Practical Breast Pathology
Tibor Tot, M.D.
Department of Pathology and Clinical Cytology
Falun Central Hospital
Falun, Sweden
László Tabár, M.D.
Professor
Department of Mammography
Falun Central Hospital
Falun, Sweden
Peter B. Dean, M.D.
Professor
Department of Diagnostic Radiology
University Central Hospital
Turku, Finland
407 illustrations
Library of Congress Cataloging-in-Publication Data is available from the publisher.
Any reference to or mention of manufacturers or specific brand names should not be interpreted as an endorsement or advertisement for any company or product.
Some of the product names, patents, and registered designs referred to in this book are in fact registered trademarks or proprietary names even though specific reference to this fact is not always made in the text. Therefore, the appearance of a name without designation as proprietary is not to be construed as a representation by the publisher that it is in the public domain.
This book, including all parts thereof, is legally protected by copyright. Any use, exploitation, or commercialization outside the narrow limits set by copyright legislation, without the publisher's consent, is illegal and liable to prosecution. This applies in particular to photostat reproduction, copying, mimeographing or duplication of any kind, translating, preparation of microfilms, and electronic data processing and storage.
Important Note: Medicine is an ever-changing science undergoing continual development. Research and clinical experience are continually expanding our knowledge, in particular our knowledge of proper treatment and drug therapy. Insofar as this book mentions any dosage or application, readers may rest assured that the authors, editors, and publishers have made every effort to ensure that such references are in accordance with the state of knowledge at the time of production of the book.
Nevertheless this does not involve, imply, or express | any guarantee or responsibility on the part of the publishers in respect of any dosage instructions and forms of application stated in the book. Every user is requested to examine carefully the manufacturer's leaflets accompanying each drug and to check, if necessary in consultation with a physician or specialist, whether the dosage schedules mentioned therein or the contraindications stated by the manufacturers differ from the statements made in the present book. Such examination is particularly important with drugs that are either rarely used or have been newly released on the market. Every dosage schedule or every form of application used is entirely at the user's own risk and responsibility. The authors and publishers request every user to report to the publishers any discrepancies or inaccuracies noticed.
© 2002 Georg Thieme Verlag,
Rüdigerstraße 14, D-70469 Stuttgart, Germany
Thieme New York, 333 Seventh Avenue,
New York, N.Y. 10001 USA
Typesetting by primustype Robert Hurler GmbH
D-73274 Notzingen, Germany
Printed in Germany by Grammlich, Pliezhausen
ISBN 3-13-129431-0 (GTV)
ISBN 0-86577-091-6 (TNY) 1 2 3 4 5
This book is dedicated to Mária, Viktória, and Kirsti
Preface
Radiologists, surgeons, oncologists, and other specialists working with diseases of the breast can perform far more effectively when they have a firm understanding of breast pathology. Fortunately, it is only the pathologist who needs to make histologic diagnoses. This book strives to provide the information which the non-pathologist needs to know and the pathologist should provide about breast diseases, without burdening the reader with details relevant only to the pathologist. Our approach emphasizes mammographic-pathologic correlation, explaining why two radiologists have joined a pathologist to write this book.
The material presented in this book has come exclusively from the Departments of Pathology and Mammography of the Central Hospital of Falun, Sweden, with patient follow-up exceeding 25 years. A collection of more than 3000 breast cancer cases with mammographic, specimen radiology, and large-section pathology correlation has been the source of our material, which includes several hundred cases with additional thick-section pathology.
Interdisciplinary diagnosis and treatment of breast diseases is slowly but irrevocably becoming accepted as the new golden standard for patient care. It requires an additional investment in time and effort, which is soon repaid by smoother delivery of care and far fewer iatrogenic complications. Interdisciplinary breast teamwork is a dynamic and demanding process, the ultimate reward of which is a significant improvement in patient care. This book has been written to assist in the implementation of interdisciplinary breast teamwork, to help the radiologist and pathologist communicate with each other, and to provide a framework for everyday cooperation within the breast team.
The Authors
Contents
1. Normal Breast Tissue or Fibrocystic Change?
2. General Morphology of Breast Lesions
3. Hyperplastic Changes with and without Atypia
4. Ductal Carcinoma In Situ (DCIS)
5. The Most Usual Types of Invasive Breast Carcinoma
6. The Most Common Benign Lesions and Their Borderline and Malignant Counterparts
7. Fine-needle Aspiration or Core Biopsy: A Preoperative Diagnostic Algorithm
9. Assessment of the Most Important Prognostic Factors
Chapter 1
Normal Breast Tissue or Fibrocystic Change?
The mammary gland, like all glandular organs, consists of parenchyma and stroma. The parenchyma contains ducts (Fig. 1.1) and lobules (Fig. 1.2), which are separated from the stroma by a continuous basement membrane (Fig. 1.3). The entire parenchyma (with the exception of the terminal parts of the lactiferous ducts) consists of a single inner layer of epithelial cells and an outer layer of myoepithelium (Fig. 1.4). Only the epithelial cells contain estrogen and progesterone receptors in their nuclei (Fig. 1.5).
Fig. 1.1