Breast Pathology in Clinical Practice

Contents
1: Introduction
	References
2: Core Biopsy
	The Patient
	The Lesion
	The Doctor
	The Needle
	Type of Biopsies
	The Sample
	The Request Form
	The Laboratory
	The Pathologist
	The Multi-disciplinary Team Meeting (MDT)
	References
3: Reporting Core Biopsies: Benign (B2) Lesions
	Introduction: Is the Lesion Benign or Malignant?
	Benign Lesions That Do Not Usually Need Further Intervention (B2 Lesions)
		Fibroadenoma
			Special Types of Fibroadenomas
		Hamartoma
		Fibrocystic Change
			Ductal Hyperplasia
			Differentiating Regular Hyperplasia (B2) from Atypical Hyperplasia (B3) and Low Grade DCIS (B5a)
		Columnar Cell Change and Columnar Cell Hyperplasia
		Sclerosing Adenosis and Apocrine Adenosis
		Duct Ectasia
		Granulomatous Mastitis
		Other Inflammatory Conditions
		Other Less Common Benign Conditions
	References
4: Reporting Core Biopsies: Benign Lesions That Usually Need Further Intervention (B3 Lesions)
	Introduction
	Atypical Epithelial Hyperplasia (ADH)
	Flat Epithelial Atypia (FEA)
	In Situ Lobular Neoplasia
	Radial Scar/Complex Sclerosing Lesions
	Intraduct Papillomas
	Cellular Fibro-Epithelial Lesions
	Spindle Cell Lesions
	Mucocele Like Lesions
	Microglandular Adenosis
	Benign and Atypical Vascular Lesions
	Granular Cell Tumour
	Collagenous Spherulosis
	Epithelial Myoepithelial Benign Lesions
	General Remark: Risk of Malignancy in Benign Breast Lesions Discovered During Mammography
	References
5: Reporting Core Biopsies: Lesions That Are Highly Suspicious of Malignancy (B4) or Definitely Malignant (B5)
	B4 Lesions
	B5 Lesions
	B5a (Non-invasive Lesions)
		In Situ Carcinoma
			Ductal Carcinoma In Situ (DCIS)
				Incidence of Metastasis and Death After Diagnosing DCIS
			Lobular Carcinoma In Situ (LCIS)
			Paget’s Disease of the Nipple
		Intracystic and Solid Papillary Carcinomas
	Invasive Lesions (B5b)
		Primary Invasive Breast Carcinoma
			Morphological Types
				Invasive Ductal Carcinoma
				Pleomorphic Invasive Ductal Carcinoma
				Invasive Lobular Carcinoma
				Invasive Tubular Carcinoma
				Invasive Cribriform Carcinoma
				Invasive Mucinous Carcinoma
				Lympho-Epithelioma-Like Carcinoma
				Invasive Apocrine Carcinoma
				Invasive Papillary Carcinoma
				Invasive Micropapillary Carcinoma
				Neuroendocrine Tumours of the Breast
			Glycogen-Rich Clear Cell Carcinoma
			Lipid-Rich Carcinoma
			Triple Negative Invasive Breast Carcinoma
			Grading of Primary Invasive Breast Carcinoma
			Other Additional Features That Should Be Mentioned in the Core Biopsy Report
			ER and PR Assessment
			HER2 Assessment [75]
			Other Immunohistological Studies
			Molecular Classification of Breast Carcinoma
			Complete Removal of Lesions
		Primary Sarcomas of the Breast
			Angiosarcoma
			Mammary Sarcoma with CD10 Expression (Fig. 5.60)
			Stromal Sarcoma
			Primary Osteogenic Sarcoma
		Lymphoma (Fig. 5.61)
		Metastatic Carcinoma in the Breast
	References
6: Dealing with the Excised Specimen
	Introduction
	Vacuum Assisted Excision
	Other Excision Biopsies
	Wire Guided Biopsies
	Wide Local Excision Biopsies and Therapeutic Mammoplasties
	Cavity Wall, Margins, Shaves and Tumour Bed Biopsies
	Re-excision Biopsies
	Lumpectomy Specimens
	Mastectomy Specimens
	Axillary Lymph Node Specimens
		Core Biopsy
		Sentinel Node Biopsies
		Axillary Lymph Node Clearance
	Examination of Breast Tissue After Neo-adjuvant Chemotherapy
		Steps of Gross Examination
	References
7: Reporting Excised Cancer Specimens
	Introduction
	Un-expected Invasive Carcinoma, Micro-invasion and Pseudo-Invasion
	DCIS in Association with Invasive Carcinoma
	Tumour Size
	Complete Removal of Lesions by Core/Vacuum Biopsy
	Presence or Absence of Lympho-Vascular Invasion
	Presence of Changes Indicating the Site of Previous Core/Vacuum Biopsy
	Presence of Necrosis, Fibrosis, Elstosis, Microcalcification and Lymphocytic Infiltration
	Multifocal Breast Carcinomas
	Has the Tumour Been Completely Excised?
	Axillary Lymph Node Status
	Benign Epithelial Inclusions in Axillary Lymph Nodes
	Additional Immunohistochemical Stains
	Reporting Excised Breast Carcinoma After Neo-adjuvant Chemotherapy
	Gene Expression Profiling
	Pathological Staging of Breast Carcinoma
		The Traditional TNM Pathological Staging of Breast Carcinoma [40]
		The Modified Pathologic Prognostic Staging
	References
8: Phyllodes Tumour and Selected Benign Breast Lesions
	Phyllodes Tumour
	Uncommon Breast Adenomas
	Pseudoangiomatous Stromal Hyperplasia
	Diabetic Mastopathy
	Silicon Mastitis and Breast Implant Associated Anaplastic Large Cell Lymphoma
	Fat Necrosis
	Fibromatosis
	Myofibroblastoma
	Nodular Fasciitis
	Ectopic Breast Tissue
	References
9: Women at Higher Risk of Developing Breast Cancer and the Concept of Risk-Based Breast Screening
	Introduction
	Women at Higher Risk of Developing Breast Cancer
	Uptake of Preventive Therapy in the UK
	References
10: Male Breast Biopsies
	Introduction
	Gynaecomastia
	Male Breast Carcinoma
	References
Index