Diagnostic Problems in Breast Pathology: Expert Consult: Online and Print

Cover......Page 1
Preface......Page 4
CHAPTER 1 - Introduction to the Diagnosis of Diseases of the Breast......Page 6
Selected Readings......Page 9
Part I - EPITHELIAL PROLIFERATIONS......Page 10
CELLULAR PROLIFERATION......Page 12
INTERCELLULAR COHESION......Page 13
CYTOLOGIC ATYPIA......Page 15
ARCHITECTURAL ATYPIA......Page 17
Selected Reading......Page 18
Relationship between Ductal Hyperplasia and Ductal Carcinoma In Situ......Page 19
Ductular Distention by Central Masses of Cells Surrounded by Crescent-Shaped Spaces......Page 20
Irregular Fenestrations......Page 22
Streaming......Page 23
Maturation......Page 24
Cytologic Characteristics......Page 25
Necrosis......Page 28
Mucin......Page 29
Cribriform Spaces and their Variants......Page 30
Regular Placement of Cells......Page 32
Cytologic Characteristics......Page 33
Qualitative Criteria......Page 37
Size Criteria......Page 38
Biologic Significance of Atypical Ductal Hyperplasia......Page 39
Histologic Characteristics......Page 40
Differential Diagnosis......Page 45
Flat Epithelial Lesions Showing Intermediate-or High-Grade Atypia......Page 47
APPROACH TO THE DIAGNOSIS OF CONVENTIONAL DUCTAL PROLIFERATIONS......Page 49
PROBLEMS IN THE DIAGNOSIS OF CONVENTIONAL DUCTAL HYPERPLASIA......Page 50
Ductal Hyperplasia in Perimenopausal Women......Page 51
Immature Hyperplasia......Page 53
Effects of Irradiation......Page 58
‘‘Apocrine-Like’’ Atypia......Page 63
Atypia in the Adolescent......Page 64
Distinction of Intermediate-Grade Ductal Carcinoma In Situ from Conventional Ductal Hyperplasia......Page 65
Dimorphic Ductal Carcinoma......Page 66
Clinging Carcinoma......Page 67
Microinvasion......Page 71
Mimicry of Benign Lobules......Page 73
Involvement of Altered Tissue......Page 74
Blunt Invasion......Page 76
Distinction between Ductal Carcinoma In Situ and Carcinoma in Lymphatic Vessels......Page 79
Interpretation of Immunohistochemical Stains for Myoepithelial Cells......Page 81
Recognition of Ductal Carcinoma In Situ in the Irradiated Breast......Page 83
Ductal Carcinoma In Situ in Gynecomastia......Page 85
Selected Readings......Page 87
BASIC CONCEPTS......Page 88
DEFINITIONS AND CLINICOPATHOLOGIC CHARACTERISTICS......Page 91
Atypical Ductal Hyperplasia and Ductal Carcinoma In Situ of Apocrine Type......Page 93
Atypical Apocrine Sclerosing Lesion......Page 95
SUMMARY......Page 97
Selected Readings......Page 98
Mucin Accumulation and Extravasation......Page 99
Architectural Characteristics......Page 102
Atypical Ductal Proliferation with Abundant Mucin......Page 103
Detection of Invasion......Page 104
The Origin of the Stromal Mucin Pools......Page 106
The Nature of the Cells within the Mucin......Page 109
The Significance of Malignant Cells and Mucin in the Stroma......Page 112
Selected Readings......Page 114
Intercellular Cohesion......Page 115
Cellular Polarization......Page 117
Cytologic Atypia......Page 118
Pattern of Growth......Page 119
Structural Alterations of Lobules......Page 120
Structural Alterations of Ducts......Page 122
Cellular Properties......Page 124
Necrosis......Page 129
Summary......Page 131
Distinction of Solid Ductal Carcinoma In situ from Lobular Carcinoma In Situ......Page 132
Distinction from Myoepithelial Proliferations......Page 133
Intralobular Growth......Page 137
Involvement of Conventional Ductal Hyperplasia......Page 139
Involvement of Altered Lobules......Page 141
Collagenous Spherulosis......Page 142
Sclerosing Adenosis......Page 145
Atrophy......Page 146
Interpretation of Immunohistochemical Stains for E-cadherin......Page 148
Pleomorphic Lobular Carcinoma In Situ......Page 150
E-cadherin-Negative High-Grade Carcinoma In Situ......Page 151
Distinction from Atypical Lobular Hyperplasia......Page 152
Detection of Invasion......Page 154
Selected Readings......Page 155
Part II - PAPILLARY PROLIFERATIONS......Page 157
PROPERTIES OF MACROPAPILLARY TUMORS......Page 159
Ancillary Characteristics......Page 160
Contents of the Gland Lumen......Page 161
Selected Readings......Page 162
DEFINITIONS AND CLINICOPATHOLOGIC CHARACTERISTICS......Page 163
Amount of Stroma......Page 164
Characteristics of the Epithelium......Page 165
Unexpected Cytologic Findings......Page 166
Scarring and Entrapment of Benign Glands......Page 168
Epithelial Proliferations on the Surface (Superficial Stratified Pattern)......Page 171
Epithelial Proliferations within the Stalk (Inverted Adenosis Pattern)......Page 176
Proliferation of Cells with Granular and Eosinophilic Cytoplasm......Page 178
Secondary Lobular Changes......Page 181
Displaced Epithelium and Fragments......Page 184
Selected Readings......Page 185
Geometric Properties of the Fronds......Page 186
Characteristics of the Epithelium......Page 187
Uncommon Histologic Features of Conventional Papillary Carcinoma......Page 189
Carcinomas Containing Cells with Clear Cytoplasm (Dimorphic Cells)......Page 190
Carcinomas Composed of Tall, Columnar Cells......Page 192
Distinction between Papilloma Involved by Ductal Carcinoma In Situ and Papillary Carcinoma......Page 193
Recognition of Blunt Invasion......Page 194
Solid Papillary Carcinoma......Page 196
Intracystic Papillary Carcinoma......Page 200
Selected Readings......Page 202
Degree of Glandular Distention......Page 203
Contents of the Duct Lumen......Page 205
Presence of Maturation......Page 206
Size and Configuration of the Micropapillae......Page 207
Presence of Maturation......Page 210
SUMMARY......Page 212
Selected Readings......Page 213
Part III - SCLEROSING LESIONS......Page 214
SHAPE OF THE LESION......Page 216
CHARACTERISTICS OF THE ASSOCIATED DUCTAL EPITHELIAL PROLIFERATION......Page 217
Selected Readings......Page 219
Structure of the Lesion......Page 220
Summary......Page 228
Invasive Lobular Carcinoma......Page 229
Atypical Apocrine Sclerosing Lesion......Page 231
Carcinoma Involving Sclerosing Adenosis......Page 232
Neural Involvement by Small Glands......Page 234
Selected Readings......Page 235
Shape of the Lesion......Page 236
Nidus......Page 237
Corona......Page 241
Characteristics of the Peripheral Epithelial Elements......Page 242
Summary......Page 244
Scars with Epithelial Necrosis......Page 246
Minimal Cytologic Atypia in Scars......Page 247
Misshapen Scars......Page 250
Early Scars......Page 253
Scars Harboring Carcinomas......Page 255
Displaced Epithelium......Page 262
Scars in Core Biopsy Specimens......Page 263
Selected Readings......Page 265
Shape of the Lesion......Page 267
Structure of the Lesion......Page 270
Characteristics of the Peripheral Epithelial Elements......Page 273
Summary......Page 275
Adenosis......Page 276
Conventional Atrophy......Page 277
Glandular Atrophy and Stromal Fibrosis......Page 283
Stromal Atrophy and Sclerosing Adenosis......Page 284
Microglandular Adenosis......Page 285
Low-Grade Adenosquamous Carcinoma......Page 289
Criteria for the Diagnosis of Tubular Carcinoma......Page 292
Selected Readings......Page 294
Part IV - FIBROEPITHELIAL LESIONS......Page 296
CHARACTERISTICS OF THE STROMA......Page 298
Growth by Invasion......Page 299
Summary......Page 300
APPROACH TO THE DIAGNOSIS OF FIBROEPITHELIAL LESIONS......Page 301
Selected Readings......Page 302
DEFINITIONS AND CLINICOPATHOLOGIC CHARACTERISTICS......Page 303
Structure of the Mass......Page 304
Characteristics of the Stroma......Page 306
Characteristics of the Glands......Page 310
Uncommon Tumors Classified as Fibroadenomas......Page 313
Selected Readings......Page 315
HISTOLOGIC CHARACTERISTICS......Page 316
Structure of the Mass......Page 317
Characteristics of the Stroma......Page 319
Characteristics of the Glands......Page 321
Selected Reading......Page 322
HISTOLOGIC CHARACTERISTICS......Page 323
Structure of the Mass......Page 324
Characteristics of the Stroma......Page 326
Characteristics of the Glands......Page 331
Summary......Page 332
Selected Readings......Page 335
Structure of the Mass......Page 336
Characteristics of the Stroma......Page 339
Summary......Page 341
PROBLEMS IN THE DIAGNOSIS OF HAMARTOMAS AND FIBROADENOMA VARIANTS......Page 342
Selected Readings......Page 343
Structure of the Mass......Page 344
Characteristics of the Stroma......Page 347
Characteristics of the Glands......Page 349
Selected Readings......Page 351
A......Page 352
D......Page 353
F......Page 355
I......Page 356
L......Page 357
M......Page 358
P......Page 359
S......Page 361
W......Page 362