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Breast malignant, males, children

Breast cancer


Reviewer: Monika Roychowdhury, M.D. (see Reviewers page)
Revised: 10 November 2012, last major update March 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.


● Most common invasive malignancy in US women after skin cancer
● Estimated 227K new cases of invasive carcinoma in US women in 2012, 2K in men (American Cancer Society)
● Estimated 63K new cases of in situ carcinoma in US women in 2012
● Occurs in 1 of 8 to 9 women in US (1 of 232 at age 30-39 years, 1 of 29 at age 70-79)
● Similar incidence in other Western countries, but much lower incidence in Japan (Cancer Research UK)
● Sharp decrease in incidence in US women 50-69 years old may reflect reduced use of hormone replacement therapy (Breast Cancer Res 2007;9:R28)

Clinical description

● 50% occur in upper outer quadrant, 17% central (subareolar), 5-15% other quadrants, 13% involve more than one quadrant (3% diffuse)
● Tumors in outer quadrant are more likely to have axillary nodes than those in inner quadrant
● Common symptoms are breast lumps and nipple abnormalities, sometimes discomfort
● Tumors presenting between mammographic screenings (interval tumors) are more aggressive


● Second tumor discovered within 2 months of initial primary tumor
● Molecular studies can determine if synchronous tumors are two primaries or one primary with metastases (Mod Pathol 2008;21:1200)

Clinical examination

● For breast, palpation is less sensitive/specific than mammography; mammographic abnormality is often presenting sign
● For axillary nodes, 40% of clinically negative nodes have tumor and 15% of clinically positive nodes lack tumor


● Can detect tumors as small as 1-2 mm via microcalcifications
● Microcalcifications are present in 50% of carcinomas vs. 20% of benign breast disease
● Suspicious mammographic features are opacity with irregular, spiculated margins, variable calcifications
● Also clusters of fine calcifications and asymmetry
● Only 20% of “suspicious” microcalcifications are actually malignant
● Up to 30% of tumors are not detectable by mammography due to poor resolution from surrounding fibrous breast (generally younger women)


● Detects increased tumor vascularity and increased tumor uptake of contrast agents
● Usually no gross findings so must examine entire specimen (Hum Pathol 2007;38:1754)


● Can distinguish solid versus cystic lesions (latter are generally benign)

Needle biopsy

● Radiologist marks microcalcifications with needle, surgeon removes area around needle, specimen is Xrayed to verify specimen includes microcalcifications of interest
● Pathologist should verify presence of microcalcifications (note: calcium oxalate crystals are easily missed by pathologists – must look for birefringence under polarized light)

Case reports

● Recurrence in myocutaneous flaps (Arch Pathol Lab Med 2004;128:1157)
● Massive thyroid tumoral emboli (Arch Pathol Lab Med 2004;128:804)

Treatment and prognosis

● Five year relative survival overall has improved from 63% in early 1960s to 89% in 2009 (US National Cancer Institute)
● Five year survival rate is 98% for localized breast cancer, dropping to 27% if distant metastases
● Death rate is 27 per 100,000 women (40,000 deaths per year in US), slowly falling since 1990 in North America, Western Europe and Australia
● #2 cause of US cancer deaths in women after lung cancer
● Main treatment is surgical excision (usually lumpectomy or modified radical mastectomy, sampling lumpectomy cavity margins may reduce need for re-excision, Am J Surg Pathol 2005;29:1625)
● Radiation therapy if positive margins or to control locally recurrent disease (44% recur without radiation if close/non-involved margins for DCIS versus 94% recurrence if margins are extensively positive, Mod Pathol 2004;17:81)
● Anti-estrogen drugs (tamoxifen and others to reduce risk of recurrence in same or opposite breast, particularly for ER+ tumors)
● Combination chemotherapy (for metastatic disease, to reduce the risk of contralateral breast carcinoma)
● Preoperative (neoadjuvant) chemotherapy shrinks large tumors to allow surgery or more conservative surgery

Clinical images

Mass and retracted nipple

Micro description

● Invasive if stromal invasion present
● Most tumors are adenocarcinomas arising from terminal duct lobular unit
● In situ carcinoma is present to variable extent (“extensive” if > 25% of tumor volume seen inside and outside of invasive tumor field)

Additional references

Wikipedia, eMedicine

End of Breast malignant, males, children > Breast cancer > General

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