Breast: Carcinoma

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A 55 yr old postmenopausal woman was found to have a 2.5cm diameter hard, irregular, non-mobile mass in the right breast.

1.    What are differential diagnoses?

Breast carcinoma

Fibroadenoma (unlikely because it is regular and mobile)

Fibrocystic change

2.    What other findings on physical examination would help you narrow down your differentials to the most likely diagnosis?

Dimpling and retraction of skin � peau d�orange

Retraction of nipple

3.    List the histological features for calling this a

Malignant tumour:

- loss of lobulocentric architecture

- invasion into stroma

- sheets, solid nests of pleomorphic cells

- pleomorphic, hyperchromatic nuclei

- mitotic figures

- one cell type, no myoepithelial cells

of ductal origin: some malignant cells form ductal structures

4.    List the 2 commonest histological types of breast cancer?

Ductal carcinoma (79%)

Lobular carcinoma (10%)

5.    List the histological parameters of prognostic value.

Histological subtype (tubular and colloid carcinomas have an exceptionally good prognosis)

Tumour grade (>80% with grade I tumour survive for 16 yrs, compared with <60% in grade II and III)

Evidence of local or vascular invasion (presence of invasion signals metastases)

6.    What is the clinical significance of immunohistochemical demonstration of hormone receptors in the tumour cells?

Slightly better prognosis

Respond to hormonal therapy : oestrogen receptor antagonist � tamoxifen

7.    Name the lymph nodes commonly affected by this cancer?

      Axillary

      Internal thoracic

      Supraclavicular

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Copyright � Joseph Ong 2003