal Carcinoma
Clinical presentation:
Tethering of the skin
Retraction of the nipple
Axillary mass (spread to regional
lymph nodes)
Distant mets (lung, brain, bone)
Invasive Ductal Carcinoma
Different histologic types exist
The most common is scirrhous
carcinoma (IDC of no special type)
This type is characterized grossly by an
irregular, hard mass
Histology shows infiltrating clusters of
malignant cells in a dense, fibrous stroma
Invasive Ductal Carcinoma
Special histologic types of IDC:
Medullary carcinoma = circumscribed
tumour; sheets of malignant cells in
dense lymphoid stroma
Tubular carcinoma = infiltrating
tubular structures on histology
Invasive Ductal Carcinoma
Special histologic types of IDC:
Mucinous/colloid carcinoma =
malignant cells in pools of mucin
Papillary carcinoma = papillary
formations like papilloma +
invasion
Invasive Lobular Carcinoma
Much less common than IDC
Can present with similar features
More likely to be bilateral and/or
multicentric (multiple lesions
within the same breast)
Invasive Lobular Carcinoma
Classic histology = small, uniform cells arranged as:
Strands/columns within a fibrous stroma (“Indian-file”)
Around uninvolved ducts ( “bull’s-eye” pattern)
Metastasize more frequently to CSF, serosal surfaces and pelvic
organs
PROGNOSIS
Stage
Staging systems inc.TNM and the
Manchester classification
Tumour size and axillary node status
are important parameters
10-year survival rate for lymph node
neg disease is 80% vs 35% for tumours
with positive nodes
PROGNOSIS
Tumour Grade
Different grading systems exist
↑tumour grade = worse prognosis
Histologic Subtypes
PROGNOSIS
Hormone Receptors
Estrogen receptors
Progesterone receptors
Molecular Markers
Inc. c-erb-B2, c-myc and p53
TREATMENT OPTIONS
Surgery
Mastectomy
Breast conservation
+/- Axillary dissection
Radiation therapy (local control)
Chemotherapy (systemic control)
Hormonal Rx (systemic control)
PHYLLODES TUMOUR
Stromal tumour arising from the
intralobular stroma
Range in size from a few cm to
massive lesions
Classically have a “leaf-like”
configuration
PHYLLODES TUMOUR
Most are low-grade lesions that can
recur locally but do not metastasize
Others are of high-grade and exhibit
aggressive clinical behaviour e.g.
spread to distant sites (cystosarcoma
phyllodes)
THE MALE BREAST
Gynecomastia
Enlargement of the male breast due to
hormonal imbalance (rel.↑estrogens):
Physiologic; seen at puberty or old age
Pathologic; associated with cirrhosis,
functional testicular tumours, certain
drugs (alcohol, marijuana and anabolic
steroids)
Gynecomastia
THE MALE BREAST
Gynecomastia
Can be unilateral/bilateral; present as
diffuse enlargement /defined mass
Most important clinically as a marker
of hyperestrinism
Neoplasia needs to be excluded in
certain cases
THE MALE BREAST
Carcinoma
Very rare occurrence; female cancer
to male cancer ratio approx 100:1
Pathology and behavior is similar to
cancers seen in women although with
less breast tissue, skin involvement is
more frequent
Histopathologic Report
The pathology report include:
The definite diagnosis
The local/regional extent of the disease
Data relevant to prognosis
Data relevant for the choice of treatment
The Pathology report, Carcinoma resection
MAIN DIAGNOSIS:
Local resection (lumpectomy) of breast with invasive ductal carcinoma
OTHER FEATURES:
TUMOR SIZE: 3 cm
LOCATION: Upper inner quadrant, right breast
TUMOR GRADE: 2
RESECTION MARGINS, MINIMUM DISTANCE TO TUMOR: 4 mm from dorsal margin, 32 mm from
ventral margin
TUMOR INVASION OF SKIN, MUSCLE, PAGET’S DISEASE OF THE NIPPLE: Absent.
VASCULAR INVASION: Present
DCIS: Present
DCIS GRADE: 3
DCIS MIN. DIST. TO RESECTION MARGIN:
1 mm to dorsal margin
NO. OF LYMPH NODES EXAMINED: 13
NO. OF LYMPH NODES WITH TUMOR: 5
HORMONE RECEPTOR STATUS:
Positive for estrogen receptor
Negative for progesteron receptor
Her-2 STATUS:
Negative (2+ by immunohistochemistry, negative by FISH)
pTNM CLASSIFICATION: pT1N2Mx
EXTRA-TUMORAL BREAST: Fibrocystic disease
MAIN DIAGNOSIS:
• Local resection (lumpectomy) of breast
with invasive ductal carcinoma
OTHER FEATURES:
• TUMOR SIZE: 3 cm
• LOCATION: Upper inner quadrant, right breast
• TUMOR GRADE: 2
• RESECTION MARGINS, MINIMUM DISTANCE TO TUMOR: 4 mm from dorsal margin, 32 mm from ventral margin
• TUMOR INVASION OF SKIN, MUSCLE, PAGET’S DISEASE OF THE NIPPLE: Absent.
• VASCULAR INVASION: Present
• DCIS: Present
DCIS GRADE: 3
DCIS MIN. DIST. TO RESECTION MARGIN:
1 mm to dorsal margin
• NO. OF LYMPH NODES EXAMINED: 13
• NO. OF LYMPH NODES WITH TUMOR: 5
• HORMONE RECEPTOR STATUS:
Positive for estrogen receptor
Negative for progesteron receptor
• Her-2 STATUS:
Negative (2+ by immunohistochemistry, negative by FISH)
• pTNM CLASSIFICATION: pT1N2Mx
• EXTRA-TUMORAL BREAST: Fibrocystic disease
Types of Invasive Carcinoma
Ductal Ductal Lobular
Tubular Mucinous Medullary
Inflammatory carcinoma
• The diagnosis is based on clinical features:
Diffuse erythema, peau d’orange, tenderness,
induration, warmth, enlargement
• And carcinoma confirmed by biopsy:
In most cases an invasive ductal carcinoma
grade 3 with tumor in dermal lymphatics
MAIN DIAGNOSIS:
• Local resection (lumpectomy) of breast with invasive ductal carcinoma
OTHER FEATURES:
• TUMOR SIZE: 3 cm
• LOCATION: Upper inner quadrant, right breast
• TUMOR GRADE (1-3): 2
• RESECTION MARGINS, MINIMUM DISTANCE TO TUMOR: 4 mm from dorsal margin, 32 mm from
ventral margin
• TUMOR INVASION OF SKIN, MUSCLE, PAGET’S DISEASE OF THE NIPPLE: Absent.
• VASCULAR INVASION: Present
• DCIS: Present
DCIS GRADE: 3
DCIS MIN. DIST. TO RESECTION MARGIN:
1 mm to dorsal margin
• NO. OF LYMPH NODES EXAMINED: 13
• NO. OF LYMPH NODES WITH TUMOR: 5
• HORMONE RECEPTOR STATUS:
Positive for estrogen receptor
Negative for progesteron receptor
• Her-2 STATUS:
Negative (2+ by immunohistochemistry, negative by FISH)
• pTNM CLASSIFICATION: pT1N2Mx
• EXTRA-TUMORAL BREAST: Fibrocystic disease
Tumor Grading
Feature Score
Tubule formation 1-3
Nuclear atypia 1-3
Number of mitoses 1-3
Grade Sum of scores
Grade 1 3-5
Grade 2 6-7
Grade 3 8-9
Tumor Grades
Grade 1 Grade 3
MAIN DIAGNOSIS:
• Local resection (lumpectomy) of breast with invasive ductal carcinoma
OTHER FEATURES:
• TUMOR SIZE: 3 cm
• LOCATION: Upper inner quadrant, right breast
• TUMOR GRADE: 2
• RESECTION MARGINS, MINIMUM DISTANCE
TO TUMOR: 4 mm from dorsal margin, 32
mm from ventral margin
• TUMOR INVASION OF SKIN, MUSCLE, PAGET’S DISEASE OF THE NIPPLE: Absent.
• VASCULAR INVASION: Present
• DCIS: Present
DCIS GRADE: 3
DCIS MIN. DIST. TO RESECTION MARGIN:
1 mm to dorsal margin
• NO. OF LYMPH NODES EXAMINED: 13
• NO. OF LYMPH NODES WITH TUMOR: 5
• HORMONE RECEPTOR STATUS:
Positive for estrogen receptor
Negative for progesteron receptor
• Her-2 STATUS:
Negative (2+ by immunohistochemistry, negative by FISH)
• pTNM CLASSIFICATION: pT1N2Mx
• EXTRA-TUMORAL BREAST: Fibrocystic disease
Orientation of the Specimen
Inking of resection margins
inked surface as seen in the microscopic slide
Examination of resection margin
Skin
Section 1 Inked
Section 2 margin
MAIN DIAGNOSIS:
• Local resection (lumpectomy) of breast with invasive ductal carcinoma
OTHER FEATURES:
• TUMOR SIZE: 3 cm
• LOCATION: Upper inner quadrant, right breast
• TUMOR GRADE: 2
• RESECTION MARGINS, MINIMUM DISTANCE TO TUMOR: 4 mm from dorsal margin, 32 mm from
ventral margin
• TUMOR INVASION OF SKIN, MUSCLE, PAGET’S DISEASE OF THE NIPPLE: Absent.
• VASCULAR INVASION: Present
• DCIS: Present
DCIS GRADE: 3
DCIS MIN. DIST. TO RESECTION MARGIN:
1 mm to dorsal margin
• NO. OF LYMPH NODES EXAMINED: 13
• NO. OF LYMPH NODES WITH TUMOR: 5
• HORMONE RECEPTOR STATUS:
Positive for estrogen receptor
Negative for progesteron receptor
• Her-2 STATUS:
Negative (2+ by immunohistochemistry, negative by FISH)
• pTNM CLASSIFICATION: pT1N2Mx
• EXTRA-TUMORAL BREAST: Fibrocystic disease
Vascular Invasion
Tumor tissue
Lymph vessel
MAIN DIAGNOSIS:
• Local resection (lumpectomy) of breast with invasive ductal carcinoma
OTHER FEATURES:
• TUMOR SIZE: 3 cm
• LOCATION: Upper inner quadrant, right breast
• TUMOR GRADE: 2
• RESECTION MARGINS, MINIMUM DISTANCE TO TUMOR: 4 mm from dorsal margin, 32 mm from ventral margin
• TUMOR INVASION OF SKIN, MUSCLE, PAGET’S DISEASE OF THE NIPPLE: Absent.
• VASCULAR INVASION: Present
• DCIS: Present
DCIS GRADE (1-3): 3
DCIS MINIMUM DISTANCE TO
RESECTION MARGIN:
1 mm to dorsal margin
• NO. OF LYMPH NODES EXAMINED: 13
• NO. OF LYMPH NODES WITH TUMOR: 5
• HORMONE RECEPTOR STATUS:
Positive for estrogen receptor
Negative for progesteron receptor
• Her-2 STATUS:
Negative (2+ by immunohistochemistry, negative by FISH)
• pTNM CLASSIFICATION: pT1N2Mx
• EXTRA-TUMORAL BREAST: Fibrocystic disease
MAIN DIAGNOSIS:
• Local resection (lumpectomy) of breast with invasive ductal carcinoma
OTHER FEATURES:
• TUMOR SIZE: 3 cm
• LOCATION: Upper inner quadrant, right breast
• TUMOR GRADE: 2
• RESECTION MARGINS, MINIMUM DISTANCE TO TUMOR: 4 mm from dorsal margin, 32 mm from ventral
margin
• TUMOR INVASION OF SKIN, MUSCLE, PAGET’S DISEASE OF THE NIPPLE: Absent.
• VASCULAR INVASION: Present
• DCIS: Present
DCIS GRADE: 3
DCIS MIN. DIST. TO RESECTION MARGIN:
1 mm to dorsal margin
• NO. OF LYMPH NODES EXAMINED: 13
• NO. OF LYMPH NODES WITH TUMOR: 5
• HORMONE RECEPTOR STATUS:
Positive for estrogen receptor
Negative for progesteron receptor
• Her-2 STATUS:
Negative (2+ by immunohistochemistry, negative by FISH)
• pTNM CLASSIFICATION: pT1N2Mx
• EXTRA-TUMORAL BREAST: Fibrocystic disease
Axillary Lymph Nodes
Breast cancer
spreads through
lymphatic channels
to axillary lymph
nodes.
When axillary
content is
removed, all nodes
are searched and
embedded for
microscopy
Micrometastasis
Micrometastasis spotted in otherwise negative
sentinel node
Tumor deposits in lymph node
Size Designated pTNM
class
> 2 mm Metastasis pN1
≤ 2 mm; > 0.2 Micrometastasis pN1(mi)
mm
≤ 0.2 mm Isolated tumor pN0 (i+)
cells
MAIN DIAGNOSIS:
• Local resection (lumpectomy) of breast with invasive ductal carcinoma
OTHER FEATURES:
• TUMOR SIZE: 3 cm
• LOCATION: Upper inner quadrant, right breast
• TUMOR GRADE: 2
• RESECTION MARGINS, MINIMUM DISTANCE TO TUMOR: 4 mm from dorsal margin, 32 mm from ventral
margin
• TUMOR INVASION OF SKIN, MUSCLE, PAGET’S DISEASE OF THE NIPPLE: Absent.
• VASCULAR INVASION: Present
• DCIS: Present
DCIS GRADE: 3
DCIS MIN. DIST. TO RESECTION MARGIN:
1 mm to dorsal margin
• NO. OF LYMPH NODES EXAMINED: 13
• NO. OF LYMPH NODES WITH TUMOR: 5
• HORMONE RECEPTOR STATUS:
Positive for estrogen receptor
Negative for progesteron receptor
• Her-2 STATUS:
Negative (2+ by immunohistochemistry, negative by FISH)
• pTNM CLASSIFICATION: pT1N2Mx
• EXTRA-TUMORAL BREAST: Fibrocystic disease
Immunohistochemistry:
Estrogen receptor
Negative: No benefit from Positive: Will benefit from
hormone therapy hormone therapy
MAIN DIAGNOSIS:
• Local resection (lumpectomy) of breast with invasive ductal carcinoma
OTHER FEATURES:
• TUMOR SIZE: 3 cm
• LOCATION: Upper inner quadrant, right breast
• TUMOR GRADE: 2
• RESECTION MARGINS, MINIMUM DISTANCE TO TUMOR: 4 mm from dorsal margin, 32 mm from ventral
margin
• TUMOR INVASION OF SKIN, MUSCLE, PAGET’S DISEASE OF THE NIPPLE: Absent.
• VASCULAR INVASION: Present
• DCIS: Present
DCIS GRADE: 3
DCIS MIN. DIST. TO RESECTION MARGIN:
1 mm to dorsal margin
• NO. OF LYMPH NODES EXAMINED: 13
• NO. OF LYMPH NODES WITH TUMOR: 5
• HORMONE RECEPTOR STATUS:
Positive for estrogen receptor
Negative for progesteron receptor
• Her-2 STATUS: Negative
• pTNM CLASSIFICATION: pT1N2Mx
• EXTRA-TUMORAL BREAST: Fibrocystic disease
Immunohistochemistry
Her-2
Her-2 positive. Will benefit from Herceptin therapy
MAIN DIAGNOSIS:
• Local resection (lumpectomy) of breast with invasive ductal carcinoma
OTHER FEATURES:
• TUMOR SIZE: 3 cm
• LOCATION: Upper inner quadrant, right breast
• TUMOR GRADE: 2
• RESECTION MARGINS, MINIMUM DISTANCE TO TUMOR: 4 mm from dorsal margin, 32 mm from ventral
margin
• TUMOR INVASION OF SKIN, MUSCLE, PAGET’S DISEASE OF THE NIPPLE: Absent.
• VASCULAR INVASION: Present
• DCIS: Present
DCIS GRADE: 3
DCIS MIN. DIST. TO RESECTION MARGIN:
1 mm to dorsal margin
• NO. OF LYMPH NODES EXAMINED: 13
• NO. OF LYMPH NODES WITH TUMOR: 5
• HORMONE RECEPTOR STATUS:
Positive for estrogen receptor
Negative for progesteron receptor
• Her-2 STATUS:
Negative (2+ by immunohistochemistry, negative by FISH)
• pTNM CLASSIFICATION: pT1N2Mx
• EXTRA-TUMORAL BREAST: Fibrocystic disease
MAIN DIAGNOSIS:
• Local resection (lumpectomy) of breast with invasive ductal carcinoma
OTHER FEATURES:
• TUMOR SIZE: 3 cm
• LOCATION: Upper inner quadrant, right breast
• TUMOR GRADE: 2
• RESECTION MARGINS, MINIMUM DISTANCE TO TUMOR: 4 mm from dorsal margin, 32 mm from
ventral margin
• TUMOR INVASION OF SKIN, MUSCLE, PAGET’S DISEASE OF THE NIPPLE: Absent.
• VASCULAR INVASION: Present
• DCIS: Present
DCIS GRADE: 3
DCIS MIN. DIST. TO RESECTION MARGIN:
1 mm to dorsal margin
• NO. OF LYMPH NODES EXAMINED: 13
• NO. OF LYMPH NODES WITH TUMOR: 5
• HORMONE RECEPTOR STATUS:
Positive for estrogen receptor
Negative for progesteron receptor
• Her-2 STATUS:
Negative (2+ by immunohistochemistry, negative by FISH)
• pTNM CLASSIFICATION: pT1N2Mx
• EXTRA-TUMORAL BREAST: Fibrocystic disease
