Breast Cancer Pathology

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Invasive carcinomas of the breast:
    • Tend to be histologically:
      • Heterogeneous tumors
  • The vast majority are:
    • Adenocarcinomas:
      • That arise from the terminal ductal lobular units
  • There are five common histologic variants of:
    • Mammary adenocarcinoma
  • Invasive ductal carcinoma:
    • Accounts for 75% of all breast cancers
    • This lesion is characterized by:
      • The absence of special histologic features
    • It is firm on palpation and gritty when transected:
      • It is associated with various degrees of fibrotic response
    • Often there is associated ductal carcinoma in situ (DCIS) within the specimen
    • Invasive ductal carcinomas:
      • May metastasize to axillary lymph nodes
    • The prognosis for patients with these tumors is poorer than that for patients with some of the other histologic subtypes:
      • Mucinous, colloid, tubular, and medullary
    • Distant metastases are found most often in the:
      • Bones, lungs, liver, and brain
  • Invasive lobular carcinoma:
    • Accounts for 15% of breast cancers
    • Clinically:
      • This lesion often has an area of ill-defined thickening within the breast
    • Microscopically:
      • Small cells in a single-file pattern are characteristically seen
    • Invasive lobular cancers:
      • Tend to grow around ducts and lobules
      • They have a tendency to present with a radiographically occult infiltrative pattern
    • Multicentricity and bilaterality:
      • Are observed more frequently in invasive lobular carcinoma than in invasive ductal carcinoma
    • The prognosis for invasive lobular carcinoma is similar to that for invasive ductal carcinoma
    • In addition to metastasizing to axillary lymph nodes:
      • Invasive lobular carcinoma is known to metastasize to unusual sites:
        • Example meninges and serosal surfaces:
          • More often than other forms of breast cancer
  • Tubular carcinoma:
    • Accounts for only 2% of breast carcinomas
    • The diagnosis of tubular carcinoma:
      • Is made only when more than 75% of the tumor demonstrates tubule formation
    • Axillary nodal metastases:
      • Are uncommon with this type of tumor
    • The prognosis for patients with tubular carcinoma:
      • Is more favorable than that for patients with other types of breast cancer
  • Medullary carcinoma of the breast:
    • Accounts for 5% to 7% of breast cancers
    • Histologically:
      • The lesion is characterized by poorly differentiated nuclei, a syncytial growth pattern, a well-circumscribed border, intense infiltration with small lymphocytes and plasma cells:
        • Little or no associated DCIS
    • The prognosis for patients with pure medullary carcinoma is favorable:
      • However, mixed variants with invasive ductal components will have prognoses similar to invasive ductal carcinoma
    • Medullary carcinoma:
      • Occurs more frequently in BRCA mutation carriers
  • Mucinous or colloid carcinoma:
    • Constitutes approximately 3% of breast cancers
    • It is characterized by an abundant accumulation of extracellular mucin:
      • Surrounding clusters of tumor cells
    • Colloid carcinoma:
      • Is slow growing and tends to be bulky
    • These tumors are associated with:
      • A favorable prognosis
  • Rare histologic types of breast malignancy include:
    • Papillary, apocrine, secretory, squamous cell and spindle cell carcinomas, and metaplastic carcinoma
  • Invasive ductal carcinomas:
    • Occasionally have small areas containing one or more of these special histologic types
    • Tumors with these mixed histologic appearances:
      • Behave similarly to pure invasive ductal carcinomas
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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