Presentation is loading. Please wait.

Presentation is loading. Please wait.

Tumors of the breast Course and slide seminar Zdeněk K I N K O R Bioptická laboratoř s.r.o. PLZEŇ 2006.

Similar presentations


Presentation on theme: "Tumors of the breast Course and slide seminar Zdeněk K I N K O R Bioptická laboratoř s.r.o. PLZEŇ 2006."— Presentation transcript:

1 Tumors of the breast Course and slide seminar Zdeněk K I N K O R Bioptická laboratoř s.r.o. PLZEŇ 2006

2 Intraductal papillary lesions of the breast

3 actin

4 3D studies papilloma papilom papillocarcinoma

5 Intraductal papillary lesions  Intraductal papilloma  Atypical papilloma / DCIS arising in papilloma ?  Intraductal papillary carcinoma micropapillary DCIS - is not papillary per se micropapillary IDC - is not papillary per se radiology / macroscopy is not helpfull in discrimination of benign from malignant lesion ________________________________

6 Intraductal papilloma 1. Central (solitary) - large ducts 2. Peripheral (multiple papillomatosis) - TDLU ____________________________________  benign, complete myoepitelial rim - globoid cells !  necrosis, apocrine / squamous metaplasia, hyperplasia, sclerosis, pseudoinvasion!  peripheral - more often associated with ADH resp. DCIS (sampling?)  CNB - controversial - excision vs. watch and wait ?  variants - adenomyoepithelioma, mixed tumor, ductal adenoma nipple adenoma

7 Intraductal papillary carcinoma 1. Central (intracystic, solitary) 2. Diffuse (multiple) - papillary DCIS __________________________________________  0,5 - 2 % of all breast carcinomas, in situ lesion !  myoepithelial layer absent; papillary, cribriform, solid  pseudoinvasion, „epithelial displacement“ by CNB  CNB - excision ! - adjacent DCIS / IDC ≤ 50 % - margin !  excellent prognosis - axillary/sentinel LN is not necessary  invasive component - usually nonpapillary G1 IDC

8 Atypical papilloma (ADH / DCIS in papilloma)  controversial - rare, definition, interpretation (CK 5/6)  more often in peripheral papilloma, CNB - excision !  structural a cytologic atypia - kvantitative criteria ? - confined to papilloma - atypical papilloma (AP) - adjacent ducts - analogous to ADH vs. DCIS  AP is not ! - problem papiloma vs. papillary carcinoma - florid ductal hyperplasia in papilloma  recurrences (DCIS, IDC) were found only in cases, where „atypia“ extended into surrounding ducts outside of original AP

9 benign malignant (in situ !) atypical papiloma papiloma carcinoma (DCIS) in papilloma papillary carcinoma

10 Take home message  central, solitary lesions are more indolent than peripheral and multiple  papilloma in CNB - excision required any time ?! - radiology  AP is rare; papillary carcinoma arises de novo  intraductal (intracystic) papillary carcinoma - in situ lesion does not metastasize !  prognosis (biology?) of papillary lesion is determined mainly by findings in surrounding ducts  conservative approach (even at invasion) - margin ! (SLN?)

11

12

13 …let´s move to the scope

14 Breast on Earth Let´s have a rest

15 …even cancer cells are miracle of the nature…

16 Low-grade adenosquamous carcinoma actin Cam 5.2

17 Low-grade adenosquamous carcinoma  Rosen - 11 cases (AJSP, 1987); 50 cases in total  recurrent, rarely metastasizing lesions - two cases described  bland-looking → mimic benignancy - RSL, nipple syringoma, FT,..  biphasic lesion - both components are tumorous ! 1) epithelial - oval/curved glandular structures display variable luminal squamous differentiation (distinct imunophenotype) - one/two flat layers of cells lacking overt atypia - absent myoepithelial rim? 2) mesenchymal - mostly hypocellular, collagenous fibrous stroma - heterologous differentiation - extremely rare

18 LGASC - differential diagnosis  radial scar - CD34+ desmoplastic stroma with central elastosis - complex ductal epithelial proliferation, calcification - intact myoepithelial layer - origin of LGASK in radial scar ? (Gobbi et al.)  phylloid tumor - benign epithelial component, myoepithelial rim - CD34/CD10/CD117+ stromal projection in cystic epithelial spaces, squamous diff. rare - structural heterogeneous; „stromal overgrowth“  nipple syringoma / microcystic adnexal carcinoma - benign and malignant adnexal skin lesions, not related to glandular breast tissue, different nonneoplastic stroma

19

20 The natural beauty of the Silicon valley ( have you ever been there ?! )

21 Wherever I go the „breast topic“ attracts me…

22 Wherever I go the „breast topic“ attacs me…

23 female, 81-year-old

24 Benign spindle cell stromal tumors of the breast desmin

25 Benign spindle cell stromal tumors of the breast  heterogeneous group of lesions with functional variability and combination of morpho- and immunophenotype 1) spindle/oval cells, storiform or hemangiopericytoma- like pattern, lipo-, chondro-, osteometaplasia, „floret-like“ cells., nc. palisading, myxoid change, collagen ropes,… 2) CD34, bcl2, CD99, actin, desmin, ER, PR, AR  common precursor - vim+/CD34+ stromal cell  hybrid a NOS features - genetics? (spindle cell lipoma,..)

26 plasticity of morfofology a immunofenotype (CD34, bcl2, CD99, actin,desmin, ER, PR, AR) vim+/CD34+ stromal cell fibroblastic myofibroblastic fibrohistiocytic mixed Benign spindle cell stromal tumors of the breast myofibroblastoma leiomyoma spindle cell lipoma-like tumor solitáry fibrous tumor fibrous histiocytoma spindle cell tumor NOS combinations of…

27 BSST - differential diagnosis B enign  fibromatosis  nodular fasciitis  schwannoma, neurofibroma perineurioma  inflammatory pseudotumor Malignant  metaplastic carcinoma  malignant myoepithelioma ?  MPNST  synovial sarcoma  myofibroblastic sarcoma  leiomyosarcoma

28

29 Future or the past, the breast will never stop to interest the mankind

30 30-year-old female

31

32

33 Angiomatosis of the breast Actin S

34 AVL ? Hemangioma of the breast

35 Low-grade angiosarcoma of the breast

36 High-grade angiosarcoma of the breast

37  perilobular hemangioma - microscopic lesion ( mm sized ) - the only one that invades in TDLU !  hemangioma - capillary, cavernous, complex,..  angiomatosis  subcutaneous nonparenchymal hemangioma Benign vascular lesions of the breast

38  well circumscribed, < 2cm, ouside the TDLU but ! - angiomatosis - widely dissects throughout the stroma  structural homogeneous, feeding vessel at the periphery, noncommunicating labyrinth of vascular channels - not absolutely valid  papillary endothelial hyperplasia - confusion with AS ! ( reactive, superficial, circumscribed, intravascular - trombus )  CNB - distinction of low-grade AS mostly impossible

39 Malignant vascular lesions of the breast  unlimited, > 3 cm, intralobular extension  diffuse growth, structuraly heterogeneous - low-grade periphery often mimics benign lesion ( cave CNB ! )  complex anastomosing vasoformative labyrinth permeating the stroma  nuclear atypia, hyperchromasia, endothelial piling, papillary projections - at least in the center  grade does not realiably predict prognosis

40 Angiosarcoma of the breast  parenchymal - rare, low-grade lesions prevail  postradiation - high-grade, generally cutaneous - AVL - low-grade precursor ? - better outcome ??  in axillary dissection lymphedema (Stewart-Treves syndrom)  heterologous component - phylloid tumor - metaplastic carcinoma

41 AVL - atypical vascular lesion of the breast ?  controversial, extremely rare lesion (Rosen)  small solitary or multiple red maculopapules arising in radiated skin - shorter half-time, < 3 years  tiny dermal gaping vascular proliferation, hyperchromasia, hobnail cc., inflammatory background; absent: atypia, mitoses, necrosis, endothelial piling,..  association (progression) with AS - no mets so far - part of morphologic spectrum of AS (Brenn et al.) - foci of angiosarcoma undiscernible from AVL ??

42

43

44

45 The End


Download ppt "Tumors of the breast Course and slide seminar Zdeněk K I N K O R Bioptická laboratoř s.r.o. PLZEŇ 2006."

Similar presentations


Ads by Google