Breast برای بزرگنمایی عکسها کلیک را روی ان نگه دارید..... Figure 36.1 Terminal Duct-Lobular Unit. A, Diagrammatic representation of this structure. B, Photo- micrograph of this unit as seen in a normal adult female. ETD, Extralobular terminal duct; ITD, intralobular terminal duct Figure 36.2 Immunohistochemical Markers of Mammary Lobule. A, Mammaglobin, showing positivity in scattered secretory epithelial cells and material in the glandular lumen. B, Smooth muscle myosin heavy chain, showing positivity in the outer myoepithelial cell component. Smooth muscle cells present in adjacent vessel walls serve as internal controls Figure 36.3 Lactational or Secretory Changes in Mammary Lobule. Some of the acini of this lobule demonstrate cytoplasmic vacuolization and protrusion as well as nuclear enlargement in keeping with lactation or secretory change Figure 36.4 Postmenopausal Breast Tissue. The TDLU undergoes involution leaving few atrophic acini Figure 36.5 Pregnancy-Like Change in Mammary Lobule. A, Low- power view. B, Higher-power view Figure 36.6 Clear cell change Figure 36.7 Gross and Microscopic Appearance of Mammary Duct Ectasia. A, Some of the dilated ducts contain a thick dark material. B, Inflammatory stage of duct ectasia in which there is dilation of a large duct, with accumulation of lipid-rich detritus in the lumen and a florid inflammatory reaction rich in macrophages and plasma cells Figure 36.8 Post-traumatic fat necrosis involving breast Figure 36.9 Retraction of skin in a patient with fat necrosis (arrow), as seen in a photograph taken from a well-seasoned paper. (From Lee BJ, Adair F. Traumatic fat necrosis of the female breast and its differentiation from carcinoma. Ann Surg. 1924;80:670-691.) Figure 36.10 Lymphocytic Mastopathy. This process is characterized by periductal and perivascular lymphocytic infiltrates, fibrosis, and epithelioid myofibroblasts present in the stroma Figure 36.11 Cystic Neutrophilic Granulomatous Mastitis. In this field note the presence of "cystic" spaces cuffed by neutrophils and a background of lymphocytes, histiocytes, and giant cells (bottom left of field) Figure 36.12 Florid Granulomatous Reaction to Silicone. Foamy macrophages, foreign body-type multinucleated giant cells, and lym- phocytes are present Figure 36.13 Apocrine Metaplasia. The cells have abundant granular eosinophilic cytoplasm, often with an apical "apocrine snout." The nuclei are round, of medium size and have prominent nucleoli Figure 36.14 Usual Ductal Hyperplasia. In this proliferation note the presence of oval nuclei that are normochromatic, with slight overlap giving the cells a streaming appearance. The clefts are preferentially located at the periphery of the duct and there is a lack polarization of cells around the spaces Figure 36.15 Usual Ductal Hyperplasia. Note the oval shape of the nuclei and the parallel arrangement, resulting in a "streaming" effect Figure 36.16 Gynecomastoid Hyperplasia. A form of UDH characterized by micropapillary tufting of the lining epithelium; the micropapillae have broader bases and narrow pinched tips. The nuclei are also smaller and more hyperchromatic at the tips than at the bases of the micropapillae Figure 36.17 Collagenous Spherulosis. The round spaces contain eosinophilic or sometimes basophilic collagen-rich spherules composed of basement membrane material. Note the more spindled nuclei of the myoepithelial cells surrounding the spaces containing the eosinophilic basement membrane material Figure 36.18 Lobular Carcinoma In Situ Involving Collagenous Spherulosis. The monomorphic appearance of the LCIS cells in combina- tion with the cribriform appearance of the collagenous spherulosis can be a mimic for ductal carcinoma in situ at low power (A). At high power (B), the cytologic atypia and cellular dyshesion of the LCIS is better appreciated. Again, note the presence of myoepithelial cells surrounding the spaces containing the eosinophilic basement membrane material Figure 36.19 A and B, Cystic hypersecretory hyperplasia (CHH) is characterized by the presence of cystically dilated spaces containing a bright pink colloid-like material lined by cells that have relatively abundant vacuolated or secretory cytoplasm (A). The lesion can demonstrate areas of architectural and cytologic atypia (B), in this case sufficient for a diagnosis of ductal carcinoma in situ Figure 36.20 A and B, Atypical ductal hyperplasia. Proliferative ductal lesion with monomorphic cells and cribriform architectural pattern diagnosed as atypical ductal hyperplasia on account of these cytoarchi- tectural features and small lesion size Figure 36.21 Atypical Ductal Hyperplasia. This micropapillary prolifera- tion demonstrates bulbous micropapillations with enlarged atypical nuclei present both at the base and the tip of the micropapillations Figure 36.22 Atypical Ductal Hyperplasia. A, A TDLU with a predomi- nantly cribriform proliferation of monomorphic epithelial cells; some rigid bridges and bars are also present. B, At high power note the low-grade nuclear atypia and the polarization around the cribriform spaces Figure 36.23 Atypical Lobular Hyperplasia. A, There is expansion of the lobules by a monomorphic proliferation of atypical epithelial cells with round nuclei and indistinct nucleoli. B, The cells are dyshesive and often have intracytoplasmic lumina, which can be appreciated at higher power Figure 36.24 Atypical Lobular Hyperplasia. There is expansion of the lobules by a monomorphic proliferation of atypical epithelial cells with enlarged nuclei and small nucleoli. The cells are dyshesive and many have intracytoplasmic vacuoles Figure 36.25 Flat Epithelial Atypia. The spaces are dilated and lined by a stratified layer of cuboidal cells with low-grade cytologic atypia Figure 36.26 Flat Epithelial Atypia. A, The acini of the terminal duct lobular unit are variably dilated and the spaces lined by a stratified layer of monomorphic cuboidal cells. B, At higher power the low-grade cytologic atypia is appreciated as well as the apical snouts and secretions Figure 36.27 Columnar Cell Change. A, The acini of the terminal duct lobular unit are variably dilated and the spaces lined by a layer of columnar epithelial cells; a calcification is present in the lower left of the field. B, At higher power the columnar cells are seen to be arrayed perpendicular to the basement membrane; apical snouts are present Figure 36.28 Columnar Cell Hyperplasia. A, The acini of the terminal duct lobular unit are variably dilated and the spaces lined by a layer of columnar epithelial cells with some multilayering and tufting; calcifications are present in some acini (upper part of field). B, At higher power the columnar nature of the cells is appreciated as well as the apical snouts Figure 36.29 Gross Appearance of a Fibroadenoma. The lesion is sharply circumscribed and has a bulging cut surface with slit-like spaces. (Photograph courtesy of Dr. M. DiStasio) Figure 36.30 Microscopic Appearance of Fibroadenoma. A, Low- power image showing the circumscribed border, mixed glandular and stromal growth. B, On higher power, the bland nature of the stromal spindle cells is appreciated as well as the presence of mild epithelial hyperplasia Figure 36.31 Juvenile Fibroadenoma. In this particular lesion the pericanalicular growth pattern predominates; florid hyperplasia is often seen as part of the epithelial component Figure 36.32 Fibroadenoma with focal involvement by low-grade ductal carcinoma in situ Figure 36.33 Gross Appearance of Phyllodes Tumor. The tumor shown in (A) exhibits the typical appearance of the cut surface. The tumor illustrated in (B) has undergone extensive infarction Figure 36.34 A and B, Two views of benign phyllodes tumor, showing cleft-like spaces and condensation of stromal cells under the epithelium Figure 36.35 A and B, Malignant phyllodes tumor with liposarcomatous differentiation of the neoplastic stromal component Figure 36.36 Periductal Stromal Tumor. A, This fibroepithelial tumor lacks the circumscription of fibroadenoma or phyllodes tumor and instead is seen as dispersed nodules. B, Higher power view reveals the hypercel- lular stroma surrounding a benign epithelial element Figure 36.37 Sclerosing Adenosis. A, Low-power view. The lobular configuration of the small glandular proliferation is readily apparent even on this core needle biopsy specimen. B, Medium-power view. Note the spindle shape of the myoepithelial cells present. C, Immunohistochemical stain for p63 showing strong immunoreactivity in the myoepithelial cell component Figure 36.38 Sclerosing Adenosis. A, Low-power view. The lobular configuration of the lesion is obvious. B, Medium-power view of the myoepithelial cells in the center of the TDLU. C, Actin immunostain showing strong reactivity in the myoepithelial cell component Figure 36.39 Benign "perineural invasion" in a breast lesion that had elsewhere the typical features of sclerosing adenosis Figure 36.40 Sclerosing Adenosis With Lobular Carcinoma In Situ. A, Note the absence of infiltrative features at the border of the proliferation on low power. B, High power confirming the presence of LCIS in adenosis Figure 36.41 Microglandular Adenosis. A, Low-power appearance, showing haphazardly scattered small round glands. B, On high power, the glands are open and contain bright eosinophilic luminal secretion. There is no myoepithelial cell layer Figure 36.42 Atypical Microglandular Adenosis. A, Intermediate-power appearance, showing haphazardly arranged small round glands peripherally, with solid nests centrally. B, On high power, the cytologic atypia is appreciated; some luminal secretions are retained (top right of field). C, An S-100 protein immunostain is strongly positive. D, Estrogen receptor immunostain is negative in microglandular adenosis with good internal control in an adjacent normal duct Figure 36.43 Apocrine Adenosis. A, This low-power image shows the lobulocentric architecture of adenosis; apocrine features are present. B, At higher power, the apocrine cells can be evaluated. The nuclei are round with large nucleoli, but there is no significant nuclear enlargement or variability Figure 36.44 Tubular Adenosis. This low-power image shows the characteristic elongated, tubular, and branching glands of tubular adenosis arranged in a somewhat haphazard pattern Figure 36.45 Gross appearance of radial scar Figure 36.46 Radial Scar. A, Typical stellate shape of radial scar as seen on low power. B, Benign ductular structures are entrapped in the central fibroelastotic stroma Figure 36.47 A and B, Radial scar with associated low-grade ductal carcinoma in situ Figure 36.48 Gross Appearance of a Lactating Adenoma. The mass has a distinct lobular configuration, yellowish color, and marked vascularization Figure 36.49 So-called Lactating Adenoma. The hyperplastic lobules show secretory change Figure 36.50 Gross Appearance of an Intraductal Papilloma. A polypoid mass is seen protruding within the lumen of a markedly dilated duct Figure 36.51 Intraductal Papilloma. A, Low-power appearance showing complex arborizing architecture. B, High-power view showing dual cell composition, with a well-defined row of myoepithelial cells Figure 36.52 Sclerosed papilloma of breast showing entrapment of epithelial structures by fibrotic stroma resulting in a pseudoinvasive appearance Figure 36.53 Intraductal Papilloma Involved by Ductal Carcinoma In Situ. A, Low-power appearance showing complex arborizing architecture with fibrovascular cores (particularly prominent in the lower left of field) and epithelial proliferation. B, High-power view showing monomorphic epithelial cells with areas of cribriforming; note the presence of scattered myoepithelial cells juxtaposed to the fibrovascular cores Figure 36.54 Displaced epithelium following core needle biopsy of a benign intraductal papilloma. The presence of nests and single squamoid- appearing cells embedded in a reactive stroma are characteristic of displaced epithelium Figure 36.55 Papillary Ductal Carcinoma In Situ. The arborizing nature of this tumor and the prominent fibrovascular core in this example are not too different from those of a benign papilloma. The absence of a myoepithelial cell layer along the fibrovascular core along with the nuclear atypia clinch the diagnosis Figure 36.56 High-Power View of Papillary Ductal Carcinoma In Situ. Note the multi layering of cells, loss of nuclear polarity, marked hyperchromasia, and lack of a myoepithelial cell layer along the fibro- vascular cores Figure 36.57 A and B, Papillary ductal carcinoma in situ with "globoid" cells. These cells, which are immunoreactive for GCDFP-15 and cytokeratin, should not be confused with myoepithelial cells. B, The globoid cells are negative for myoepithelial cell markers, as is demonstrated with this smooth muscle actin immunostain Figure 36.58 Encapsulated Papillary Carcinoma of the Breast. The papillary configuration of the tumor is grossly evident Figure 36.59 Encapsulated Papillary Carcinoma. A, Low-power view showing the fibrous capsule surrounding an encapsulated papillary carcinoma. At this power, the papillary architecture is apparent. B, At higher power the monotonous neoplastic epithelial cell population is better appreciated; in addition, note the cribriform architecture, the absence of myoepithelial cells at the periphery of the EPC (lower left of field), and the absence of myoepithelial cells running along the fibrovascular cores Figure 36.60 Solid Papillary Carcinoma. A, Low-power view showing multiple solid nests of neoplastic epithelial cells. B, High-power view reveals the fibrovascular network not readily appreciated at low power. The cells have a streaming appearance in areas but are monotonous with cytologic atypia Figure 36.61 Solid Papillary Carcinoma with Reverse Polarity. A, Low-power view showing solid papillary nests of neoplastic epithelial cells infiltrating through the breast parenchyma. B, Higher-power dem- onstrating the fibrovascular core and the characteristic reverse polarization of the tumor cells Figure 36.62 A, Typical polypoid shape of nipple adenoma, as seen in a whole mount section. B, The complex architectural arrangement can lead to overdiagnosis. C, The continuity with the squamous epithelium of the skin is a characteristic feature of this entity Figure 36.63 Nipple Adenoma. High-power view showing usual ductal hyperplasia and necrosis present in a nipple adenoma Figure 36.64 Squamous Metaplasia of Lactiferous Ducts. A, Low- power view of a dilated nipple duct partially lined by squamous epithelium, with surrounding inflammation. B, High-power view of the squamous epithelial lining Figure 36.65 Eczematous hyperemic and eroded clinical appearance of Paget disease. (Courtesy of Dr RA Cooke, Brisbane, Australia. From Cooke RA, Stewart B. Colour Atlas of Anatomical Pathology. Edinburgh: Churchill Livingstone; 2004.) Figure 36.66 A and B, Low- and high-power views of Paget disease. A, The cleft-like separation between the tumor cells and the overlying squamous epithelium is characteristic. B, At high power, striking cytologic atypia in the tumor cells is readily apparent Figure 36.67 Immunohistochemical demonstration of malignant intraepidermal cells in Paget disease. A, EMA immunostain. B, HER2 immunostain Figure 36.68 Biopsy of nipple showing scattered clear cells without nuclear atypia in the basal layer ("Toker cells") Figure 36.69 Demonstration of the Use of Specimen Radiography. A mammographically detected breast lesion was excised. A, The specimen was sliced into four portions and a radiograph taken. A pattern of calcification identical to that seen in original mammogram was detected in slice 1 (arrow). B, The portion corresponding to this area of calcification was further divided into four fragments, and all four were embedded in paraffin. A radiograph of the cassettes shows that the suspicious area is in cassette 2 (arrow). The remainder of the slice (two fragments at right) shows no calcification. C and D, Low- and high-power views of the corresponding microscopic specimen demonstrating the microcalcifications Figure 36.70 Cytologic features of various types of breast lesion as seen in FNA specimens: (A) fibro- adenoma; (B) apocrine metaplasia; (C and D) invasive ductal carcinoma; (E) mucinous carcinoma; (F) invasive lobular carcinoma Figure 36.71 Ductal carcinoma in situ, low nuclear grade, cribriform pattern Figure 36.72 Ductal carcinoma in situ, intermediate nuclear grade, cribriform pattern with necrosis. There is greater nuclear variability compared with that seen in low-grade DCIS Figure 36.73 Ductal carcinoma in situ, high nuclear grade, solid pattern with necrosis Figure 36.74 Microinvasive carcinoma associated with high-grade ductal carcinoma in situ. Notice the clusters and single highly atypical epithelial cells present in the stroma surrounding the high-grade DCIS. A dense lymphocytic infiltrate is often present Figure 36.75 Ductal Carcinoma In Situ, Intermediate Nuclear Grade. Note how even in the absence of well-formed cribriform spaces, the cells are arranged in rosettes or microacinar structures Figure 36.76 Trabecular Bars in Atypical Ductal Hyperplasia. Note the perpendicular arrangement of the nuclei in relation to the long axis of the bars Figure 36.77 Ductal carcinoma in situ, micropapillary pattern Figure 36.78 Ductal Carcinoma In Situ, Clinging Pattern. One or two layers of highly atypical cells line dilated glandular structures containing necrosis Figure 36.79 Ductal carcinoma in situ, with comedo necrosis Figure 36.80 Ductal Carcinoma In Situ Involving Lobules. The terminal duct lobular unit is markedly expanded and composed of relatively large DCIS cells Figure 36.81 Ductal carcinoma in situ with apocrine features Figure 36.82 Ductal Carcinoma In Situ With Endocrine Features. A, Hematoxylin-eosin stain. B, Chromogranin immunostain Figure 36.83 Typical pattern of involvement of terminal duct-lobular unit by lobular carcinoma in situ Figure 36.84 Marked expansion of a lobular unit by lobular carcinoma in situ Figure 36.85 Pagetoid Involvement of Duct by Lobular Carcinoma In Situ. Note the presence of a monomorphic population of dyshesive cells underlying the attenuated layer of native ductal epithelium Figure 36.86 Pleomorphic Lobular Carcinoma In Situ. A, A lobule involved by pleomorphic LCIS. The cells are large with abundant eosinophilic cytoplasm and have pleomorphic nuclei with prominent nucleoli. B, E-cadherin immunostain. There is absence of staining in the LCIS cells. Myoepithelial cells and adjacent normal ductal epithelium show a membranous staining pattern. C, p120 catenin immunostain. There is cytoplasmic staining in the LCIS cells. Myoepithelial cells and adjacent normal ductal epithelium show a membranous staining pattern. D, B-Catenin immunostain. Like E-cadherin, there is absence of staining in the LCIS cells with myoepithelial cells and adjacent normal ductal epithelium showing a membranous staining pattern Figure 36.87 Lobular Carcinoma In Situ With Comedo Necrosis. The space is expanded by a monotonous proliferation of dyshesive epithelial cells (most pronounced in the lower right of the field); there is an absence of polarization of the cells. Comedo necrosis and calcifications are present in the center of the space Figure 36.88 Lobular Carcinoma In Situ Involving a Benign Phyllodes Tumor. The ducts are expanded by a monotonous proliferation of dyshesive LCIS cells Figure 36.89 Lobular Carcinoma In Situ Involving Collagenous Spherulosis. The cribriform pattern conferred by this process can be a mimic for ductal carcinoma in situ Figure 36.90 Typical Gross Appearance of Invasive Ductal Carcinoma. Note the irregular (crab-like) shape of the tumor, white fibrous appearance, and chalky streaks Figure 36.91 Prototypical Invasive Ductal Carcinoma. A, Irregularly shaped glands infiltrate through the stroma in a haphazard pattern. B, There is cytologic atypia present and myoepithelials cell are absent Figure 36.92 Vascular invasion by breast carcinoma demonstrated by positivity of endothelial cells for Ulex europaeus lectin I Figure 36.93 Invasive Lobular Carcinoma. The tumor cells are small and uniform with round nuclei and grow in single file fashion Figure 36.94 Typical target-like growth of tumor cells around an uninvolved duct in invasive lobular carcinoma Figure 36.95 Single file pattern of growth of invasive lobular carcinoma Figure 36.96 Invasive carcinoma with ductal and lobular features; in some areas there is gland formation, while in others, the tumor cells align in a single file (lower portion of field) Figure 36.97 Pleomorphic variant of invasive lobular carcinoma Figure 36.98 A, and B, Signet Ring Carcinoma of the Breast. This is regarded as a variant of lobular carcinoma. B, Alcian blue-PAS stain Figure 36.99 Lipid-Rich Carcinoma of the Breast. The cells show cytoplasmic vacuolation with nuclear displacement due to lipid accumula- tion. A, Intermediate power. B, High power Figure 36.100 Tubular Carcinoma of Breast. The angulated shape of the glands percolating haphazardly through the cellular stroma are characteristic of this lesion. In this particular case, there is prominent stromal elastosis Figure 36.101 Invasive Cribriform Carcinoma. In this example, all the nests have a cribriform pattern. The irregular contour of the nests and the infiltrative growth pattern help distinguish this lesion from cribriform pattern DCIS Figure 36.102 Typical Gelatinous Gross Appearance of Pure Mucinous Carcinoma. Note the sharply circumscribed quality of the tumor. (Courtesy of Dr RA Cooke, Brisbane, Australia. From Cooke RA, Stewart B. Colour Atlas of Anatomical Pathology. Edinburgh: Churchill Livingstone; 2004.) Figure 36.103 Mucinous Carcinoma of the Breast. Clusters of well-differentiated tumor cells are seen floating in a sea of mucin. Hypocellular variant, at low power (A) and high power (B). Hypercellular variant, at low power (C) and high power (D) Figure 36.104 Mucocele-Like Lesion. Cystically dilated ducts are lined by an attenuated epithelium which are filled with mucin. Focally there is rupture with extravasation of mucin into the stroma. Note the association with calcifications in this case Figure 36.105 Carcinoma With Medullary Features. The large tumor cells grow in a "syncytial" fashion and are sharply separated from the surrounding stroma, which is heavily infiltrated by lymphocytes and plasma cells Figure 36.106 Invasive Micropapillary Carcinoma. A, At low power the tumor is characterized by the formation of micropapillary structures lacking a fibrovascular core and by tubular structures free-floating in clear empty spaces. B, At higher power the reverse polarity of the tumor cells can be appreciated Figure 36.107 Carcinoma With Apocrine Differentiation. The large tumor cells have abundant eosinophilic, somewhat granular cytoplasm, which may contain eosinophilic or golden brown granules that are strongly PAS positive. The nuclei are vesicular and nucleoli are readily seen Figure 36.108 Gross Appearance of Secretory Carcinoma. The tumor is well circumscribed and shows a variegated cut surface Figure 36.109 Secretory Carcinoma. The small uniform glands are filled by a secretory material Figure 36.110 Breast carcinoma with neuroendocrine features Figure 36.111 Strong reactivity for chromogranin in breast carcinoma with neuroendocrine differentiation Figure 36.112 Gross Appearance of Metaplastic Carcinoma. A large, fleshy mass is seen protruding inside a cavity. Microscopically, this tumor showed an admixture of squamous and spindle cell elements Figure 36.113 Metaplastic Carcinoma. The tumor shown in (A) exhibits a blending of the epithelial and spindle cell components making it more difficult to recognize this as a carcinoma, whereas that depicted in (B) has more readily recognizable epithelial elements admixed with the malignant spindle cell component Figure 36.114 Low-grade Fibromatosis-like Metaplastic Carcinoma. A, At low power the tumor appears to be composed of bland spindle cells embedded in dense collagen resembling a scar. B, At high power the cytologic atypia of the spindle cells can be appreciated. The tumor cells were positive for cytokeratin (MNF116) Figure 36.115 Metaplastic carcinoma, squamous cell type Figure 36.116 A, Metaplastic carcinoma, squamous cell type with acantholytic pattern mimicking angiosarcoma. B, Cytokeratin 903 immunostain Figure 36.117 Low-grade Adenosquamous Carcinoma. A, At low power glands and squamous nests can be seen infiltrating haphazardly in a variably cellular and dense collagenous stroma. B, At high power the cytologic atypia and mitotic activity of the tumor cells is readily apparent Figure 36.118 Large tumor embolus in a dermal lymph vessel in a case with the clinical appearance of inflammatory carcinoma Figure 36.119 Adenoid Cystic Carcinoma. The appearance is similar to that of its more common homologue in salivary glands. The tumor is characterized by two types of cavity formation; true glandular lumina and pseudolumens containing basement membrane material surrounded by basal-myoepithelial cells, a feature that is more pronounced in this image Figure 36.120 Solid Variant of Adenoid Cystic Carcinoma With Basaloid Features. A, At low power, solid nests of high-grade tumor cells with basaloid features and abundant necrosis are appreciated. Basement membrane material is also present at the lower left portion of the field. B, At higher power, pseudolumens with basement membrane material are confirmed to be present. The identification of true glandular lumens can be more challenging (arrow) Figure 36.121 Acinic Cell Carcinoma of Breast. The cells have abundant eosinophilic or clear cytoplasm with round nuclei and prominent nucleoli. Coarse eosinophilic cytoplasmic granules can usually be identified Figure 36.122 Immunostain for Estrogen Receptor in Invasive Ductal Carcinoma. Strong nuclear positivity of the tumor cells is shown Figure 36.123 HER2-positive (3+) immunostain in high-grade invasive ductal carcinoma showing the required strong, complete, membranous pattern of staining in >10% of tumor cells Figure 36.124 Breast Carcinoma Metastatic to Vertebra. The normal bone marrow has been flushed out by placing a thin slice of tissue under a strong jet of water Figure 36.125 A and B, Metastasis of mammary lobular carcinoma to lamina propria of large bowel mucosa. B, Cytokeratin 7 immunostain Figure 36.126 Radiation Effect in Non-Neoplastic Breast. The epithelial cells of the lobules show cytomegaly with smudgy nuclear features and cytoplasmic vacuolation associated with lobular sclerosis and atrophy. Note the absence of any epithelial proliferation Figure 36.127 Chemotherapy Effect. Residual ductal carcinoma showing the effects of chemotherapy: nuclear enlargement, prominent nucleoli, and cellular vacuolization Figure 36.128 Tumor bed which is characterized by a hyalinized vascular stroma with fibroelastosis and edema infiltrated by histiocytes. Lymphocytes and hemosiderin are also noted in this field Figure 36.129 Pleomorphic Adenoma/Benign Mixed Tumor of the Breast. A prominent myxochondroid stroma is interspersed among the glandular structures Figure 36.130 Adenomyoepithelioma. This well-circumscribed, mul- tilobulated tumor is composed of polygonal cells with optically clear cytoplasm, arranged in nests. The gland-forming epithelial cells, with more eosinophilic cytoplasm, are harder to appreciate Figure 36.131 Typical Hemorrhagic Gross Appearance of Angio- sarcoma of Breast. (Courtesy of Dr Pedro J Grases Galofrè. From Grases Galofrè P. Patologia ginecològica, Bases para el diagnòstico morfològico. Barcelona: Masson; 2002.) Figure 36.132 Well-Differentiated Angiosarcoma of Breast Figure 36.133 Complex anastomosing vascular pattern in angiosarcoma of breast Figure 36.134 Poorly Differentiated Angiosarcoma of Breast. A, At low power, the interanastomosing vascular channels are apparent, as well as areas of solid growth and "blood lakes." B, High power, showing the significant endothelial cell atypia and brisk mitotic activity Figure 36.135 Papillary Endothelial Hyperplasia. High-power view showing a pattern of vascular anastomosis and prominent endothelial cells, which may be a mimic for low-grade angiosarcoma Figure 36.136 Diffuse Large B-cell Lymphoma of Breast. The breast parenchyma is infiltrated by a population of abnormal lymphoid cells which are medium and large in size, with irregular nuclear contours. Numerous apoptotic cells are seen Figure 36.137 Extranodal Marginal Zone Lymphoma of Mucosa- Associated Lymphoid Tissue (MALT Lymphoma) of Breast. Some of the neoplastic lymphocytes infiltrate the glandular structures Figure 36.138 Granulocytic Sarcoma of Breast. It is easy to misdi- agnose this lesion as a large cell lymphoma Figure 36.139 Gross Appearance of So-Called Hamartoma. There is a combination of cystic dilation of ducts, fibrosis, and entrapment of adipose tissue. This lesion is more distinctive and impressive grossly than microscopically Figure 36.140 Glandular epithelium and fibrous stroma with distorted arrangement in hamartoma of breast Figure 36.141 Myofibroblastoma. A, At low power, the well-circum- scribed margin of this bland spindle cell tumor is appreciated. B, At high power, the spindle cells are bland, arranged in short fascicles separated by broad bands of collagen Figure 36.142 Gross appearance of fibromatosis involving breast. The mass is solid and ill defined Figure 36.143 Fibromatosis. The lesion is composed of long, sweeping fascicles of bland spindle cells that entrap the native ducts and lobules. Lymphoid infiltrates are commonly seen at the periphery of the lesion Figure 36.144 Pseudoangiomatous Stromal Hyperplasia. Thin channels lined by spindle cells are seen scattered within a hyalinized stroma Figure 36.145 Bizarre Multinucleated Cells in Mammary Stroma. This non-neoplastic change is analogous to that more often seen in the stroma of the upper aerodigestive tract and in the genital tract Figure 36.146 So-called "virginal hypertrophy" of breast, showing prolifera- tive changes in epithelium and stroma Figure 36.147 Juvenile Papillomatosis (Swiss Cheese Disease). The gross appearance is that of clustered cystic formations Figure 36.148 Juvenile Papillomatosis (Swiss Cheese Disease). Whole-mount view showing variously sized cystic formations, alternating with solid epithelial proliferations Figure 36.149 Epithelial proliferation surrounded by a hypocellular myxoid halo in gynecomastia
