Breast Cancer Lecture 2.doc

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Anatomy and Cell Biology
Anatomy and Cell Biology 4461B
Geordie Shepherd

LP Lecture 5: Breast Cancer Breast Cancer Location • Breast cancer arises from epithelial cells Typically found in the upper outer quadrant • • Different levels of involvment result in different prognosis and different symptoms Small palpable loose nodule • • Skin dimples with movement (Cooper’s ligament) • Nipple discharge (Paget’s); lactiferous duct invasion • Loss of mobility with muscle invasion • Various maladies with metastasis Classification • Non-invasive • Epithelial proliferation that is still confined to the TDLU • Has not invaded basement membrane • Is not capable of metastasis • 2 main types • Ductal carcinoma in situ (DCIS) • Heterogenous group of non-invasive lesions • Distends and distorts ducts of TDLUs • Neoplastic cells can spread throughout ductal system creating multiple lesions and affecting large areas of the breast • Involvement of lactiferous duct and nipple lead to Paget’s disease • Mean age of diagnosis is 50-59 years • Often not palpable • Detected with mammography as microcalcifications • 15-30% of all cancers detected; >90% survival regardless of treament • Usually E-cadherin+ Morphological classifications; comedo, papillary, micropapillary, solid, cribiform • • Comedocarcinoma Involves multiple ducts • • Produces firm mass Calcifications are frequent • • Grows in solid pattern with central area of necrosis • Usually treated with masectomy; almost 100% progression to invasive disease if left untreated • Cribiform and Micropapillary • Lesions lack necrosis • Cribiform: small irregular fenestrations with sieve like appearance • Micropapillary: papillary (nodule like) structures • 30% progress to invasive disease if pure • Lobular carcinoma in situ • Neoplastic cells are limited to the lobular acini and terminal ductules and do not invade through the basement membrane into the stroma • Usually e-cadherin negative • Does not form palpable mass and has few calcifications, not detected by mam- mography • Tends to be bilateral • Mean age of diagnosis is 44-54 years • 30% progress to invasive disease in 20 years if left untreated • Invasive carcinoma • Originates from TDLU • Breast cancer that has extended across basement membrane • Metastatic compentence • Subtypes • Invasive Ductal Carcinoma NOS (IDC) • Up to 80% of invasive lesions • Often cause stromal reaction producing hard, palpable m
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