Differential Diagnoses in Surgical Pathology: Breast

587 Pages·2016·167.09 MB·English

by  Jean F. Simpson

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Differential Diagnoses in Surgical Pathology:
Breast
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Differential Diagnoses in Surgical Pathology:
Breast
Jean F. Simpson, MD
President
Breast Pathology Consultants, Inc.
Nashville, Tennessee
Adjunct Professor of Pathology
University of South Alabama
Mobile, Alabama
Melinda E. Sanders, MD
Professor of Pathology, Microbiology, and Immunology
Vanderbilt University Medical Center
Nashville, Tennessee
SERIES EDITOR
Jonathan I. Epstein, MD
Professor of Pathology, Urology and Oncology
The Reinhard Professor of Urological Pathology
Director of Surgical Pathology
The Johns Hopkins Medical Institutions
Baltimore, Maryland
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Library of Congress Cataloging-in-Publication Data
Names: Simpson, Jean F., author. | Sanders, Melinda E., author.
Title: Breast/Jean F. Simpson, Melinda E. Sanders.
Other titles: Differential diagnoses in surgical pathology series.
Description: Philadelphia: Wolters Kluwer Health, [2017] | Series: Differential diagnoses in surgical
pathology | Includes bibliographical references and index.
Identifiers: LCCN 2016038688 | eISBN 9781496375391
Subjects: | MESH: Breast Neoplasms—diagnosis | Breast Neoplasms—pathology | Diagnosis, Differential |
Pathology, Surgical--methods
Classification: LCC RC280.B8 | NLM WP 870 | DDC 616.99/449—dc23 LC record available at
https://lccn.loc.gov/2016038688
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DEDICATION
In memory of Lowell W. Rogers and J. Allan Tucker, gentle giants who inspired others.
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PREFACE
Histopathology remains the cornerstone of the diagnosis and treatment of breast
disease. There have been advances in breast imaging techniques, molecular
analysis, and immunotherapy of breast cancer, yet the fundamental decisions
regarding the need for additional surgery, chemoprevention, radiation, and/or
chemotherapy are based on morphologic features.
Histopathology is far from a static or “out of date” discipline. Indeed, specific
histologic criteria have been defined that allow for reproducibility in diagnosis;
linking these criteria to outcome data for thousands of women through long-term
follow-up studies has defined the epidemiology of benign breast disease and
helps identify women who may benefit from chemoprevention strategies. These
studies also provide concrete evidence that merely undergoing a breast biopsy
does not increase risk for later cancer development, a welcome relief for
thousands of women.
The widespread use of core needle biopsy has had a major impact on the
practice of breast pathology, and many of the images shown in this book are
from core needle biopsy specimens. Our approach to the diagnosis of core
biopsy specimens is similar to a frozen section, that is, what should the next step
be, specifically, should the lesion be formally excised?
We are grateful for the opportunity to have learned breast pathology from Dr.
David Page, whose adherence to reproducible criteria and interpretation within
the clinical context guide us daily. We also are grateful to pathologists who have
trusted us with their difficult cases in consultation. The vast majority of such
cases come with a differential diagnosis of one or two entities, underscoring the
importance of a textbook that compares and contrasts differential diagnostic
partners.
Jean F. Simpson
Melinda E. Sanders
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CONTENTS
Preface
Chapter 1 NONPROLIFERATIVE ALTERATIONS OF ACINI
Chapter 2 EPITHELIAL PROLIFERATIVE LESIONS, USUAL AND ATYPICAL DUCTAL
HYPERPLASIA
Chapter 3 LOBULAR NEOPLASIA AND ITS DISTINCTION FROM OTHER
EPITHELIAL PROLIFERATIVE LESIONS
Chapter 4 DUCTAL CARCINOMA IN SITU
Chapter 5 PAPILLARY AND SCLEROSING LESIONS
Chapter 6 INVASIVE CARCINOMA: SPECIAL TYPES AND IMPORTANT
CONSIDERATIONS
Chapter 7 FIBROEPITHELIAL LESIONS
Chapter 8 BENIGN AND REACTIVE STROMAL LESIONS
Chapter 9 SENTINEL LYMPH NODES
Chapter 10 VASCULAR LESIONS
Chapter 11 MALE BREAST
Index
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1
Nonproliferative Alterations of Acini
1.1 Columnar cell lesion without atypia vs. Cystically dilated lobular unit
1.2 Columnar cell lesion without atypia vs. Columnar cell lesion with atypia
1.3 Apocrine change vs. Columnar cell lesion with atypia
1.4 Secretory change vs. Columnar cell lesion with atypia
1.5 Cystically dilated lobular unit vs. Duct ectasia
1.6 Mucocele-like lesion vs. Disrupted cyst