Breast pathology : problematic issues

This Book Covers Practical Diagnostic Issues In Breast Pathology, With Special Emphasis On Areas Which Pose Diagnostic Difficulties. These Include Dealing With The Gross Specimens Derived From Patients Treated With Conservative Surgery And Those Who Had Neo-adjuvant Therapy Before Surgery. It Also Discusses How To Deal With Axillary Lymph Nodes, Proliferative Breast Lesions, Including Dcis, And Problematic Core Biopsies, As Well As Fibro-epithelial, Spindle Cell, Lobular, Mucinous, Metaplastic And Papillary Lesions, Molecular Classification Of Breast Cancers, Breast Lesions In Male Patients And Breast Immunohistochemistry. There Is A Focus On Unusual Benign And Malignant Breast Lesions And A Large Number Of High-quality Images Help The Reader Diagnose Difficult Cases. Breast Pathology: Problematic Issues Is Aimed At Histopathology Consultants And Senior Trainees Who Deal With Breast Pathology. Introduction; Contents; Contributors; 1: Dealing With€the€gross Specimen; Introduction; Core Biopsies; Dealing With€specimens From€conservative Surgery; Reporting Excision Margin Status; Lumpectomy Specimens; Mastectomy Specimens; Axillary Lymph Node Specimens And€specimens Received After€neoadjuvant Therapy; References; 2: Handling Neoadjuvant Therapy Specimens; Introduction; Pretreatment Diagnosis; Specimen Handling; Wide Local Excision Specimens; Mastectomies; Axillary Lymph Nodes; Histological Reporting; Breast; Axillary Lymph Nodes; Definition Of€pcr. Grading Of€response Retesting Of€tumor Markers Post-Ưneoadjuvant Therapy; Neoadjuvant Therapy And€clinical Trials; References; 3: Proliferative Breast Lesions; Introduction; Ductal Lesions; Usual Epithelial Hyperplasia; Atypical Ductal Hyperplasia; Ductal Carcinoma In€situ; Epithelial Proliferation (hyperplasia, Atypia, And€dcis) Within€papillary Lesions; Paget's Disease Of€the€nipple; Lobular Lesions; Atypical Lobular Hyperplasia And€classical Lobular Carcinoma In€situ (in Situ Lobular Neoplasia); Columnar Cell Lesions; Columnar Cell Change And€columnar Cell Hyperplasia. Flat Epithelial Atypiareferences; 4: Problematic Core Biopsies; Introduction; Macroscopic Specimen Handling; Calcification Problems; Reporting Categories; B1, Normal Tissue; B2, Benign; B5, Malignant; Category B5a: In€situ Carcinoma; Category B5b: Invasive; Assessment Of€prognostic And€predictive Factors In€invasive Carcinoma In€core Biopsy; Problematic Malignant Lesions; B3, Lesion Of€uncertain Malignant Potential; Atypical Intraductal Epithelial Proliferations (aideps); Lobular Neoplasia; Flat Epithelial Atypia; Apocrine Lesions; Papillary Lesions. Radial Scar/complex Sclerosing Lesion (csl) Phyllodes Tumor; Spindle Cell Lesions; Mucocele-like Lesions; Other Rare Lesions; B4, Suspicious; References; 5: Ductal Carcinoma In€situ; Introduction; Specimen Handling; Diagnostic Core Biopsies; Diagnostic And€therapeutic Excision Specimens; Re-excision Specimens; Therapeutic Mammoplasties; Mastectomy Specimens; Disease Extent In€excision Specimens; Diagnostic Approaches With€core Biopsies And€excisions; Reporting Diagnostic Core Biopsies (small And€large Volume); Reporting Therapeutic Large Core (vacuum-assisted) Biopsies. Reporting Excision Biopsies Grading Dcis; Low-grade Dcis; Intermediate-grade Dcis; High-grade Dcis; Problems In€grading Dcis; Architectural Patterns And€special Types Of€dcis; Micropapillary Dcis; Apocrine Dcis; Dcis Arising In€the€context Of€a€columnar Cell Lesion With€atypia; Rare Forms Of€dcis; Dcis Following€neoadjuvant Systemic Therapy; Microinvasion And€invasion In€dcis; The Use Of€immunohistochemistry In€dcis; Differentiating Low/intermediate-Ưgrade Dcis From€benign Proliferations; Distinguishing Complex Sclerosing Processes From€invasive Disease. Sami Shousha, Editor. Includes Bibliographical References And Index. Introduction......Page 6 Contents......Page 7 Contributors......Page 9 Introduction......Page 10 Dealing with Specimens from Conservative Surgery......Page 11 Reporting Excision Margin Status......Page 14 Mastectomy Specimens......Page 17 References......Page 18 Introduction......Page 19 Specimen Handling......Page 20 Wide Local Excision Specimens......Page 21 Mastectomies......Page 22 Axillary Lymph Nodes......Page 23 Breast......Page 25 Axillary Lymph Nodes......Page 28 Grading of Response......Page 31 Retesting of Tumor Markers Post-­neoadjuvant Therapy......Page 34 Neoadjuvant Therapy and Clinical Trials......Page 35 References......Page 36 Introduction......Page 41 Usual Epithelial Hyperplasia......Page 42 Atypical Ductal Hyperplasia......Page 43 Epithelial Proliferation (Hyperplasia, Atypia, and DCIS) Within Papillary Lesions......Page 45 Columnar Cell Change and Columnar Cell Hyperplasia......Page 46 Flat Epithelial Atypia......Page 47 References......Page 48 Introduction......Page 50 Macroscopic Specimen Handling......Page 51 Calcification Problems......Page 52 B1, Normal Tissue......Page 53 Category B5a: In Situ Carcinoma......Page 54 Category B5b: Invasive......Page 55 Problematic Malignant Lesions......Page 56 B3, Lesion of Uncertain Malignant Potential......Page 57 Atypical Intraductal Epithelial Proliferations (AIDEPs)......Page 58 Lobular Neoplasia......Page 59 Flat Epithelial Atypia......Page 60 Papillary Lesions......Page 61 Radial Scar/Complex Sclerosing Lesion (CSL)......Page 62 Phyllodes Tumor......Page 63 Mucocele-Like Lesions......Page 64 B4, Suspicious......Page 65 References......Page 66 Specimen Handling......Page 68 Diagnostic Core Biopsies......Page 69 Mastectomy Specimens......Page 70 Reporting Therapeutic Large Core (Vacuum-Assisted) Biopsies......Page 71 Grading DCIS......Page 72 Low-Grade DCIS......Page 73 Intermediate-Grade DCIS......Page 74 High-Grade DCIS......Page 75 Micropapillary DCIS......Page 76 Apocrine DCIS......Page 77 DCIS Arising in the Context of a Columnar Cell Lesion with Atypia......Page 78 DCIS Following Neoadjuvant Systemic Therapy......Page 79 Differentiating Low/Intermediate-­Grade DCIS from Benign Proliferations......Page 80 Confluent Proliferations......Page 81 References......Page 82 Incidence and Significance......Page 84 Pleomorphic LCIS (PLCIS)......Page 85 LCIS with Prominent Basal/Myoepithelial Proliferation......Page 88 Immunoprofile......Page 90 Management of LCIS......Page 91 References......Page 92 Introduction......Page 94 Grading Requires High-Quality Tissue Preservation and Section Preparation......Page 96 Grading Methodology......Page 97 Reproducibility of Histological Grade......Page 99 References......Page 100 Fibroadenoma......Page 103 Phyllodes Tumor......Page 104 Differentiating Malignant Phyllodes Tumor from Sarcomas and Spindle Cell Carcinoma......Page 105 Differentiating Benign Phyllodes Tumor from Fibroadenoma......Page 106 Core Biopsy Diagnosis......Page 107 Genetics......Page 110 Prognostic Factors of Phyllodes Tumors......Page 111 References......Page 112 Introduction......Page 115 Mucocele-Like Lesions......Page 116 Mucinous DCIS......Page 120 Invasive Mucinous Carcinoma......Page 123 Signet Ring Cell Carcinoma......Page 124 References......Page 126 Spindle Cell Lesions in Core Biopsies......Page 128 Fibromatosis......Page 129 Diabetic Mastopathy......Page 131 Leiomyoma, Myoid Hamartoma, Schwannoma, and Inflammatory Myofibroblastic Tumor......Page 133 Fibrosarcoma-Malignant Fibrous Histiocytoma [28]......Page 135 Angiosarcoma......Page 137 Chest Wall Sarcomas Presenting as Breast Lumps......Page 139 References......Page 140 Introduction......Page 142 Differentiating Benign from Malignant Papillary Lesions......Page 144 General Considerations......Page 146 Intraductal Papillary Carcinoma (Papillary DCIS)......Page 147 Encapsulated Papillary Carcinoma (EPC)......Page 148 Solid Papillary Carcinoma (SPC)......Page 151 Invasive Papillary Carcinoma......Page 153 Immunohistochemistry of Papillary Lesions......Page 154 References......Page 155 Introduction......Page 158 Microscopic Pathology......Page 159 Adenosquamous Carcinoma......Page 160 Spindle Cell Carcinoma......Page 161 Matrix-Producing Metaplastic Carcinoma......Page 163 Low-Grade Adenosquamous Carcinoma......Page 164 Diagnosing Metaplastic Carcinoma with Extensive “Mesenchymal-Like” Differentiation......Page 165 Differential Diagnoses......Page 166 Diagnosis of MBC on Core Biopsy......Page 167 Genetics of Metaplastic Breast Carcinoma......Page 168 References......Page 169 Introduction......Page 172 How to Diagnose Metastases in the Breast......Page 173 Distinguishing Ovarian Metastases from Primary Breast Carcinoma......Page 175 Distinguishing Neuroendocrine Metastases from Primary Breast Carcinoma with Neuroendocrine Differentiation......Page 178 References......Page 179 Current Scheme for Dealing with Axillary Lymph Nodes in Patients with Breast Carcinoma......Page 180 Preoperative Microbubble Contrast-­Enhanced Axillary Sentinel Node Core Biopsy......Page 181 Sentinel Lymph Nodes......Page 182 Microscopic Classification......Page 183 Intraoperative Molecular Assessment......Page 185 Morphology......Page 187 Further Radiological Investigations......Page 188 Molecular Studies......Page 189 References......Page 190 15: A Practical Approach to the Use of Immunohistochemistry in the Diagnosis and Management of Breast Disease......Page 193 General Issues......Page 194 General Principles......Page 197 Identification of Occult Carcinoma......Page 198 Identification of Low-Volume Residual Malignant Disease Post-chemotherapy......Page 199 High Molecular Weight (Basal) Cytokeratins......Page 200 Low Molecular Weight (Luminal) Cytokeratins......Page 203 Markers of Lobular Neoplasia......Page 206 Neuroendocrine Markers......Page 208 Hormone Receptors......Page 209 Vascular Markers......Page 211 Markers of Breast Differentiation......Page 212 Epithelial Membrane Antigen......Page 214 References......Page 215 Introduction......Page 219 Molecular Classification of Breast Carcinoma......Page 221 An Alternative Molecular Classification: The Integrative Clusters......Page 222 Prognostic and Predictive Tests......Page 223 MammaPrint......Page 224 PAM50/Prosigna......Page 225 Genomic Grade Index (MapQuant Dx)......Page 226 Oncotype DX......Page 227 Other Tests......Page 228 Monitoring Disease: Liquid Biopsies (Circulating Tumor Cells)......Page 229 References......Page 230 Microglandular Adenosis......Page 236 Adenomyoepithelioma......Page 238 Collagenous Spherulosis......Page 239 Pleomorphic Adenoma......Page 240 Adenosis Tumor......Page 241 Hidradenoma......Page 243 Other Benign Screen-Detected Lesions......Page 245 References......Page 247 Adenoid Cystic Carcinoma......Page 249 Epithelial-Myoepithelial Carcinoma......Page 251 Carcinoma Arising in Association with Microglandular Adenosis......Page 253 Breast Carcinoma with Neuroendocrine Features......Page 256 Glycogen-Rich Clear Cell Carcinoma......Page 258 Lymphoma......Page 261 References......Page 263 19: Male Breast Lesions......Page 266 Microscopic Features......Page 267 Ethnicity......Page 269 Familial and Genetic Factors......Page 270 Macroscopic Features......Page 271 References......Page 273 Index......Page 276 ​This book covers practical diagnostic issues in breast pathology, with special emphasis on areas which pose diagnostic difficulties. These include dealing with the gross specimens derived from patients treated with conservative surgery and those who had neo-adjuvant therapy before surgery. It also discusses how to deal with axillary lymph nodes, proliferative breast lesions, including DCIS, and problematic core biopsies, as well as fibro-epithelial, spindle cell, lobular, mucinous, metaplastic and papillary lesions, molecular classification of breast cancers, breast lesions in male patients and breast immunohistochemistry. There is a focus on unusual benign and malignant breast lesions and a large number of high-quality images help the reader diagnose difficult cases.__Breast Pathology: Problematic Issues__