Practical Breast Pathology. Tibor Tot

      

      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

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      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

       8. The Postoperative Work-up

       9. Assessment of the Most Important Prognostic Factors

       10. Case Demonstrations

       Index

      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