Diseases of the liver and pancreas

1b. Invasive ductal carcinoma with Paget’s disease

2. Invasive lobular carcinoma

3. Medullary carcinoma

4. Colloid carcinoma (mucinous carcinoma)

5. Tubular carcinoma

6. Adenoid cystic carcinoma

7. Apocrine carcinoma

8. Invasive papillary carcinoma

Intraductal Carcinoma

• Constitutes approximately 20 to 30% of carcinomas

• Defined as a malignant population of cells that lack the capacity to invade through the basement membrane and, therefore, are incapable of distant metastasis.

• However, these cells can spread throughout a ductal system and produce extensive lesions involving an entire sector of a breast

• Movement of these cells up the main duct and into the nipple skin results in the clinical appearance of Paget’s disease of the nipple

• Histologically, these tumors are divided into five subtypes:

• Comedocarcinoma

• Solid

• Cribriform

• Papillary

• Micropapillary

• Except for comedocarcinoma, these lesions are usually clinically occult and are detected as incidental findings in breast biopsies or by mammography

Intraductal carcinoma Comedocarcinoma

• Characterized by rapidly proliferating high-grade malignant cells

• Cells in the center of the ducts are often necrotic and commonly calcify

• These necrotic cells are detected

• Grossly - Cut section by punctate areas of cheesy necrotic material (“comedone” like)

• Mammography - Linear and branching microcalcifications

• Are thought to be precursors/predictors of invasive cancer

• In women with intraductal carcinoma treated with lumpectomy alone, recurrences or invasion occurs in from 0 to 10% of low-grade or intermediate nonpalpable tumors to 40% of high-grade comedocarcinomas

COMEDOCARCINOMA

Paget’s disease of the nipple

• Is a form of ductal carcinoma

• Arises in the main excretory ducts of the breast and extends intraepithelially to involve the skin of the nipple and areola.

• Most striking gross characteristics

• Involvement of the skin of the nipple and areola

• Is frequently fissured, ulcerated, and oozing.

• There is surrounding inflammatory hyperemia and edema and, occasionally, total nipple ulceration.

• An underlying lump or mass is present in 50 to 60% of cases.

• Histologic hallmark

• Involvement of the epidermis by malignant cells, referred to as Paget’s cells.

• Large, have abundant clear or lightly staining cytoplasm

• Nuclei with prominent nucleoli

• Stain positively for mucin, epithelial membrane antigens, and low-molecular-weight keratins.

Lobular Carcinoma in Situ

• Is a histologically unique lesion

• Manifested by proliferation, in one or more terminal ducts and/or ductules (acini), of cells that are loosely cohesive, are somewhat larger than normal, and have rare mitoses and oval or round nuclei with small nucleoli

• Seen in breasts removed

• For fibrocystic disease

• In the vicinity of invasive carcinoma

• Admixed with the foci of intraductal carcinoma

• Is a marker for invasive carcinoma

Invasive (infiltrating) Carcinoma

• Invasive Ductal Carcinoma NOS (Not Otherwise Specified)

• Medullary Carcinoma

• Colloid or Mucinous Carcinoma

• Invasive Lobular Carcinoma

NST (No Special Type)

• Is the most common type

• ~70 to 80% of all mammary cancers

• Most exhibit a marked increase in dense, fibrous tissue stroma, giving the tumor a hard consistency (scirrhous carcinoma)

• Sharply delimited nodules

• Stony-hard consistency

• ~1 to 2 cm in diameter and rarely exceed 4 to 5 cm

• On palpation

• Infiltrative attachment to the surrounding structures

• Fixation to the underlying chest wall

• Dimpling of the skin

• Retraction of the nipple

• On cut section: the mass is quite characteristic

• Retracted below the cut surface

• Has a hard cartilaginous consistency

• Produces a grating sound when scraped.

• Within the central focus, there are small pinpoint foci or streaks of chalky-white necrotic tumor and small foci of calcification.

Scirrhous Carcinoma

Invasive Ductal Carcinoma

• Histologically

• Malignant duct lining cells diposed in cords, solid cell nests, tubules, glands, anastomosing masses, and mixtures of all these

• Cells clearly invade the connective tissue stroma

•