Farid Moinfar Essentials of Diagnostic Breast Pathology

Transcription

1 Farid Moinfar Essentials of Diagnostic Breast Pathology

2 Farid Moinfar Essentials of Diagnostic Breast Pathology A Practical Approach With 116 Figures in 1128 Seperate Illustrations and 6 Tables 123

3 Farid Moinfar, MD Associate Professor of Pathology Director, Unit of Breast & Gynecologic Pathology Department of Pathology Medical University Graz Auenbruggerplatz Graz Austria Library of Congress Control Number: ISBN Springer Berlin Heidelberg New York This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permissions for use must always be obtained from Springer.Violations are liable for prosecution under the German Copyright Law. Springer is a part of Springer Science+Business Media springer.com Springer-Verlag Berlin Heidelberg 2007 The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product liability:the publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. In every individual case the user must check such information by consulting the relevant literature. Editor: Gabriele Schröder, Heidelberg, Germany Desk Editor: Ellen Blasig, Heidelberg, Germany Production: LE-T E X Jelonek, Schmidt &Vöckler GbR, Leipzig, Germany Cover design: Frido Steinen-Broo, EStudio, Calamar, Spain Reproduction and typesetting: am-productions GmbH, Wiesloch, Germany Printed on acid-free paper 24/3100/YL

4 Dedication This work is dedicated with great appreciation and gratitude to My dear parents, Shamsi and Ali Akbar Moinfar My wonderful wife, Shokufeh Sodeifi-Moinfar and All my teachers and mentors, particularly Dr. John G. Azzopardi, whose magnificent book and other papers inspired me, and Dr. Fattaneh A. Tavassoli, a great mentor and friend.

5 Preface Several excellent and comprehensive textbooks have been written on breast pathology [1 5]. The magnificent book Problems in Breast Pathology [1] written by John G. Azzopardi, and two more recent great works by Fattaneh A. Tavassoli [4] and Paul P. Rosen [3] cover almost all aspects of classic and modern breast pathology. So why should one dare to write a new book on this subject? Over the past few years, the Department of Pathology, Medical University Graz has organized annual intensive 5-day courses on diagnostic breast pathology in order to share the experience in this field and demonstrate and discuss several common diagnostic problems, including tumor-like lesions, intraductal proliferative lesions, variants of ductal and lobular intraepithelial neoplasias, papillary neoplasms, and a variety of infiltrating breast carcinomas. During these courses, it has been my constant experience that most practicing pathologists and pathologists in training appreciate receiving a precise summary of the diagnostic criteria for each entity combined with a brief and accurate discussion of the main differential diagnoses. In dealing with a variety of breast lesions in daily practice, surgical pathologists want and need to know the essentials of diagnostic breast pathology. So, the idea to write this book gradually evolved from these diagnostic courses, with a main focus on the essentials. This book is therefore designed as a diagnostic aid for pathologists when they encounter common as well as unusual or even challenging and very difficult cases. In trying to achieve this goal, it was necessary to reduce the text but emphasize case presentations that deal with the described entities. Indeed, this book contains over 1,100 full-color illustrations demonstrating gross, histologic, cytologic, and immunohistochemical findings of common as well as challenging benign and malignant breast lesions. I am most grateful to Dr. Fattaneh A. Tavassoli for her constructive comments, suggestions, and encouragement throughout the preparation of this book. I am indebted to the staff pathologists at the Department of Pathology, Medical University Graz, who have supported me during the preparation of this book. I am thankful to Drs. Helmut Denk, Manfred Ratschek and Wolfgang Öhlinger for their kind support. I would like to acknowledge the excellent assistance and expertise of Mrs. Andrea Kaps in preparing the photomicrographs. I would like to thank the staff of the publisher, Springer, in particular Mrs. Gabriele M. Schröder and Mrs. Ellen Blasig for their professional and efficient cooperation and consideration in the production of this book. Once again, I would like to express my special thanks to my wife, Shokufeh Sodeifi-Moinfar, for her support and tolerance over the past three years. Graz, Austria November 2006 Farid Moinfar References 1. Azzopardi JG. Problems in breast pathology. WB Saunders, London, Page DL, Anderson TJ. Diagnostic histopathology of the breast. Churchill Livingstone, Edinburgh, Rosen PP. Rosen s breast pathology, 2nd edn. Lippincott Williams & Wilkins, Philadelphia, Tavassoli FA. Pathology of the breast, 2nd edn. Appleton & Lange, Stamford, CT, Tavassoli FA, Devilee P (eds). World Health Organization classification of tumours. Pathology and genetics. Tumours of the breast and female genital organs. IARC Press, Lyon, 2003

6 One relies on one s experience. But experience can be merely the repetition of the same error often enough One must be willing, even anxious, to learn from one s error. This requires a degree of humility, a readiness to listen to the arguments of others, including those of one s juniors, and the inclination to re-examine cases in which a mistaken diagnosis has been made and to analyse the reasons for the original mistake. John G. Azzopardi Problems in Breast Pathology Thus I learned early on the great importance of a close correlation between clinical and pathological studies. Each complements and supplements the other; it is impossible to do intelligent surgery without a thorough understanding of the pathology of disease and it is equally impossible to make an intelligent interpretation of pathology without a clear understanding of its clinical implications. Arthur Purdy Stout Guiding the Surgeon s Hand: The History of American Surgical Pathology Juan Rosai (Editor)

7 Contents 1 The Normal Breast 1.1 Anatomy Pregnancy and Lactation Menopause Immunoprofile Further Reading Specimen Processing 2.1 Frozen Section Core Needle Biopsy Excisional Biopsy Mastectomy Axillary Lymph Nodes Sentinel Lymph Nodes Further Reading Fibrocystic Change and Duct Ectasia 3.1 Fibrocystic Change Duct Ectasia (Periductal Mastitis) Adenosis 4.1 Definition, Types, and Macroscopy of Adenosis Blunt Duct Adenosis Sclerosing Adenosis Apocrine Adenosis (Adenosis with Apocrine Metaplasia) Tubular Adenosis Adenomyoepithelial Adenosis Microglandular Adenosis Radial Scar/Complex Sclerosing Lesion Collagenous Spherulosis Intraductal Proliferative Lesions 5.1 Usual Ductal Hyperplasia Ductal Intraepithelial Neoplasia (DIN) Ductal Intraepithelial Neoplasia (DIN), Flat Type Low-Grade Ductal Intraepithelial Neoplasia (WHO: DIN1b; Atypical Ductal Hyperplasia) Ductal Intraepithelial Neoplasia (WHO: DIN1c DIN3, DCIS) Intraductal Papillary Neoplasms 6.1 Central Papilloma Peripheral Papilloma Sclerosing Papilloma Intraductal Papillary Carcinoma (Papillary Ductal Intraepithelial Neoplasia) Role of Immunohistochemistry in Diagnosing Intraductal Papillary Neoplasms Additional Comments Further Reading Lobular Intraepithelial Neoplasia (LIN) 7.1 Synonyms Background Microscopic Features Additional Comments Further Reading Infiltrating Ductal Carcinoma (NOS Type) 8.1 Definition Macroscopy Microscopic Features Grading Additional Comments Further Reading

8 XII Contents 9 Invasive Lobular Carcinoma (ILC) 9.1 Macroscopy Microscopic Features Additional Comments Immunohistochemistry of LIN and ILC Grading Further Reading Special Types of Breast Carcinomas 10.1 Tubular Carcinoma Mucin-Producing Carcinomas of the Breast Carcinoma with Neuroendocrine Differentiation Invasive Papillary Carcinoma Invasive Micropapillary Carcinoma Apocrine Carcinoma Secretory Carcinoma Adenoid Cystic Carcinoma Acinic Cell Carcinoma Sebaceous Carcinoma Infiltrating Cribriform Carcinoma Medullary Carcinoma Metaplastic Carcinomas Clear Cell (Glycogen-Rich) Carcinoma Lipid-Rich Carcinoma (Lipid-Secreting Carcinoma) Metastatic Carcinoma Inflammatory Carcinoma Biphasic Tumors 11.1 Fibroadenoma Phylloides Tumor Diseases of the Nipple 12.1 Paget s Disease Nipple Duct Adenoma (Infiltrating) Syringomatous Adenoma Male Breast Lesions 13.1 Gynecomastia Papilloma Primary Male Breast Carcinoma Further Reading Mesenchymal Lesions/Tumors 14.1 Stromal Elastosis Fat Necrosis Metaplasias Pseudoangiomatous Stromal Hyperplasia Fibromatosis Myofibroblastoma Lipoma Angiolipoma Granular Cell Tumor Hamartoma Perilobular Hemangioma Hemangioma Angiomatosis Angiosarcoma Leiomyosarcoma Liposarcoma Rhabdomyosarcoma Malignant Fibrous Histiocytoma Osteosarcoma Spindle Cell Sarcoma, Not Otherwise Specified (NOS-Type Mammary Sarcoma) Myoepithelial Lesions/Neoplasms 15.1 Background Immunoprofile Myoepithelial Cell Hypertrophy Myoepitheliosis (Myoepithelial Hyperplasia) Adenomyoepithelioma Sarcomatoid Carcinoma with Myoepithelial Differentiation (Myoepithelial Carcinoma, Malignant Myoepithelioma)

9 Contents XIII 16 Miscellaneous Lesions 16.1 Acute Mastitis (Puerperal Mastitis) Subareolar Abscess Plasma Cell Mastitis Idiopathic Granulomatous Mastitis Lymphocytic Mastitis (Diabetic Mastopathy) Eosinophilic Mastitis Silicone Mastitis and Diseases Associated with Cosmetic Augmentation Further Reading Pathologic Effects of Adjuvant Radiotherapy Pathologic Effects of (Neo)adjuvant Chemotherapy Malignant Lymphoma Diffuse Large B-cell Lymphoma Burkitt s Lymphoma Extranodal Marginal-Zone B-cell Lymphoma of MALT Type Follicular Lymphoma Cytopathology of Benign and Malignant Lesions (Selected Topics) 17.1 Introduction Fibrocystic Change Proliferative Breast Diseases Without Atypia (Adenosis, Ductal Hyperplasia) Proliferative Breast Lesions with Atypia Lactating Adenoma and Lactating Changes Fibroadenoma Intraductal Papilloma Ductal Intraepithelial Neoplasia (Ductal Carcinoma In Situ) Lobular Intraepithelial Neoplasia Intraductal Papillary Carcinoma Infiltrating Ductal Carcinoma Infiltrating Lobular Carcinoma Tubular Carcinoma Mucinous Carcinoma Medullary Carcinoma Apocrine Carcinoma Adenoid Cystic Carcinoma Metaplastic (Sarcomatoid) Carcinoma Phylloides (Phyllodes) Tumor Further Reading Immunohistochemistry (Selected Topics) 18.1 Role of Immunohistochemistry in Diagnostic Breast Pathology Immunohistochemistry in the Differential Diagnosis of Epithelial Lesions: Myoepithelial Cells Carcinomas with Myoepithelial Differentiation Versus Primary Sarcoma Microinvasive Carcinoma Cell Population in Intraductal Proliferative Lesions: Homogeneous Versus Heterogeneous Cell Population (Neoplasia Versus Hyperplasia) Paget s Disease Distinction Between DIN (DCIS) and LIN (LCIS) Systemic Metastasis of Breast Carcinoma Micrometastatic Disease in Axillary Lymph Nodes (Including Sentinel Nodes) Immunohistochemistry for Prognostic or Predictive Factors in Breast Carcinoma: Hormone Receptors HER2/neu Overexpression Further Reading Subject Index

10 Abbreviations ADH CK CNB CSL DLBCL DCIS DIN FA FISH FNA FS H&E HMW IDC IHC ILC LCIS LIN Atypical ductal hyperplasia Cytokeratin Core needle biopsy Complex sclerosing lesion Diffuse large B-cell lymphoma Ductal carcinoma in situ Ductal intraepithelial neoplasia Fibroadenoma Fluorescence in situ hybridization Fine needle aspiration Frozen section Hematoxylin and eosin High molecular weight Infiltrating ductal carcinoma Immunohistochemistry Invasive lobular carcinoma Lobular carcinoma in situ Lobular intraepithelial neoplasia LMW MALT MEC MFH MSA N/C NDA PASH PSA PT RS SA SLN SMA SMMHC TDLU UDH Low molecular weight Mucosa-associated lymphoid tissue Myoepithelial cells Malignant fibrous histiocytoma Muscle-specific actin Nucleus/cytoplasm Nipple duct adenoma Pseudoangiomatous stromal hyperplasia Prostatic specific antigen Phylloides tumor Radial scar Sclerosing adenosis Sentinel lymph node Smooth muscle actin Smooth muscle myosin, heavy chain Terminal duct-lobular unit Usual ductal hyperplasia