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| Contents | ||||||
| 1 | The Normal Breast | |||||
| 1.1 | Anatomy | 2 | ||||
| 1.2 | Pregnancy and Lactation | 2 | ||||
| 1.3 | Menopause | 3 | ||||
| 1.4 | Immunoprofile | 3 | ||||
| 1.5 | Further Reading | 3 | ||||
| 2 | Specimen Processing | |||||
| 2.1 | Frozen Section | 8 | ||||
| 2.2 | Core Needle Biopsy | 9 | ||||
| 2.3 | Excisional Biopsy | 10 | ||||
| 2.4 | Mastectomy | 11 | ||||
| 2.5 | Axillary Lymph Nodes | 11 | ||||
| 2.6 | Sentinel Lymph Nodes | 12 | ||||
| 2.7 | Further Reading | 12 | ||||
| 3 | Fibrocystic Change and Duct Ectasia | |||||
| 3.1 | Fibrocystic Change | 16 | ||||
| 3.2 | Duct Ectasia (Periductal Mastitis) | 17 | ||||
| 4 | Adenosis | |||||
| 4.1 | Definition,Types, and Macroscopy of Adenosis | 28 | ||||
| 4.2 | Blunt Duct Adenosis | 28 | ||||
| 4.3 | Sclerosing Adenosis | 29 | ||||
| 4.4 | Apocrine Adenosis (Adenosis with Apocrine Metaplasia) | 30 | ||||
| 4.5 | Tubular Adenosis | 31 | ||||
| 4.6 | Adenomyoepithelial Adenosis | 31 | ||||
| 4.7 | Microglandular Adenosis | 32 | ||||
| 4.8 | Radial Scar/Complex Sclerosing Lesion | 32 | ||||
| 4.9 | Collagenous Spherulosis | 34 | ||||
| 5 | Intraductal Proliferative Lesions | |||||
| 5.1 | Usual Ductal Hyperplasia | 68 | ||||
| 5.2 | Ductal Intraepithelial Neoplasia (DIN) | 70 | ||||
| 5.3 | Ductal Intraepithelial Neoplasia (DIN), Flat Type | 72 | ||||
| 5.4 | Low-Grade Ductal Intraepithelial Neoplasia (WHO: DIN1b; Atypical Ductal Hyperplasia) | 74 | ||||
| 5.5 | Ductal Intraepithelial Neoplasia (WHO: DIN1c-DIN3,DCIS) | 76 | ||||
| 6 | Intraductal Papillary Neoplasms | |||||
| 6.1 | Central Papilloma | 124 | ||||
| 6.2 | Peripheral Papilloma | 124 | ||||
| 6.3 | Sclerosing Papilloma | 125 | ||||
| 6.4 | Intraductal Papillary Carcinoma (Papillary Ductal Intraepithelial Neoplasia) | 125 | ||||
| 6.5 | Role of Immunohistochemistry in Diagnosing Intraductal Papillary Neoplasms | 126 | ||||
| 6.6 | Additional Comments | 126 | ||||
| 6.7 | Further Reading | 127 | ||||
| 7 | Lobular Intraepithelial Neoplasia (LIN) | |||||
| 7.1 | Synonyms | 156 | ||||
| 7.2 | Background | 156 | ||||
| 7.3 | Microscopic Features | 156 | ||||
| 7.4 | Additional Comments | 156 | ||||
| 7.5 | Further Reading | 157 | ||||
| 8 | Infiltrating Ductal Carcinoma (NOS Type) | |||||
| 8.1 | Definition | 180 | ||||
| 8.2 | Macroscopy | 180 | ||||
| 8.3 | Microscopic Features | 180 | ||||
| 8.4 | Grading | 180 | ||||
| 8.5 | Additional Comments | 181 | ||||
| 8.6 | Further Reading | 181 | ||||
| 9 | Invasive Lobular Carcinoma (ILC) | |||||
| 9.1 | Macroscopy | 192 | ||||
| 9.2 | Microscopic Features | 192 | ||||
| 9.3 | Additional Comments | 192 | ||||
| 9.4 | Immunohistochemistry of LIN and ILC | 192 | ||||
| 9.5 | Grading | 192 | ||||
| 9.6 | Further Reading | 193 | ||||
| 10 | Special Types of Breast Carcinomas | |||||
| 10.1 | Tubular Carcinoma | 223 | ||||
| 10.2 | Mucin-Producing Carcinomas of the Breast | 224 | ||||
| 10.3 | Carcinoma with Neuroendocrine Differentiation | 226 | ||||
| 10.4 | Invasive Papillary Carcinoma | 227 | ||||
| 10.5 | Invasive Micropapillary Carcinoma | 227 | ||||
| 10.6 | Apocrine Carcinoma | 228 | ||||
| 10.7 | Secretory Carcinoma | 229 | ||||
| 10.8 | Adenoid Cystic Carcinoma | 230 | ||||
| 10.9 | Acinic Cell Carcinoma | 231 | ||||
| 10.10 | Sebaceous Carcinoma | 232 | ||||
| 10.11 | Infiltrating Cribriform Carcinoma | 232 | ||||
| 10.12 | Medullary Carcinoma | 233 | ||||
| 10.13 | Metaplastic Carcinomas | 234 | ||||
| 10.14 | Clear Cell (Glycogen-Rich) Carcinoma | 237 | ||||
| 10.15 | Lipid-Rich Carcinoma (Lipid-Secreting Carcinoma) | 238 | ||||
| 10.16 | Metastatic Carcinoma | 238 | ||||
| 10.17 | Inflammatory Carcinoma | 239 | ||||
| 11 | Biphasic Tumors | |||||
| 11.1 | Fibroadenoma | 320 | ||||
| 11.2 | Phylloides Tumor | 321 | ||||
| 12 | Diseases of the Nipple | |||||
| 12.1 | Paget's Disease | 352 | ||||
| 12.2 | Nipple Duct Adenoma | 353 | ||||
| 12.3 | (Infiltrating) Syringomatous Adenoma | 354 | ||||
| 13 | Male Breast Lesions | |||||
| 13.1 | Gynecomastia | 366 | ||||
| 13.2 | Papilloma | 367 | ||||
| 13.3 | Primary Male Breast Carcinoma | 367 | ||||
| 13.4 | Further Reading | 367 | ||||
| 14 | Mesenchymal Lesions/Tumors | |||||
| 14.1 | Stromal Elastosis | 377 | ||||
| 14.2 | Fat Necrosis | 377 | ||||
| 14.3 | Metaplasias | 378 | ||||
| 14.4 | Pseudoangiomatous Stromal Hyperplasia | 378 | ||||
| 14.5 | Fibromatosis | 379 | ||||
| 14.6 | Myofibroblastoma | 380 | ||||
| 14.7 | Lipoma | 381 | ||||
| 14.8 | Angiolipoma | 381 | ||||
| 14.9 | Granular Cell Tumor | 382 | ||||
| 14.10 | Hamartoma | 383 | ||||
| 14.11 | Perilobular Hemangioma | 383 | ||||
| 14.12 | Hemangioma | 384 | ||||
| 14.13 | Angiomatosis | 384 | ||||
| 14.14 | Angiosarcoma | 385 | ||||
| 14.15 | Leiomyosarcoma | 386 | ||||
| 14.16 | Liposarcoma | 387 | ||||
| 14.17 | Rhabdomyosarcoma | 387 | ||||
| 14.18 | Malignant Fibrous Histiocytoma | 388 | ||||
| 14.19 | Osteosarcoma | 389 | ||||
| 14.20 | Spindle Cell Sarcoma, Not Otherwise Specified (NOS-Type Mammary Sarcoma) | 389 | ||||
| 15 | Myoepithelial Lesions/Neoplasms | |||||
| 15.1 | Background | 410 | ||||
| 15.2 | Immunoprofile | 410 | ||||
| 15.3 | Myoepithelial Cell Hypertrophy | 410 | ||||
| 15.4 | Myoepitheliosis (Myoepithelial Hyperplasia) | 411 | ||||
| 15.5 | Adenomyoepithelioma | 411 | ||||
| 15.6 | Sarcomatoid Carcinoma with Myoepithelial Differentiation (Myoepithelial Carcinoma, Malignant Myoepithelioma) | 412 | ||||
| 16 | Miscellaneous Lesions | |||||
| 16.1 | Acute Mastitis (Puerperal Mastitis) | 420 | ||||
| 16.2 | Subareolar Abscess | 420 | ||||
| 16.3 | Plasma Cell Mastitis | 420 | ||||
| 16.4 | Idiopathic Granulomatous Mastitis | 421 | ||||
| 16.5 | Lymphocytic Mastitis (Diabetic Mastopathy) | 421 | ||||
| 16.6 | Eosinophilic Mastitis | 422 | ||||
| 16.7 | Silicone Mastitis and Diseases Associated with Cosmetic Augmentation | 422 | ||||
| 16.8 | Further Reading | 422 | ||||
| 16.9 | Pathologic Effects of Adjuvant Radiotherapy | 423 | ||||
| 16.10 | Pathologic Effects of (Neo)adjuvant Chemotherapy | 423 | ||||
| 16.11 | Malignant Lymphoma | 424 | ||||
| 16.12 | Diffuse Large B-cell Lymphoma | 424 | ||||
| 16.13 | Burkitt's Lymphoma | 425 | ||||
| 16.14 | Extranodal Marginal-Zone B-cell Lymphoma of MALT Type | 425 | ||||
| 16.15 | Follicular Lymphoma | 425 | ||||
| 17 | Cytopathology of Benign and Malignant Lesions (Selected Topics) | |||||
| 17.1 | Introduction | 440 | ||||
| 17.2 | Fibrocystic Change | 440 | ||||
| 17.3 | Proliferative Breast Diseases Without Atypia (Adenosis, Ductal Hyperplasia) | 440 | ||||
| 17.4 | Proliferative Breast Lesions with Atypia | 441 | ||||
| 17.5 | Lactating Adenoma and Lactating Changes | 441 | ||||
| 17.6 | Fibroadenoma | 441 | ||||
| 17.7 | Intraductal Papilloma | 441 | ||||
| 17.8 | Ductal Intraepithelial Neoplasia (Ductal Carcinoma In Situ) | 441 | ||||
| 17.9 | Lobular Intraepithelial Neoplasia | 442 | ||||
| 17.10 | Intraductal Papillary Carcinoma | 442 | ||||
| 17.11 | Infiltrating Ductal Carcinoma | 442 | ||||
| 17.12 | Infiltrating Lobular Carcinoma | 442 | ||||
| 17.13 | Tubular Carcinoma | 443 | ||||
| 17.14 | Mucinous Carcinoma | 443 | ||||
| 17.15 | Medullary Carcinoma | 443 | ||||
| 17.16 | Apocrine Carcinoma | 443 | ||||
| 17.17 | Adenoid Cystic Carcinoma | 443 | ||||
| 17.18 | Metaplastic (Sarcomatoid) Carcinoma | 444 | ||||
| 17.19 | Phylloides (Phyllodes) Tumor | 444 | ||||
| 17.20 | Further Reading | 444 | ||||
| 18 | Immunohistochemistry (Selected Topics) | |||||
| 18.1 | Role of Immunohistochemistry in Diagnostic Breast Pathology | 472 | ||||
| 18.2 | Immunohistochemistry in the Differential Diagnosis of Epithelial Lesions: Myoepithelial Cells | 472 | ||||
| 18.3 | Carcinomas with Myoepithelial Differentiation Versus Primary Sarcoma | 473 | ||||
| 18.4 | Microinvasive Carcinoma | 473 | ||||
| 18.5 | Cell Population in Intraductal Proliferative Lesions: Homogeneous Versus Heterogeneous Cell Population (Neoplasia Versus Hyperplasia) | 473 | ||||
| 18.6 | Paget's Disease | 474 | ||||
| 18.7 | Distinction Between DIN (DCIS) and UN (LCIS) | 474 | ||||
| 18.8 | Systemic Metastasis of Breast Carcinoma | 474 | ||||
| 18.9 | Micrometastatic Disease in Axillary Lymph Nodes (Including Sentinel Nodes) | 474 | ||||
| 18.10 | Immunohistochemistry for Prognostic or Predictive Factors in Breast Carcinoma: Hormone Receptors | 475 | ||||
| 18.11 | HER2/neu Overexpression | 475 | ||||
| 18.12 | Further Reading | 475 | ||||
| Subject Index | 493 | |||||
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, 1979.
2. Page DL, Anderson TJ. Diagnostic histopathology of the breast. Churchill Livingstone, Edinburgh, 1987.
3. Rosen PP. Rosen's breast pathology, 2nd edn. Lippincott Williams & Wilkins, Philadelphia, 2001.
4. Tavassoli FA. Pathology of the breast, 2nd edn. Appleton & Lange, Stamford, CT, 1999.
5. 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
This abundantly illustrated reference work focuses on the essential information needed by pathologists in order to interpret breast lesions (tumors) appropriately. Particular attention is paid to the diagnostic criteria with systematic analysis of differential diagnoses. Value and limitations of immunohistochemistry as a diagnostic adjunct are demonstrated as well. Using a systematic approach, this book contains the fundamental information required to avoid misinterpreting breast lesions and thus the under or overtreatment of patients.
Moinfar
Essentials of Diagnostics
Breast Pathology
A Practical Approach
ISBN 978-3-540-45117-4
From the reviews: "The pathologist-in-training and general pathologist will benefit from the addition of Dr Farid Monifar's Essentials of Diagnostic Breast Pathology: A Practical Approach to their personal library. The goal of this 470-page combination text-atlas is to serve as an efficient reference to both educate and update the practicing diagnostician through guiding the processing, microscopic analysis, and clinico-pathologic correlation of a wide spectrum of common and uncommon breast lesions. Monifar uses focused and captioned text describing more than 1100 full-color illustrations to aid in this challenging task." (Giovanna Crisi, Journal of the American Medical Association, Vol. 298 (15), 2007) "This is a succinct and practical guide to diagnosis of breast disease with over 1,100 full-color illustrations demonstrating gross, histologic, cytologic, and immunohistochemical findings of common and challenging breast lesions. The text is short and precise and each disease entity is emphasized with case presentations. ... a nice addition to the existing breast pathology books as it stresses specifically the practical diagnostic essentials in breast pathology. ... written for practicing pathologists and pathologists in training who deal with breast pathology on a daily basis." (Fang Fan, Ph.D, MD, Doody's Review Service, March, 2008)