外科学教学课件：BENIGN BREAST DISEASES.pptVIP

Invasive Lobular Carcinoma Much less common than IDC Can present with similar features More likely to be bilateral and/or multicentric (multiple lesions within the same breast) Invasive Lobular Carcinoma Classic histology = small, uniform cells arranged as: Strands/columns within a fibrous stroma (“Indian-file”) Around uninvolved ducts ( “bull’s-eye” pattern) Metastasize more frequently to CSF, serosal surfaces and pelvic organs PROGNOSIS ? Stage Staging systems inc.TNM and the Manchester classification Tumour size and axillary node status are important parameters 10-year survival rate for lymph node neg disease is 80% vs 35% for tumours with positive nodes PROGNOSIS ? Tumour Grade Different grading systems exist ?tumour grade = worse prognosis ? Histologic Subtypes PROGNOSIS ? Hormone Receptors Estrogen receptors Progesterone receptors ? ? Molecular Markers Inc. c-erb-B2, c-myc and p53 TREATMENT OPTIONS Surgery Mastectomy Breast conservation +/- Axillary dissection Radiation therapy (local control) Chemotherapy (systemic control) Hormonal Rx (systemic control) PHYLLODES TUMOUR Stromal tumour arising from the intralobular stroma Range in size from a few cm to massive lesions Classically have a “leaf-like” configuration?? PHYLLODES TUMOUR Most are low-grade lesions that can recur locally but do not metastasize Others are of high-grade and exhibit aggressive clinical behaviour e.g. spread to distant sites (cystosarcoma phyllodes) THE MALE BREAST ? Gynecomastia Enlargement of the male breast due to hormonal imbalance (rel.?estrogens): Physiologic; seen at puberty or old age Pathologic; associated with cirrhosis, functional testicular tumours, certain drugs (alcohol, marijuana and anabolic steroids) THE MALE BREAST ? Gynecomastia Can be unilateral/bilateral; present as diffuse enlargement /defined mass Most important clinicall