Pathology
Breast
Breast pathology for MBBS and NEET-PG: fibroadenoma, phyllodes tumour, fibrocystic disease and the classification, molecular subtypes and staging of breast carcinoma, mapped to NMC codes PA31.1 to PA31.4.
MedNext Academy | 3 min read
Breast
Breast pathology for MBBS and NEET-PG: fibroadenoma, phyllodes tumour, fibrocystic disease and the classification, molecular subtypes and staging of breast carcinoma, mapped to NMC codes PA31.1 to PA31.4.
This chapter covers breast pathology. It includes fibroadenoma and phyllodes tumour, fibrocystic disease and its relationship to cancer, and the classification, molecular subtypes, spread and staging of breast carcinoma, along with gynaecomastia.
High-yield: Breast
- Fibroadenoma is the most common benign breast tumour in young women and presents as a firm, mobile, painless lump.
- A phyllodes tumour is a fibroepithelial tumour with a leaf-like architecture that can be benign or malignant and tends to recur.
- Fibrocystic change is the most common benign breast condition, with cysts, fibrosis and adenosis.
- Proliferative fibrocystic change with atypia carries a modestly increased risk of later carcinoma.
- Invasive ductal carcinoma (no special type) is the most common form of breast cancer.
- Invasive lobular carcinoma grows in a single-file pattern and is more often bilateral and multifocal.
- Ductal carcinoma in situ is confined by the basement membrane and may show comedo necrosis.
- Paget disease of the nipple is an eczematous change caused by intraepidermal spread of ductal carcinoma cells.
- Breast cancer is graded histologically and staged by the TNM system, both guiding prognosis.
- Oestrogen and progesterone receptor status and HER2 status determine treatment and prognosis.
- Triple-negative breast cancer lacks oestrogen, progesterone and HER2 receptors and has a worse prognosis.
- Breast cancer spreads to the axillary lymph nodes, and nodal status is a strong prognostic factor.
- BRCA1 and BRCA2 mutations markedly increase the hereditary risk of breast and ovarian cancer.
- Gynaecomastia is enlargement of male breast tissue due to a relative excess of oestrogen over androgen.
Breast carcinoma essentials
- **Commonest type:** Invasive ductal carcinoma of no special type.
- **Lobular carcinoma:** Single-file growth; often bilateral and multifocal.
- **In situ disease:** Ductal carcinoma in situ, confined by basement membrane; comedo necrosis.
- **Molecular markers:** Oestrogen, progesterone and HER2 receptors; triple-negative has worse prognosis.
NMC competencies in this chapter
- **PA31.1:** Pathogenesis and hormonal dependency of fibroadenoma and phyllodes tumour
- **PA31.2:** Pathology, molecular classification, spread and staging of carcinoma of the breast
- **PA31.3:** Fibrocystic disease and its relationship with breast carcinoma
- **PA31.4:** Aetiology and pathogenesis of gynaecomastia
Frequently Asked Questions
What is the most common benign breast tumour?
Fibroadenoma, which presents in young women as a firm, mobile, painless lump.
What is the most common type of breast cancer?
Invasive ductal carcinoma of no special type, which accounts for most breast cancers.
Why do receptor and HER2 status matter?
Because oestrogen, progesterone and HER2 status guide hormonal and targeted treatment and predict prognosis; triple-negative disease has the worst outlook.
What is Paget disease of the nipple?
An eczema-like change of the nipple caused by intraepidermal spread of underlying ductal carcinoma cells.
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