Breast Cancer Classification

by Carlo Raj, MD

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    Classification: In situ, ductal and lobular. Stop here for one second. What does in situ mean to you? Malignancy. What’s the difference between this and invasive? In situ, the basement membrane is intact and if it’s ductal, can you picture it? Major terminal duct and the membrane’s intact. I’d walk you through comedocarcinoma already. Lobular carcinoma in situ, the lobule and its membrane will be intact. What happens now? There’s every possibility that the basement membrane is then going to rupture. Welcome to invasive. Would you please tell me as to what is the most common invasive breast cancer? It’s this one. Invasive ductal cancer. Lobular carninoma, invasive type. Upon histology, it would show you those cells that would be all marching one behind the other. And this is the one that loves to spread. This is the one that loves to spread to the other breast in fact, contralateral. Non-invasive with in situ: Malignant population of cells that lack the capacity to invade. Acini are distorted, unfolded and take appearance of small ducts. Non-invasive in situ. With in situ, special subtype, we’ll walk you through comedocarcinoma. What does that mean to you? This means that inside the actual tumor, you’d find areas that are necrotic, characterized by solid sheets of high-grade malignant cells and central necrosis. Comedo-, comedocarcinoma. There’s another subtype here, punctate area of necrotic material with comedone-like appearance. The other subtype, I’m not going to spend so much time with, but you pay attention to the comedo, which to you should mean central, necrotic areas. Now what’s interesting about this one is the following: First, take a look at the histologic picture and you find Paget cells. The Paget cells are filled with mucin and it would stain for positive periodic acid-Schiff. "So why in the world,...

    About the Lecture

    The lecture Breast Cancer Classification by Carlo Raj, MD is from the course Breast Disease. It contains the following chapters:

    • Breast Carcinoma Classification
    • Differential Diagnosis of Non-Invasive Carcinoma
    • Differential Diagnosis of Invasive Carcinoma

    Included Quiz Questions

    1. It is a type of lobular carcinoma in situ.
    2. It presents with solid sheets of high grade malignant cells with central necrosis.
    3. All are incorrect.
    4. It arises from a malignant population of ductal cells.
    5. Punctate areas of necrotic material appear comedone-like.
    1. Retraction of nipple
    2. Bilateral lesions
    3. Frequently metastasize to CSF, ovary, uterus and bone marrow.
    4. Often has diffusely invasive pattern
    5. Multicentric lesions
    1. Polyploidy
    2. High nuclear grade.
    3. Hyperexpression of HER2/neu
    4. Absence of hormone receptors
    5. Increased tumor size
    1. Paget’s disease with ductal carcinoma
    2. Lobular carcinoma in situ
    3. Phyllodes tumor
    4. Invasive lobular carcinoma
    5. Medullary carcinoma

    Author of lecture Breast Cancer Classification

     Carlo Raj, MD

    Carlo Raj, MD

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