Breast cancer remains the leading cause of cancer in women, which makes accurate diagnoses on core needle biopsy (CNB) specimens of vital importance in staging and guiding therapy decisions for patients. The first edition of this multi-authored text written by leaders in the field from major academic medical centers provided a comprehensive guide on diagnostic breast pathology in the core biopsy setting. In addition to in-depth coverage of benign and malignant entities encountered in breast core biopsies, the book provided additional resources to improve diagnostic accuracy such as pattern-based approaches to evaluation, mimickers of breast lesions arising in extra-mammary sites, and pitfalls specific to small tissue samples. In recent years, there have been several notable developments in the field of breast pathology including revisions in AJCC breast cancer staging, updated guidelines in the testing and reporting of ER, PR, and HER2, as well as implementation of immunotherapy and companion biomarker testing. In addition, several key updates were included in the most recent edition of the WHO Classification of Breast Tumours (2020).
In addition to updates specific to individual breast entities, the second edition will detail updates regarding biomarker testing in the primary and metastatic setting, and incorporate newly defined entities and updated definitions of rare tumors in alignment with the WHO Classification of Breast Tumours (2020). Furthermore, this edition will address the role of CNB in companion biomarker testing for eligibility for immunotherapy in the context of advanced triple-negative breast carcinoma.
Written by leaders in the field and edited by expert breast pathologists, The Second Edition of Comprehensive Guide to Core Needle Biopsies of the Breast is the definitive reference on breast core needle biopsies for practicing pathologists, pathology trainees, oncologists and clinicians of patients with breast disease.
Author(s): Sandra J. Shin, Yunn-Yi Chen, Paula S. Ginter
Edition: 2
Publisher: Springer
Year: 2022
Language: English
Pages: 1024
City: Cham
Preface (Reprinted from the First Edition)
Reference
Acknowledgments
Contents
Editors and Contributors
About the Editors
Contributors
1: Essential Components of a Successful Breast Core Needle Biopsy Program: Imaging Modalities, Sampling Techniques, Specimen Processing, Radiologic/Pathologic Correlation, and Appropriate Follow-Up
Introduction
Benefits to Patients
Benefits to Radiologists
Benefits to Pathologists
Benefits to Surgeons
Benefits for Biomedical Research
Benefits to the Medical Care System
Breast Imaging Modalities
Breast Imaging Reporting and Data System (BI-RADS)
Mammography
Masses
Size
Margin
Density
Architectural Distortion
Focal Asymmetry
Calcifications
Reasons for Absent Calcifications
Ultrasound
Magnetic Resonance Imaging
Focus of Enhancement
Mass-Like Enhancement
Non-mass Enhancement
Types of Needle Biopsies
Needle Size
Fine Needle Aspiration
Advantages
Disadvantages
Core Needle Biopsies: Non-vacuum-Assisted
Advantages
Disadvantages
Core Needle Biopsies: Vacuum-Assisted
Advantages
Disadvantages
Core Needle Biopsy: Cryobiopsy
Disadvantages
Very Large Core Needle Biopsies
Advantage
Disadvantages
“Intact” Biopsies
Advantages
Disadvantages
Tru-Cut Core Needle Biopsies for Palpable Masses
Clips and Bio-absorbable Carrier Material
Clips
Bio-absorbable Carrier Material (BCM)
Core Needle Biopsy Specimen Processing
Specimen Requisition Form
Specimen Preparation in the Radiology Department
Touch Preparations from Cores
Specimen Processing in the Pathology Department
Specimen Processing: Histology
Procedure-Related Tissue Changes in Core Needle Biopsies
Radiologic/Pathologic Correlation
Role of Pathologist
Role of Radiologist
Role of a Core Correlation Conference
Excisions and Mastectomies After Core Needle Biopsies
Clips
Causes of Clip Migration
Localization Devices
Specimen Radiography of Excisions
Mastectomies
Core Sites in Excisions and Mastectomies
Gross Appearance
Acute Biopsy Site Changes and Biodegradable Carrier Material (BCM)
Carcinomas with Indeterminant Size by Pathology
Effects on Molecular Assays
Epithelial Displacement
True Needle Track Seeding by Malignant Cells
Squamous Cells at Core Sites
Reactive Spindle Cell Nodule
Infarction
Hemorrhage
Cautery or Freezing Artifact
Healed Core Needle Biopsy Sites
Missing Cancers After Core Needle Biopsy
Complete Removal of Cancer by Core Needle Biopsy
Neoadjuvant Therapy
The Surgery Did Not Remove the Cancer
The Original Core Needle Biopsy Diagnosis Was Incorrect
The Cancer Was Not Found in the Specimen
The Specimen Has Been Misidentified
Recurrent Cancers After Core Needle Biopsy
Carcinoma at a Prior Core Site Showing Carcinoma
Carcinoma at the Site of the Needle Track
Carcinoma at a Prior Core Site Showing Benign Results
References
2: Pattern-Based Evaluation of Breast Core Needle Biopsies
Introduction
Pattern-Based Approach to Core Needle Biopsies
Small Glandular Proliferations
ER-Positive Small Glandular Proliferations
ER-Negative (Triple-Negative) Small Glandular Proliferations
Spindle Cell Proliferations
Cystically Dominant Lesions of the Breast
Characteristics of Luminal Secretions and Calcifications in Cystically Dominant Lesions
References
3: Multiples in Core Needle Biopsy Samples
Introduction
The Value of H&E Levels
Scenario 1: Seemingly Nondiagnostic Findings on Initial H&E Levels
Scenario 2: Excluding Concomitant Microinvasive Carcinoma
Scenario 3: Incomplete or Tangential Sections
Multiple Diagnoses in Core Needle Biopsy Samples
Multiplex Immunohistochemistry
References
4: Inflammatory, Reactive, and Infectious Conditions of the Breast
Fat Necrosis
Overview
Gross and Radiologic features
Microscopic Features
Differential Diagnosis
Prognosis
Mammary Duct Ectasia
Overview
Gross and Radiologic Features
Microscopic Features
Differential Diagnosis
Immunohistochemistry
Pathogenesis
Prognosis
Granulomatous Lobular Mastitis
Overview
Gross and Radiologic Features
Microscopic Features
Differential Diagnosis
Special Histochemical Stains and Methods to Identify Bacteria
Pathogenesis
Prognosis
Sarcoidosis
Overview
Gross and Radiologic Features
Microscopic Features
Differential Diagnosis
Prognosis
Diabetic Mastopathy
Overview
Gross and Radiologic Features
Microscopic and Immunohistochemical Features
Differential Diagnosis
Pathogenesis
Prognosis
Amyloidosis
Overview
Pathogenesis
Gross and Radiologic Findings
Microscopic Features
Differential Diagnosis
Prognosis
IgG4-Related Sclerosing Mastitis
Overview
Gross and Radiologic Features
Microscopic Features
Differential Diagnosis
Prognosis
Inflammatory Myofibroblastic Tumor
Overview
Gross and Radiologic Features
Microscopic Features
Immunohistochemistry
Differential Diagnosis
Prognosis
Abscess and Infectious Conditions of the Breast
Overview
Abscess
Overview
Radiologic Features
Microscopic Features
Differential Diagnosis
Pathogenesis
Prognosis
Other Infectious Conditions
Bacterial Infections
Tuberculous Mastitis
Fungal Infections
Parasitic Infections
References
5: Adenosis, Sclerosing Lesions, Microglandular Adenosis, and Mucocele-Like Lesions
Adenosis
Overview
Clinical, Radiologic, and Gross Features
Microscopic Features
Differential Diagnosis
Immunohistochemical Workup
Pathogenesis
Clinical Management and Prognosis
Apocrine Adenosis
Radial Scars and Complex Sclerosing Lesions
Overview
Clinical, Radiologic, and Gross Features
Microscopic Features
Differential Diagnosis
Immunohistochemical Workup
Pathogenesis
Clinical Management and Prognosis
Microglandular Adenosis
Overview
Clinical, Radiologic, and Gross Features
Microscopic Features
Differential Diagnosis
Immunohistochemical Workup
Pathogenesis
Clinical Management and Prognosis
Mucocele-Like Lesions
Overview
Clinical, Radiologic, and Gross Features
Microscopic Features
Differential Diagnosis
Immunohistochemical Workup
Pathogenesis
Clinical Management and Prognosis
References
6: Papillary and Epithelial–Myoepithelial Tumors
Papillary Lesions
Overview
Intraductal Papilloma
Overview and Clinical Presentation
Gross and Radiographic Features
Microscopic Features
Differential Diagnosis and Immunohistochemical Features
Molecular Features of Intraductal Papilloma
Management of Papilloma in Core Needle Biopsy
Prognosis
Papillary Carcinoma
Overview
Gross and Radiographic Features
Microscopic Features
Subtypes of Papillary Carcinoma: Specific Key Features
Papillary DCIS
Encapsulated Papillary Carcinoma
Solid Papillary Carcinoma
Invasive Papillary Carcinoma
Molecular Features of Papillary Carcinoma
Other Considerations with Core Needle Biopsy
Epithelial–Myoepithelial Tumors
Pleomorphic Adenoma
Overview
Gross and Radiographic Features
Microscopic Features and Differential Diagnosis
Immunohistochemistry
Molecular Features
Management in Core Needle Biopsy
Prognosis
Adenomyoepithelioma
Overview
Gross and Radiographic Features
Microscopic Features and Differential Diagnosis
Immunohistochemistry
Molecular Features
Management in Core Needle Biopsy
Malignancy in Adenomyoepithelioma (Adenomyoepithelioma with Carcinoma)
References
7: Fibroepithelial Lesions
Mammary Hamartoma
Overview and Clinical Presentation
Gross and Radiologic Features
Microscopic Features
Immunohistochemistry
Differential Diagnosis
Pathogenesis and Risk Factors
Prognosis and Clinical Management
Fibroadenoma
Overview and Clinical Presentation
Gross and Radiologic Features
Microscopic Features
Immunohistochemistry
Differential Diagnosis
Pathogenesis and Risk Factors
Molecular Pathology
Prognosis and Clinical Management
Risk of Development of Subsequent Carcinoma
Clinical Management and Outcomes
Phyllodes Tumor
Overview and Clinical Presentation
Gross and Radiologic Features
Microscopic Features
Histological Features
Phyllodes Tumor Grading
Recurrent and Metastatic Phyllodes Tumors
Immunohistochemistry
Differential Diagnosis
Pathogenesis, Molecular Pathology, and Risk Factors
Prognosis and Clinical Management
Local Recurrence
Metastases and Survival
Treatment
References
8: Columnar Cell Lesions and Flat Epithelial Atypia
Overview
Clinical and Radiographic Features
Microscopic Features
Differential Diagnosis
Immunohistochemical Features
Pathogenesis
Management in Core Needle Biopsy
Prognosis
References
9: Intraductal Proliferations (DCIS, ADH, and UDH)
Introduction
Ductal Carcinoma In Situ
Overview
Gross and Radiologic Features
High-Grade DCIS Spectrum
Low-Grade DCIS Spectrum
Microscopic Features
High-Grade DCIS Spectrum
Low-Grade DCIS Spectrum
Differential Diagnosis
High-Grade DCIS Spectrum
Invasion Versus High-Grade DCIS
Pleomorphic LCIS
Atypical Cystic Hypersecretory or Atypical Pregnancy-Like (Pseudolactational) Changes
Posttreatment Changes
Low-Grade DCIS Spectrum
Limited Extent Low-Grade DCIS Versus ADH
Solid Patterns
Cribriform Patterns
Spindled Patterns
Papillary Patterns
Immunohistochemistry
Pathogenesis
Outcomes
Atypical Ductal Hyperplasia
Overview
Gross and Radiologic Features
Microscopic Features
Differential Diagnosis
ADH Borderline with Low-Grade DCIS
ADH Versus UDH
Minimal Extent ADH Versus FEA or Non-atypical Columnar Cell Change/Benign
Immunohistochemistry
Pathogenesis
Outcomes
Usual Ductal Hyperplasia
Overview
Gross and Radiologic Features
Microscopic Features
Differential Diagnosis
Immunohistochemistry
Pathogenesis
Outcomes
References
10: Invasive Breast Carcinoma of No Special Type, Microinvasive Carcinoma, Tubular Carcinoma, and Cribriform Carcinoma
Invasive Breast Carcinoma of No Special Type
Overview
Gross and Radiologic Features
Microscopic Features
Histologic Grading
Reporting Core Needle Biopsy
Differential Diagnosis
Immunohistochemistry
Pathogenesis
Prognosis
Microinvasive Breast Carcinoma
Overview
Gross and Radiologic Features
Microscopic Features
Differential Diagnosis
Immunohistochemistry
Prognosis
Tubular Carcinoma
Overview
Gross and Radiologic Features
Microscopic Features
Differential Diagnosis
Complex Sclerosing Lesions/Radial Scar
Tubular Adenosis and Sclerosing Adenosis
Microglandular Adenosis
Syringomatous Tumor of the Nipple-Areolar Region
Well-Differentiated IBC with Tubule Formation
Low-Grade Adenosquamous Carcinoma
Tubulolobular Carcinoma
Immunohistochemistry
Pathogenesis
Prognosis
Invasive Cribriform Carcinoma
Overview
Gross and Radiologic Features
Microscopic Features
Differential Diagnosis
Cribriform DCIS
Adenoid Cystic Carcinoma (AdCC)
Collagenous Spherulosis
Invasive Mammary Carcinoma with Osteoclast-Like Giant Cells
Immunohistochemistry
Prognosis
References
11: Triple-Negative/Basal-Like Breast Carcinomas
Overview
Gross and Radiologic Features
Microscopic Features
Differential Diagnosis
Pathogenesis: Histopathology and Biology
Prognosis and Review of the Core Needle Biopsy Literature and Its Significance to Clinical Management
Conclusions
References
12: Less Common Triple-Negative Breast Cancers
Adenoid Cystic Carcinoma
Overview and Clinical Presentation
Gross and Radiologic Features
Microscopic Features
Immunohistochemistry
Differential Diagnosis
Pathogenesis and Risk Factors
Prognosis and Clinical Management
Tall Cell Carcinoma with Reversed Polarity
Overview and Clinical Presentation
Gross and Radiologic Features
Microscopic Features
Immunohistochemistry
Differential Diagnosis
Pathogenesis and Risk Factors
Prognosis and Clinical Management
Mucoepidermoid Carcinoma
Overview and Clinical Presentation
Gross and Radiologic Features
Microscopic Features
Immunohistochemistry
Differential Diagnosis
Pathogenesis
Prognosis and Clinical Management
Secretory Carcinoma
Overview
Gross and Radiologic Features
Microscopic Features
Immunohistochemistry
Differential Diagnosis
Pathogenesis
Prognosis and Clinical Management
Carcinoma with Apocrine Differentiation
Overview and Clinical Presentation
Gross and Radiologic Features
Microscopic Features
Immunohistochemistry
ER, PR, AR, and HER2 Biomarkers
Markers of Apocrine Differentiation
Other Immunohistochemical Markers
Differential Diagnosis
Pathogenesis and Risk Factors
Prognosis and Clinical Management
Metaplastic Carcinoma
Overview and Clinical Presentation
Gross and Radiologic Features
Low-Grade Adenosquamous Carcinoma
Microscopic Features
Immunohistochemistry
Differential Diagnosis
Fibromatosis-Like Metaplastic Carcinoma
Microscopic Features
Immunohistochemistry
Differential Diagnosis
Spindle Cell Carcinoma
Microscopic Features
Immunohistochemistry
Differential Diagnosis
Squamous Cell Carcinoma
Microscopic Features
Immunohistochemistry
Differential Diagnosis
Metaplastic Carcinoma with Heterologous Mesenchymal Differentiation
Microscopic Features
Immunohistochemistry
Differential Diagnosis
Mixed Metaplastic Carcinomas
Pathogenesis and Risk Factors
Prognosis and Clinical Management
Invasive Breast Carcinoma with Medullary Pattern
Overview and Clinical Presentation
Gross and Radiologic Features
Microscopic Features
Immunohistochemistry
Differential Diagnosis
Pathogenesis and Risk Factors
Prognosis and Clinical Management
References
13: Special Histologic Types and Special Morphologic Patterns of Invasive Ductal Carcinoma of No Special Type: Mucinous, Micropapillary, Mucinous Cystadenocarcinoma, Neuroendocrine Neoplasm, Cystic Hypersecretory, Glycogen-Rich Clear Cell, Carcinoma with
Mucinous Carcinoma
Overview
Gross and Radiologic Features
Microscopic Features
Differential Diagnosis
Immunohistochemical Workup
Pathogenesis
Prognosis
Invasive Micropapillary Carcinoma
Overview
Gross and Radiologic Features
Microscopic Features
Differential Diagnosis
Immunohistochemical Workup
Pathogenesis
Prognosis
Mucinous Cystadenocarcinoma
Overview
Gross and Radiologic Features
Microscopic Features
Differential Diagnosis
Immunohistochemical Workup
Pathogenesis
Prognosis
Neuroendocrine Neoplasm
Overview
Gross and Radiologic Features
Microscopic Features
Differential Diagnosis
Immunohistochemical Workup
Pathogenesis
Prognosis
Cystic Hypersecretory Lesions Including Cystic Hypersecretory Carcinoma
Overview
Gross and Radiologic Features
Microscopic Features and Differential Diagnosis
Immunohistochemical Workup
Pathogenesis
Prognosis and Management in the Core Biopsy Setting
Glycogen-Rich Clear-Cell Carcinoma
Overview
Gross and Radiologic Features
Microscopic Features
Differential Diagnosis
Immunohistochemical Workup
Pathogenesis
Prognosis
Invasive Mammary Carcinoma with Osteoclast-like Giant Cells
Overview
Gross and Radiologic Features
Microscopic Features
Differential Diagnosis
Immunohistochemical Workup
Pathogenesis
References
14: Atypical Lobular Hyperplasia and Lobular Carcinoma In Situ
Overview
Nomenclature and Classification
Clinical Features
Gross and Radiologic Features
Radiologic Features in ALH and Classic LCIS
Radiologic Features in Pleomorphic and Florid LCIS
Microscopic Features
Atypical Lobular Hyperplasia and Classic LCIS
Pleomorphic LCIS
Florid LCIS
Immunohistochemistry
Differential Diagnosis
Distinction of ALH from Classic LCIS
Distinction of ALH from Benign Mimics
Distinguishing Between LCIS and DCIS
Distinguishing Classic LCIS from Pleomorphic/Florid LCIS
Diagnosis of Subtle Invasive Lobular Carcinoma Arising in Association with LCIS
Lobular Neoplasia (or LCIS) Involving Different Lesions
Pathogenesis
Prognosis and Management
Lobular Neoplasia as a Risk Factor for Invasive Breast Carcinoma
LN as a Non-obligate Precursor of Invasive Breast Carcinoma
Management of ALH and Classic LCIS
Management of Pleomorphic LCIS and Florid LCIS
References
15: Invasive Lobular Carcinoma
Overview
Incidence and Clinical Presentation
Gross and Radiologic Features
Microscopic Features
Classic ILC
Morphologic Variants of ILC
Histologic Grading
Tumor Microenvironment
Immunohistochemistry
Prognostic/Predictive Markers
Other Immunohistochemical Adjuncts
Differential Diagnosis
Pathogenesis
Prognosis and Clinical Management
References
16: Benign and Malignant Mesenchymal Tumors
Overview
Benign Adipose, Smooth Muscle, and Hamartomatous Lesions
Lipoma
Overview
Gross and Radiologic Features
Microscopic Features
Differential Diagnosis
Immunohistochemical Workup
Pathogenesis
Prognosis and Management
Angiolipoma
Overview
Gross and Radiologic Features
Microscopic Features
Differential Diagnosis
Immunohistochemical Workup
Pathogenesis
Prognosis and Management
Hibernoma
Overview
Gross and Radiologic Features
Microscopic Features
Differential Diagnosis
Immunohistochemical Workup
Pathogenesis
Prognosis and Management
Leiomyoma
Overview
Gross and Radiologic Features
Microscopic Features
Differential Diagnosis
Immunohistochemical Workup
Pathogenesis
Prognosis and Management
Hamartoma
Overview
Gross and Radiologic Features
Microscopic Features
Differential Diagnosis
Immunohistochemical Workup
Pathogenesis
Prognosis and Management
Nodular Mucinosis
Overview
Gross and Radiologic Features
Microscopic Features
Differential Diagnosis
Immunohistochemical Workup
Pathogenesis
Prognosis and Management
Myofibroblast/Fibroblast-Derived Lesions
Myofibroblastoma
Overview
Gross and Radiologic Features
Microscopic Features
Differential Diagnosis
Immunohistochemical Workup
Pathogenesis
Prognosis and Management
Pseudoangiomatous Stromal Hyperplasia
Overview
Gross and Radiologic Features
Microscopic Features
Differential Diagnosis
Immunohistochemical Workup
Pathogenesis
Prognosis and Management
Fibromatosis
Overview
Gross and Radiologic Features
Microscopic Features
Differential Diagnosis
Immunohistochemical Workup
Pathogenesis
Prognosis and Management
Dermatofibroma
Overview
Gross and Radiologic Features
Microscopic Features
Differential Diagnosis
Immunohistochemical Workup
Pathogenesis
Prognosis and Management
Neural Derived Tumors
Granular Cell Tumor
Overview
Gross and Radiologic Features
Microscopic Features
Differential Diagnosis
Immunohistochemical Workup
Pathogenesis
Prognosis and Management
Neurofibroma
Overview
Gross and Radiologic Features
Microscopic Features
Differential Diagnosis
Immunohistochemical Workup
Pathogenesis
Prognosis and Management
Schwannoma
Overview
Gross and Radiologic Features
Microscopic Features
Differential Diagnosis
Immunohistochemical Workup
Pathogenesis
Prognosis and Management
Primary Breast Sarcomas
Overview
Gross and Radiologic Features
Microscopic Features
Differential Diagnosis
Immunohistochemical Workup
Pathogenesis
Prognosis and Management
References
17: Vascular Lesions of the Breast
Benign Vascular Lesions
Overview
Clinical and Radiologic Features
Microscopic Features
Differential Diagnosis
Immunohistochemical Workup
Treatment and Prognosis
Angiosarcoma
Overview
Clinical and Radiologic Features
Gross and Microscopic Features
Epithelioid Angiosarcoma
Differential Diagnosis
Immunohistochemistry and Molecular Alterations
Treatment and Prognosis
Atypical Vascular Lesions
Overview
Clinical and Radiologic Features
Microscopic Features
Differential Diagnosis
Immunohistochemistry
Treatment and Prognosis
References
18: Breast Tumors in Adolescents/Children and Males
Children and Adolescents
Overview
Developmental and Congenital Abnormalities
Nonneoplastic Lesions
Benign Masses
Fibroadenoma
Pseudoangiomatous Stromal Hyperplasia (PASH)
Juvenile Papillomatosis
Carcinoma
Secretory Carcinoma
Overview
Gross and Radiologic Features
Microscopic Features
Immunohistochemistry and Molecular Characterization
Treatment and Prognosis
Other Malignant Tumors
Males Including Adolescents
Gynecomastia
Overview
Gross and Radiologic Features
Microscopic Features (Including ADH and DCIS Arising in Gynecomastia)
Immunohistochemistry
Treatment and Prognosis
Ductal Carcinoma In Situ (DCIS)
Overview
Gross and Radiologic Features
Microscopic Features
Differential Diagnosis
Immunohistochemistry
Treatment and Prognosis
Invasive Carcinoma
Overview
Gross and Radiologic Features
Microscopic Features
Differential Diagnosis
Immunohistochemistry (Biomarkers)
Treatment and Prognosis
Metastases to the Adult Male Breast
References
19: Lesions of the Nipple
Overview
Lesions of the Large Lactiferous Ducts
Squamous Metaplasia of Lactiferous Ducts
Gross and Radiologic Features
Microscopic Features
Differential Diagnosis
Pathogenesis: Histopathology and Biology
Prognosis and Clinical Management
Mammary Duct Ectasia
Gross and Radiologic Features
Microscopic Features
Differential Diagnosis
Pathogenesis: Histopathology and Biology
Prognosis and Clinical Management
Nipple Adenoma
Gross and Radiologic Features
Microscopic Features
Differential Diagnosis
Pathogenesis: Histopathology and Biology
Prognosis and Clinical Management
Subareolar Sclerosing Duct Hyperplasia
Gross and Radiologic Features
Microscopic Features
Differential Diagnosis
Pathogenesis: Histopathology and Biology
Prognosis and Clinical Management
Syringomatous Tumor
Gross and Radiologic Features
Microscopic Features
Differential Diagnosis
Pathogenesis: Histopathology and Biology
Prognosis and Clinical Management
Nipple-Invasive Primary Carcinomas
Lesions that Involve the Skin
Paget Disease of the Nipple
Gross and Radiologic Features
Microscopic Features
Differential Diagnosis
Pathogenesis: Histopathology and Biology
Prognosis and Clinical Management
Conclusion
References
20: Lymphoid and Hematopoietic Tumors of the Breast
Overview
Primary Lymphoma of the Breast
Overview
Gross and Radiologic Features
Microscopic Features and Immunohistochemical Workup
Diffuse Large B-Cell Lymphoma
Extranodal Marginal Zone Lymphoma (MALT Lymphoma)
Follicular Lymphoma
Burkitt Lymphoma
Breast Implant-Associated Anaplastic Large-Cell Lymphoma
Other Rare Types of Primary Breast Lymphoma
Differential Diagnosis
Pathogenesis
Treatment and Prognosis
Secondary Lymphoma of the Breast
Other Rare Malignant Hematopoietic Disorders of the Breast
Myeloid Sarcoma (Granulocytic Sarcoma)
Histiocytic Sarcoma
Plasma Cell Neoplasm
References
21: Special Clinical Settings: Tumors Arising in Pregnancy, Pregnancy-Like (Pseudolactational) Proliferations, Breast Carcinoma in the Pre-neoadjuvant Chemotherapy Setting, Recurrent Breast Carcinoma, and Inflammatory Breast Carcinoma
Tumors During Pregnancy
Histopathologic and Physiologic Changes in the Pregnant or Lactating Breast
Management of Breast Conditions in the Pregnant Patient
Radiologic Imaging and Biopsy
Surgery
Chemotherapy
Benign Tumors During Pregnancy
Lactating Adenoma
Overview
Gross and Radiologic Features
Microscopic Features
Differential Diagnosis
Immunohistochemical Workup
Pathogenesis
Treatment and Prognosis
Pregnancy-Associated Breast Carcinomas
Overview
Gross and Radiologic Features
Microscopic Features
Immunohistochemical Workup
Biomarker Evaluation
Molecular Subtypes
Treatment and Prognosis
Pregnancy-Like (Pseudolactational) Proliferations
Pregnancy-Like Change and Pregnancy-Like Hyperplasia
Overview
Gross and Radiologic Features
Microscopic Features
Differential Diagnosis for Pregnancy-Like Change
Differential Diagnosis for Pregnancy-Like Hyperplasia
Immunohistochemistry
Pathogenesis and Biologic Behavior
Treatment and Prognosis
Breast Carcinoma in the Pre-neoadjuvant Chemotherapy Setting
Overview
Evaluation and Reporting of the Pre-neoadjuvant Chemotherapy Core Biopsy Specimen
Evaluation of the Sentinel/Axillary Lymph Nodes (Pre-neoadjuvant Chemotherapy)
Predictive Factors for Response to Neoadjuvant Chemotherapy Assessed in the Core Biopsy Sample
Evaluation and Reporting of the Neoadjuvant Chemotherapy-Treated Excisional Specimen
Recurrent Breast Carcinoma
Overview
Clinical Presentation and Workup
Treatment and Prognosis
Inflammatory Breast Carcinoma
Overview
Gross and Radiologic Features
Microscopic Features
Differential Diagnosis and Immunohistochemical Workup
Pathologic Reporting in a Biopsy Sample
Pathogenesis
Treatment and Prognosis
References
22: Current Standard Clinical Predictive Markers
Introduction
Biomarker Testing in Specific Clinical Scenarios
Hormone Receptors
Interpretation
Androgen Receptor
Limitations and Pitfalls
HER2
HER2 Testing by Immunohistochemistry
Interpretation
Limitations and Pitfalls
HER2 Testing by In Situ Hybridization
Limitations and Pitfalls
Molecular Subtyping
Proliferation
Interpretation
Limitations and Pitfalls
References
23: Future Role of Molecular Profiling in Small Breast Samples and Personalised Medicine
Introduction
Genomics for Personalised Medicine
Gene Expression Profiling
Gene Expression-Based Clinical Tools
Proteomics
Ductal Carcinoma In Situ (DCIS)
Sentinel Lymph Node Biopsies: OSNA
Practical Considerations for the Molecular Analysis of Small Tissue Biopsies
The ‘Liquid Biopsy’
Summary
References
24: Metastases to the Breast
Overview
Gross and Radiologic Features of Metastases to the Breast
Microscopic Features
Breast-Specific Markers
Specific Entities
Hematopoietic Neoplasms
Metastatic Melanoma
Microscopic Features
Differential Diagnosis
Immunohistochemical Workup
Metastatic Carcinomas and Epithelial Neoplasms
Pulmonary Adenocarcinoma
Microscopic Features
Differential Diagnosis
Immunohistochemical Workup
Pulmonary Squamous Cell Carcinoma
Microscopic Features
Differential Diagnosis
Immunohistochemical Workup
Pulmonary Small-Cell Carcinoma
Microscopic Features
Differential Diagnosis
Immunohistochemical Workup
Ovarian Carcinoma
Microscopic Features
Differential Diagnosis
Immunohistochemical Workup
Endometrial Carcinoma
Microscopic Features
Differential Diagnosis
Immunohistochemical Workup
Renal Cell Carcinoma
Microscopic Features
Differential Diagnosis
Immunohistochemical Workup
Well-Differentiated Neuroendocrine Tumor/Carcinoid Tumor
Microscopic Features
Differential Diagnosis
Immunohistochemical Workup
Prostate Carcinoma
Microscopic Features
Differential Diagnosis
Immunohistochemical Workup
Other Rare Carcinomas
Microscopic Features, Differential Diagnosis, and Immunohistochemical Workup
Metastatic Sarcomas
Leiomyosarcoma
Microscopic Features
Differential Diagnosis
Immunohistochemical Workup
Alveolar Rhabdomyosarcoma
Microscopic Features
Differential Diagnosis
Immunohistochemical Workup
Other Rare Sarcomas
Microscopic Features, Differential Diagnosis, and Immunohistochemical Workup
Pathogenesis, Prognosis, and Review of the Literature
References
25: Dermatologic Mimickers of Breast Lesions Arising in the Breast Skin, Subcutis, or Axilla
General Clinical and Radiologic Considerations
Algorithmic Approach to Establish a Differential Diagnosis
Immunohistochemical Workup
Epithelial Neoplasms
Spindle Cell Tumors
Histopathological Differential Diagnosis
Pseudoneoplastic Lesions of Sweat Glands
Eccrine Nevus (Hamartoma)
Apocrine Nevus (Hamartoma)
Reactive Lesions/Syringometaplasias
Tumors of the Surface Epithelium
Basal Cell Carcinoma
Fibroepithelioma of Pinkus
Squamous Cell Carcinoma
Hair Follicle Neoplasms
Trichoblastoma
Benign and Malignant Sebaceous Neoplasms
Sebaceous Adenoma and Sebaceoma
Extraocular Sebaceous Carcinoma
Benign and Malignant Apocrine Neoplasms
Apocrine Hidrocystoma and Cystadenoma
Syringocystadenoma Papilliferum
Nipple Adenoma
Chondroid Syringoma
Sweat Gland Adenomas (Tubular Apocrine Adenoma Versus Papillary Eccrine Adenoma)
Apocrine Adenocarcinomas
Ductopapillary Apocrine Adenocarcinoma
Ductal Apocrine Adenocarcinoma
Primary Cutaneous Mucinous Carcinoma
Benign and Malignant Eccrine Tumors
Syringoma
Eccrine Poroma
Eccrine Porocarcinoma
Eccrine Syringofibroadenoma
Eccrine Cylindroma
Eccrine Spiradenoma
Eccrine Hidradenoma
Hidradenocarcinoma
Microcystic Adnexal Carcinoma
Squamoid Eccrine Ductal Carcinoma
Adenoid Cystic Carcinoma of the Skin
Eccrine Adenocarcinomas that Histologically Simulate Metastatic Tumors
Ductal Eccrine Adenocarcinoma
Extramammary Paget Disease
Paget Disease of the Skin, Apocrine Type
Neuroendocrine Tumors
Merkel Cell Carcinoma
Melanocytic Proliferations
Mesenchymal Tumors
Fibrohistiocytic Tumors
Dermatofibroma
Atypical Fibroxanthoma
Fibroblastic Tumors
Keloid
Storiform Collagenoma
Dermatofibrosarcoma Protuberans
Myofibroblastic Tumors
Dermatomyofibroma
Smooth Muscle Tumors
Smooth Muscle Hamartoma (Becker’s Nevus)
Cutaneous Leiomyomas
Cutaneous Leiomyosarcomas
Nerve Sheath Tumors
References
Index
