1. British/ Arab School of Pathology, June 2008 Slide Seminars

2. 44A F51, Lt breast biopsy

3. Diagnosis: Intraduct papilloma with adjacent DCIS

4. 49 F40, Nipple discharge Diagnosis: Intraduct papilloma with in situ malignant change

5. 143 F46, Rt breast lump Diagnosis: Solid papillary carcinoma+ Invasive Ductal carcinoma

6. Solid papillary carcinoma/ Immunohistochemistry Cytokeratin 5/6 CD10 SM Actin

7. Case No. 152 F 64y, Left Breast, Cystic Lump

10. K5/6 SMA Diagnosis: Intracystic papillary Carcinoma

11. Case 184

12. Case 184 (CK 5/6)

13. Case 184 SMAER Diagnosis: Intraduct papilloma With usual type hyperplasia

14. Case 185

15. Case 185 (CK 5/6)

16. Case 185 SMA p63 Diagnosis: Benign intraduct papillomas

17. Core biopsy 54

18. SMA CK5/6 Diagnosis: Intracystic Papillary Carcinoma (B5)

20. 136 FF67, Rt breast lump, 20mm Diagnosis: Myoid hamartoma SMA

21. 33 (for 139) F85, Lt breast, Asymmetry M3, US 8mm solid/cystic lesion Diagnosis: Atypical Apocrine Adenosis (B4)

22. Case No. 144 F 71y, Lt breast Lump, 3cm

23. Diagnosis: Malignant phyllodes tumour

24. 145. F58, Lt breast lump Tubular adenoma rich in myoepithelial cells

25. 150. F53, Rt breast lump, Stopped breast feeding 1 year ago Extensive sclerosing adenosis (Adenosis tumour)

26. Case No. 153 F 58y, Rt breast Lump, Screen-detected lesion

28. Diagnosis: Adenomyoepithelioma

29. Adenomyoepithelioma/ Myoepithelial markers p63

30. Adenomyoepithelioma/ Myoepithelial markers CD10 SMA

31. 165 F 40y, Right Breast Lump Ductal or Lobular?

32. 165 F 40y, Right Breast Lump

33. E-Cadherin

35. ER In situ Invasive

36. HER2

37. 165 F 40y, Right Breast Lump

38. E-Cadherin HER2

39. Case No. 165 F 40y, Right Breast Lump Diagnosis: Pleomorphic in situ & Invasive Lobular Carcinoma+ DCIS

40. 187. F53, Rt breast lump Benign complex sclerosing lesion

42. Core 41 F44y, Lt breast microcalcification, ?fibrocystic. M3, U3

43. 41

44. Microcalcification

45. 41 Cysts lined by cuboidal epithelium and containing mucin

46. 41. AB/ PAS Diagnosis: Mucocele-like lesion (B3)

47. Mucocele-like lesions First described by Rosen as mucin-filled cysts lined by flat, cuboidal or columnar epithelium with extrusion of mucin into surrounding stroma (1) The epithelial lining may show a cribriform or micropapillary atypical proliferative pattern, or even frank in situ malignant change. Detached epithelial cells may be sometimes found within intracystic or extracystic mucin (2) Most cases present with mammographic coarse calcification. If presenting as mass lesion, malignancy is a high possibility (1)Rosen PP. Am J Surg Pathol 1986; 10: 464-469 (2)Hoda SA & Rosen PP. Breast J. 2004; 10: 522-527

48. Excision biopsies of mucocele-like lesions diagnosed on cores P J Carder et al (2004)*  10 cases: Excision: 3 (30%) malignant (2DCIS+ 1 mucinous carcinoma) 3 had ADH 4 benign R Ramsaroop et al (2005)**  12 cases: Excision: 5 (41%) malignant 1 ADH 6 benign J Wang et al (2007)***  11 cases: Excision: all proved to be benign * Histopathology 45:148-154 **Breast J 11:321-325 ***Am J Clin Pathol 127; 124-127

49. Mucocele-like lesions: B2 or B3? At the moment: Surgical excision seems to be warranted, hence B3 may be more appropriate

50. Mucocele-like lesions: Relationship to invasive mucinous carcinoma It has been suggested that there is a spectrum of changes representing a pathway progressing through:  mucin-filled ducts  to mucinous ADH,  mucinous DCIS  and ultimately invasive mucinous carcinoma (1,2) This is supported by recent evidence concerning staining for WT-1 (1) Hamele-Bena D et al. Am J Surg Pathol 1996; 20: 1081-1085 (2) Fisher CJ et al. Histopathology 1992; 21:69-71

51. Mucinous Carcinoma: WT1 positive

52. 41. Mucocele- like lesion: WT1 positive Supporting a link between mucinous carcinoma and mucocele-like lesions

53. Core biopsy 50

54. ER Diagnosis: Adenoid cystic carcinoma

55. Differential diagnosis 1. Cribriform DCIS ER: Uniformly positiveCells: monomorphic

56. 2. Collagenous Spherulosis

57. Differential diagnosis: Using ER & CD10 Cribriform DCIS Adenoid cystic carcinoma Collagenous spherulosis ER CD10

59. 147 F73, Rt breast lump

60. ER – PgR – HER2 – Triple Negative (Basal Cell Type) Breast Carcinoma ER PgR HER2

61. CK5/6 CK14

62. SMA

63. EGFR EGFR Kinase Inhibitors: Lapatinib Gefitinib

64. 176 F73, Rt breast lump

66. AE1/AE3 CK5/6 SMA p63ER Diagnosis: Metaplastic carcinoma + DCIS

67. Case No. 157 M 58y, Lt breast Lump

68. CD20 CD3

70. M 58, Lt breast Lump

71. AE1/AE3

72. CK5/6

73. SMA CD68 CD10

74. Diagnosis: Diabetic mastopathy

75. Diabetic Mastopathy  Fibrotic breast lumps  presenting in patients with long standing diabetes, more than 10 years, particularly the insulin- dependent variety.  Patients are relatively young (average 42 years), but a range of 32-66 years  Other diabetic complications are usually present.  It has also been described, less commonly, in patients with:  type 2 diabetes  patients with auto-immune thyroid and connective tissue diseases.

76. Diabetic Mastopathy/ Histopathology  Lesions vary in size between 2-6 cm  can be single or multiple  and are bilateral in 50% of cases.  Histology:  Dense keloid-like fibrosis  heavy lobular and peri-vascular lymphocytic infiltration.  ‘Epithelioid fibroblasts’, sometimes multinucleated, are present in the stroma.  Cysts are characteristically absent.

77. Diabetic Mastopathy  The disease is self-limiting, but can recur.  Reported recurrence rates varies between 32-80% of patients  Hence follow up is recommended, and any new lumps developing examined by FNA or a core biopsy  The disease is not associated with an increased risk of breast carcinoma or lymphoma, although sporadic cases of breast carcinoma developing in association with diabetic mastopathy have been described

78. 164. F72, ‘Eczema’, Rt nipple Glandular Paget’s disease

79. 182: M 95y, ‘Contents of a breast cyst’

80. CX3: M 95y, ‘Contents of a breast cyst’ Diagnosis: Mucinous Carcinoma, ?breast ?skin ?Colon AB/PAS

81. M 95y, ‘Contents of a breast cyst’ CK7 CK20 ER PgR

82. M 95y, ‘Contents of a breast cyst’/ HER2/ IH IHC ++

83. M 95y, ‘Contents of a breast cyst’/ p63 P63 negativity is in favour of ‘non-skin’ origin D.Evans et al. J Cutan Pathol 2007, 34; 474-480

84. M 95y, ‘Contents of a breast cyst’ Final Diagnosis: Mucinous Carcinoma of breast, ER+, PgR+, HER2-

85. 188. F 43, Rt breast lump

86. ER S100 SMA CD10 Microglandular adenosis

88. ER S100 Diagnosis: Microglandular adenosis and matrix producing invasive carcinoma

89. Case No. 135 F 61y, Lt breast haemorrhagic tumour, 11cm. Had Lt Breast Carcinoma, 5y ago xxxxxxx_

90. Case No. 135 F 61y, Lt breast haemorrhagic tumour, 11cm.

94. Ae1/AE3

95. Case No. 135 F 61y, Lt breast haemorrhagic tumour, 11cm. CD31 Factor VIII Diagnosis: Angiosarcoma

96. Thank you