“ “ Strength does not come from Strength does not come from winning. Struggles & Hardship winning. Struggles & Hardship develop your strength. When develop your strength. When you go through hardship and you go through hardship and decide not to surrender, that is decide not to surrender, that is strength” strength” Arnold Arnold Schwarzenegger Schwarzenegger Bodybuilder and Actor Bodybuilder and Actor
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““Strength does not come from Strength does not come from winning. Struggles & Hardship winning. Struggles & Hardship develop your strength. When you go develop your strength. When you go through hardship and decide not to through hardship and decide not to surrender, that is strength”surrender, that is strength”
Arnold SchwarzeneggerArnold Schwarzenegger Bodybuilder and ActorBodybuilder and Actor
Pathology of Breast Pathology of Breast CancerCancer
Dr. Venkatesh M. ShashidharDr. Venkatesh M. ShashidharSenior Lecturer in PathologySenior Lecturer in PathologyFiji School of MedicineFiji School of Medicine
IntroductionIntroduction
Modified sweat glands.Modified sweat glands. Lobes and lobules of gland Lobes and lobules of gland in fat tissue stroma.in fat tissue stroma. Ducts emerge from acini of glandsDucts emerge from acini of glands Smaller ducts join to form lactiferous Smaller ducts join to form lactiferous
ductsducts Lactiferous ducts merge just beneath the Lactiferous ducts merge just beneath the
nipple to form a lactiferous sinus.nipple to form a lactiferous sinus. Then individually open on nipple Then individually open on nipple
Features (Fibroadenoma)Features (Fibroadenoma) Young age 3Young age 3rdrd decade. decade. Single, rounded, mobile, painless lumps. Single, rounded, mobile, painless lumps. No scarring or calcification.No scarring or calcification. Slit like glands in Fibrous stromaSlit like glands in Fibrous stroma
Breast Carcinoma Breast Carcinoma
20% of all cancers in 20% of all cancers in womenwomen
Commonest cause of death - Commonest cause of death - 35-55y35-55y
In UK 1 in 10-12 chancesIn UK 1 in 10-12 chances 1 in 8 women in US1 in 8 women in US Less incidence in AsiaLess incidence in Asia Majority of cancers arise in Majority of cancers arise in
the ducts.the ducts. Very rare before age 25Very rare before age 25
Risk Factors:Risk Factors:
Female sex..!, Age, Obesity, high fat diet Female sex..!, Age, Obesity, high fat diet Maternal relative with breast cancer. Maternal relative with breast cancer. Longer reproductive span. Longer reproductive span. Nulliparity, Oral contraceptivesNulliparity, Oral contraceptives Later age at first pregnancy. Later age at first pregnancy. Atypical epithelial hyperplasia. Atypical epithelial hyperplasia. Previous breast cancer/Endometrial Ca. Previous breast cancer/Endometrial Ca. Geographic factors - countryGeographic factors - country BRCA1 and BRCA2BRCA1 and BRCA2 genes genes
Etiology of Breast Carcinoma:Etiology of Breast Carcinoma:
Clinical Features:Clinical Features:
Physiologic vs Pathologic changesPhysiologic vs Pathologic changes Lump / lumpsLump / lumps Lumps are much more common than CaLumps are much more common than Ca Characters of Characters of lumplump* and * and ageage** Discharge in many conditions.Discharge in many conditions. Hard, soft, inflammationHard, soft, inflammation Skin fixation / Skin fixation / SkinSkin retractionretraction * *
Estrogen receptor expression is Estrogen receptor expression is proportional to differntiation of tumorproportional to differntiation of tumor
inversly proportional to prognosis and inversly proportional to prognosis and response to tamoxifen (receptor antagonist) response to tamoxifen (receptor antagonist) therapy.therapy.
Demonstrated by Immunoperoxidase Demonstrated by Immunoperoxidase special stain.special stain.
HER2HER2 The HER2 proto-oncogene encodes a cell The HER2 proto-oncogene encodes a cell
surface receptor that is overexpressed in surface receptor that is overexpressed in approximately 25%-30% of breast cancers. approximately 25%-30% of breast cancers.
Trastuzumab (Herceptin®) is the first Trastuzumab (Herceptin®) is the first monoclonal antibody that targets the monoclonal antibody that targets the extracelluar domain of the HER2 protein, extracelluar domain of the HER2 protein, and inhibits growth of breast cancer cells and inhibits growth of breast cancer cells that over express this protein. that over express this protein.
Estrogen receptor (ER) in nucleiEstrogen receptor (ER) in nuclei