Etiopathogenesis

Etiology

Age Gender Genetic Race & ethnicity Estrogen exposure Radiation Diet breastfeeding

Etiology
Age: Peak incidence in 70 to 80 years Rare in younger age groups Gender Less than 0.5% of patients with breast cancer are male. Genetic Family history of breast carcinoma increases the risk Mutation of BRCA1,BRCA2,p53 gene

Etiology

Syndrome associated with breast carcinoma:

Li-Frauners syndrome (LFS): It is autosomal dominant condition with breast cancer inheritance (90%) along with sarcoma, leukemia,brain tumors, adrenocortical tumors. Cowdens syndrome : It is an autosomal dominant condition, with bilateral brain,thyroid tumors

Etiology

Race Non-Hispanic white women have the highest rates of breast cancer African American and Hispanic women tend to develop cancers at a younger age, prior to menopause Estrogen exposure hormone replacement therapy increases the risk of breast cancer 1.2- to 1.7- fold OCP increases the risk of breast carcinoma

Etiology

Radiation exposure The risk is greatest with exposure at young ages and with high radiation doses Diet Moderate or heavy alcohol consumption increases risk of carcinoma Breastfeeding Has a protective effect

Etiology

Benign lesions:
Moderate risk(5 times) :Atypical hyperplasia (ductal or lobular)

Slight risk(1.5-2 times) :Hyperplasia, moderate or florid, solid or papillary Papilloma with a fibrovascular core

Pathology
95% of breast malignancies are adenocarcinoma In situ carcinoma:15-30% Invasive :70-85%
Ductal Lobular Tubular Mucinous Papillary Medullary metaplastic

Ductal Lobular

Ductal carcinoma in situ[DCIS]

DCIS consists of a malignant clonal population of cells limited to ducts by the basement membrane. Incidence is 5-15%

Histological types : comedocarcinoma, solid, cribriform, papillary, and micropapillary

Untreated DCIS becomes infiltrative carcinoma in >50% cases

Pagets disease of nipple

In situ carcinoma of lactiferous ducts with extension to epidermis Involves the nipple and areola

May present with nipple discharge, crusting, or excoriation of nipple surface

Pagets disease of nipple

Lobular carcinoma in situ

Neoplastic transformation of epithelial cells lining terminal ducts and acini of small size Incidence is 3-5%

6 - 9 fold increased risk for development of invasive cancer

35% of LCIS may develop invasive lobular carcinoma either in same or contralateral breast

Lobular carcinoma in situ

Invasive ductal carcinoma

Most common type -80% Histological types

Well differentiated :prominent tubules ,small round nuclei, rare mitotic figures. Moderately differentiated :nuclear pleomorphism & mitotic figures present Poorly differentiated : enlarged irregular nuclei ,high proliferative rate and tumor necrosis present

Invasive ductal carcinoma

Invasive lobular carcinoma

Difficult to detect by palpation Bilateral Histology:

dyscohesive infiltrating tumor cells Tubule formation is absent

Invasive carcinoma

Medullary carcinoma Most common in the sixth decade of life Tumour is soft fleshy well circumscribed Large cells with pleomorphic nuclei & frequent mitotic figures Colloid carcinoma Common in older women Tumor is soft or rubbery in consistency, borders are cicumscribed Abundant mucin is produced by tumour cells

Invasive carcinoma

Tubular carcinoma: Detected in the late 40s and are uncommon tumors consist exclusively of well-formed tubules Calcifications are present within the lumen Associated with atypical lobular hyperplasia, LCIS, or low grade DCIS Inflammatory carcinoma: highly aggressive cancer painful, swollen breast, which is warm with cutaneous oedema blockage of the subdermal lymphatics with carcinoma cells

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