| 10/26/98 I: INTRODUCTION | |
| THANK YOUDESCRIPTION OF PATHOLOGY VS ROLE OF PATHOLOGIST | |
| PERSONAL BACKGROUND | HOSPITAL LOCATIONS AND SIZESDEPARTMENT MEMBERSYEARLY SURGICAL CASELOAD
PERCENTAGE OF BREAST CASES |
| ROLE OF PATHOLOGIST | FIND MALIGNANCYDETERMINE MALIGNANCYDESCRIBE MALIGNANCY |
| CHANGING ROLE | Model Spheres |
| TWO THINGS CHANGED | EARLY DETECTIONCLINICAL TRIALS |
| EARLY DETECTION | IMPACT OF ACS SELF EXAMIMPACT OF MAMMOGRAPHY |
| CLINICAL TRIALS | DESCRIBE MALIGNANCY RELATE ELEMENTS OF PATHOLOGY TOVARIOUS THERAPIES
PATIENT OUTCOME PRECISION OF DIAGNOSIS/ DESCRIPTION TEMPLATES |
| TEAM CONCEPT | PRECISION OF CARE SPECIFIC JOB IN ASSEMBLY OF CARE |
| II: ADENOCARCINOMA OF THE BREAST: MASTECTOMY, BIOPSY
INITIAL GENERAL DESCRIPTION |
|
| NORMAL BREAST DISSECTION PROCEDURE
HISTOLOGIC EXAM |
Model Sponge
Casette Glass Slide Kodachrome |
| CELL TYPE: DUCTAL Also SUBTYPES: MEDULLARY
TUBULAR, COLLOID LOBULAR |
Old data (survival): lower virulence Newer data: not associated with risk of recurrence |
| EXTENT: INVASIVE IN-SITU | |
| III. INTRADUCTAL ADENOCARCINOMA OF THE BREASTADENOCARCINOMA-IN-SITU OF THE BREAST | |
| HISTOLOGIC TYPE(S): COMEDOCARCINOMA
OTHER SOLID CRIBRIFORM MICRO-PAPILLARY STRATIFIED SPINDLED |
Slide 1: Normal Breast Duct Slide 2: Comedocarcinoma
Comedo most aggressive (recurrence) |
| GRADE3 TO 9 / 9 = I-III/III | CriteriaRecurrence increases with grade |
| NUCLEAR SIZE | RBC 1-1.5->2 |
| NUCLEAR CHROMATIN | Diffuse Coarse Vesicular |
| NUCLEOLI | None Rare Many |
| EXTENT | Measure from Slide Duct Model Add up 2mm Blocks Cassette |
| MARGINS OF RESECTION:NOT INVOLVED
EXTENDING TO WITHIN |
Ink BeakersMost Important Predictor of
Recurrence |
| VAN NUYS PREDICTIVE INDEX : 3 – 9/ 9= I-III/III | 100% in situ only |
| SCORE 1 TO 3 | NUCLEAR GRADECOMEDOCARCINOMA (NECROSIS) |
| SIZE | MEASUREMENT (MM2) 15 /16-40/41 |
| MARGINS OF RESECTION (MM 3) | 10/1-9/0-1 Slide 3: Margin |
| ADENOCARCINOMA OF THE BREAST, INVASIVE | |
| 4 DESCIPTORS | TUMOR TYPEGRADE
SIZE MARGINS |
| AJCC (ACS): TNM STAGING | Tumor SizeNode Status
Grade Distant Mets |
| TUMOR SIZE (DIAMETER) | Stage/treatment Ruler, Tissue Slide Tamoxifen (>1cm) |
| GRADE 3 TO 9/ 9 = I-III/III | Tubule Lumens Slide 4: Tubular CA< Slide 5: Solid CA
Nuclear Cytology Number of Mitoses |
| LYMPH NODES (IPSILATERAL AXILLARY) | |
| NUMBER PRESENT | |
| METASTASES | Present/absent Number Positive |
| LARGEST | Size |
| EXTENSION BEYOND CAPSULE | |
| FIXED TO EACH OTHER | |
| ADENOCARCINOMA OF THE BREAST, INVASIVE | |
| INVASION: LYMPHATICSVESSELS
OVERLYING SKIN |
Recurrence, lymph nodes |
| EXTENTMULTIFOCAL DISEASE
MULTICENTRIC DISEASE |
Sizable tissue /Multiple biopsies Mammogram
Recurrence/mastectomy |
| INTRADUCTAL COMPONENT | Biopsy only |
| EXTENT 25%: EID | 20% of patientsTumor load /more extensive disease than
clinically apparent Recurrence |
| LOCATIONASSOCIATED
ADJACENT DISTANT TO MASS |
Multiple biopsies, quadrantmastectomy |
| MARGINS OF RESECTION:NOT INVOLVED
EXTENDING TO WITHIN |
InkGreatest predictor of recurrence
Gross / microscopic |
| ADENOCARCINOMA-IN-SITU OF THE BREAST, INVASIVE: OTHER FEATURES | |
| NIPPLE (MASTECTOMY, WIDE) | PAGET’S DISEASE |
| LOBULAR CARCINOMA (COEXISTENT)IN SITU/HYPERPLASIA
INVASIVE |
Increase Risk for Breast CA
Increase Risk Contralateral CA |
| BIOPSY: CALCIFICATIONS PRESENT/ABSENT
LOCATION DUCTAL LOBULAR STROMAL |
10% DCIS without mammographically evident calcium
Xray blocks |
| RE-EXCISION: CYSTIC CAVITY | |
| ADENOCARCINOMA-IN-SITU OF THE BREAST, INVASIVE: REPORT COMMENTS | |
| ESTROGEN/PROGESTERONE RECEPTORS | Slide 6: Receptors |
| IF NOT SENT: | Previous tissue submitted ( 9 – )Insufficient tissue
Invasive tumor not present |
| TUMOR SIZE/GRADE | Actual vs Estimation, Adequacy |
| INTRA-DEPARTMENTAL REVIEW | |
| RESULTS COMMUNICATED | |
PROPS:
Branch
Wooden spheres
Ruler
Block
Tissue slide
Sponge
Slide 1: Normal Breast Duct
Slide 2: Comedocarcinoma
Slide 3: Grading
Slide 4: Margin
Slide 5: Tubular CA
Slide 6: Solid CA
Slide 7: Receptors