Pathology - Breast Cancer
Risk factors for breast cancer include a family history of first-degree relative with breast cancer at a young age, autosomal dominant inheritance of mutations in BRCA1 or BRCA2 gene, female gender, increased age, early first menarche, delayed first pregnancy, nulliparity, late menopause, radiation exposure, and exogenous estrogen use. Incidence rises with advancing age. Pathology Infiltrating ductal carcinoma is characterized by tumor cells organized in cords, islands, or glands inside a dense fibrous stroma. It may develop from ductal carcinoma in situ (DCIS). Intraductal comedocarcinoma is characterized by a cluster of tumor cells enclosed within a duct, with central necrosis, periductal fibrosis, and inflammation. Inflammation: Lymphatic system affecting the skin above. Paget disease is characterized by the invasion of giant cells with a visible halo of pale cytoplasm from ducts into the epidermis of the nipple. This condition always involves underlying ductal adenocarcinoma inside subareolar excretory channels. Lobular infiltration: Frequently found in multiple and bilateral locations; cells align in a single file pattern with tumor cells surrounding the lobule in a target-like manner; presence of signet ring cells; may develop from lobular carcinoma in situ (LCIS) over an extended period. Medullary: Dense cell sheets with prominent nucleoli in minimal connective tissue; presence of lymphocytic infiltration. A painless, typically immobile, firm lump commonly located in the upper outer quadrant of the breast; skin and nipple changes; detectable axillary lymph nodes; bone discomfort if metastasis to bones occurs. Treatment Notes Infiltrating ductal carcinoma: Dense, immovable, fibrous lump. Characterized by redness, swelling, heat, agony upon touch, and skin resembling an orange peel. Paget's disease presents as pruritic, scaly, and painless eczematous lesions on the nipple. Medullary: Soft mass with a fleshy consistency. Lab results indicate that a paraneoplastic illness causing the release of PTH-related peptide can result in high levels of calcium in the blood. Imaging: Mammogram showing microcalcifications or a spiculated, growing tumor. Treatment options include surgery, radiation treatment, chemotherapy, hormonal therapy (tamoxifen or aromatase inhibitors) for patients with estrogen receptor-positive cancer cells, and monoclonal antibody therapy (trastuzumab) for individuals with HER2/neu expression. Metastasis spreads to lymph nodes, lungs, liver, central nervous system (CNS), and bones. Mucinous (colloid) refers to pools of extracellular mucin around tumor cell clusters with a gelatinous nature. Among women, breast carcinoma ranks as the second leading cause of cancer-related mortality. Clinical Symptoms A painless, typically immobile, firm lump commonly located in the upper outer quadrant of the breast; skin and nipple retraction; detectable axillary lymph nodes; bone discomfort if metastasis to the bone occurs. Infiltrating ductal cancer presents as a firm, fixed, fibrous mass. Characterized by redness, swelling, heat, agony upon touch, and a skin texture like an orange peel. Paget's disease presents as pruritic, scaly, and painless eczematous lesions on the nipple. Medullary: Soft mass with a fleshy consistency. Lab results indicate that a paraneoplastic condition causing the release of PTH-related peptide can result in hypercalcemia. Imaging: Mammogram showing microcalcifications or spiculated, growing mass. Therapies Treatment options include surgery, radiation treatment, chemotherapy, hormonal therapy (tamoxifen or aromatase inhibitors) for patients with estrogen receptor-positive cancer cells, and monoclonal antibody therapy (trastuzumab) for individuals with HER2/neu expression. Metastasis can spread to lymph nodes, lungs, liver, central nervous system (CNS), and bones.
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