Practical breast pathology. Frequently asked questions

269 Pages·2019·67.588 MB·English

by  Ping Tang (editor), Yan Peng (editor)

Practical Anatomic Pathology
Series Editors: Fan Lin · Ximing J. Yang
Yan Peng
Ping Tang Editors
Practical Breast
Pathology
Frequently Asked Questions
Practical Anatomic Pathology
Series Editors
Fan Lin
Geisinger Health System
Danville, PA, USA
Ximing J. Yang
Feinberg School of Medicine
Northwestern University
Chicago, IL, USA
The proposed Book Series will be designed to provide a comprehensive, practical and state-of-
the art review and update of the major issues and challenges specific to each subspecialty field
of surgical pathology in a question and answer (Q&A) format. Making an accurate diagnosis
especially from a limited sample can be quite challenging, yet crucial to patient care. The
proposed Book Series, using the most current and evidence-based resources, will 1) focus on
frequently asked questions in surgical pathology in day-to-day practice; 2) provide quick,
accurate, terse, and useful answers to many practical questions encountered in daily practice;
3) emphasize the importance of a triple test (clinical, radiologic, and histologic correlation); 4)
delineate how to appropriately utilize immunohistochemistry, in situ hybridization and
molecular tests; and 5) minimize any potential diagnostic pitfalls in surgical pathology. These
books will also include highly practical presentations of typical case scenarios seen in an
anatomic pathology laboratory. These will be in the form of case presentations with step-by-
step expert analysis. Sample cases would include common but challenging situations, such as
evaluation of well-differentiated malignant tumors vs. benign/reactive lesions; distinction of
two benign entities; sub-classification of a malignant tumor; identification of newly described
tumor and non-tumor entities; workup of a tumor of unknown origin; and implementation of
best practice in immunohistochemistry and molecular testing in a difficult case. The Q&A
format will be well accepted, especially by junior pathologists, for several reasons: 1) this is the
most practical and effective way to deliver information to a new generation of pathologists
accustomed to using the Internet as a resource and, therefore, comfortable and familiar with a
Q&A learning environment; 2) it’s impossible to memorialize and digest massive amounts of
new information about new entities, new and revised classifications, molecular pathology,
diagnostic IHC, and the therapeutic implications of each entity by reading large textbooks; 3)
sub-specialization is a very popular practice model highly demanded by many clinicians; and
4) time is very precious for a practicing pathologist because of increasing workloads in recent
years following U.S. health care reforms. This Book Series will meet all of the above expectations.
These books will be written by established and recognized experts in their specialty fields and
will provide a unique and valuable resource in the field of surgical pathology, both for those
currently in training and for those already in clinical practice at various skill levels. It does not
seek to duplicate or completely replace other large standard textbooks; rather, it will be a new,
comprehensive yet concise and practical resource on these timely and critical topics.
More information about this series at http://www.springer.com/series/13808
Yan Peng • Ping Tang
Editors
Practical Breast Pathology
Frequently Asked Questions
Editors
Yan Peng, MD, PhD Ping Tang, MD, PhD
Department of Pathology Department of Pathology and Laboratory
UT Southwestern Medical Center Medicine
Dallas, TX Loyola University Medical Center
USA Maywood, IL
USA
Practical Anatomic Pathology
ISBN 978-3-030-16517-8 ISBN 978-3-030-16518-5 (eBook)
https://doi.org/10.1007/978-3-030-16518-5
© Springer Nature Switzerland AG 2019
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is
concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction
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The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not
imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and
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The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed
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expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been
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This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
To my husband, Zhongyue Jiang, PhD, and to our beloved daughter,
Sharon, for their love, inspiration and continuous support”
Yan Peng
To my husband, Bruce Xu, and two daughters, Sara and Lora, for their
unconditional love and support
Ping Tang
Preface
With recent understanding of breast tumor biology and rapid advances in breast cancer treat-
ment, timely updates on diagnostic surgical pathology of breast disease become keenly neces-
sary and important. The purpose of this book is to provide a practical, evidence-based,
up-to-date, problem-solving guide to frequently encountered diagnostic problems, challenges,
and controversies in breast pathology and associated molecular pathology practice, with
emphasis on addressing diagnostic issues that have significant impact on clinical
management.
This textbook is based on a PubMed (US National Library of Medicine, Bethesda, Maryland)
literature review and the editors’ and chapter authors’ personal experiences. It consists of ten
chapters with an abundance of color photomicrographs and images. The book is organized in
a question-and-answer format accompanied by case presentations. We hope this format will
facilitate finding answers to frequently asked questions in breast pathology. The book also
discusses genetic alterations and molecular abnormalities in breast cancer and commonly
encountered interpretation dilemmas regarding immunohistochemistry in breast cancer and
metastatic cancer to the breast, with a focus on prognostic and predictive tumor biomarkers. In
addition, the book covers some uncommon, diagnostically challenging breast lesions.
We hope that practicing pathologists and pathologists-in-training will find this book helpful
for efficiently solving diagnostic problems in their daily practice in breast pathology.
Dallas, TX, USA Yan Peng, MD, PhD
Maywood, IL, USA Ping Tang, MD, PhD
vii
Acknowledgments
We are grateful to all the contributing chapter authors for working with us on this book and for
making this collaboration a memorable and rewarding experience.
We are honored to have been invited to contribute to this volume in the Practical Anatomic
Pathology series, which is edited by Dr. Fan Lin and Dr. Ximing J. Yang and published by
Springer.
We greatly appreciate our outstanding mentors—Dr. David Dabbs, Dr. Steven Hajdu, and
Dr. Daryl Carter—for their teaching and guidance during our breast pathology training.
Dallas, TX, USA Yan Peng, MD, PhD
Maywood, IL, USA Ping Tang, MD, PhD
ix
Contents
1 Intraductal Proliferative Disease of the Breast ......................... 1
Xiuzhen Duan, Yihong Wang, Hua Guo, and Ping Tang
2 Invasive Ductal Carcinoma (NOS) of the Breast ........................ 25
Xiaoxian Li, Zaibo Li, Xiaoyan Cui, and Yan Peng
3 Invasive Carcinoma of the Breast: Special Types ....................... 39
Zaibo Li, Xiaoyan Cui, Xiaoxian Li, and Yan Peng
4 Lobular Breast Lesions ............................................. 73
Megan L. Troxell, Yun An Chen, Jing Yu, Debra M. Ikeda,
and Kimberly H. Allison
5 Papillary Lesions of the Breast (IDP, IDPC, EPC, SPC) .................. 145
Julia Y. Tsang, Ping Tang, and Gary M. Tse
6 Fibroepithelial Lesions (Phyllodes Tumor and Fibroadenoma)
of the Breast ...................................................... 159
Julia Y. Tsang and Gary M. Tse
7 Immunohistochemistry in Breast Cancer .............................. 173
Ping Tang, Marilyn M. Bui, and Yan Peng
8 Breast Cancer with Hereditary Cancer Predisposition Syndromes ......... 193
Roshni Rao, Caitlin B. Mauer, Margaret Chen-Seetoo, and Yan Peng
9 Mesenchymal and Lymphoid Lesions in the Breast ..................... 203
Xi Wang and Andrew G. Evans
10 Metastatic Cancer in the Breast ..................................... 237
Bradley M. Turner
Index ................................................................ 259
xi
Contributors
Kimberly H. Allison, MD Stanford University School of Medicine, Department of Pathology,
Stanford, CA, USA
Marilyn M. Bui, MD, PhD Department of Pathology, Moffitt Cancer Center, Tampa, FL, USA
University of South Florida, Department of Pathology, Tampa, FL, USA
Yun An Chen, MD University of Washington, Department of Radiology, Seattle, WA, USA
Margaret Chen-Seetoo, MD Department of Surgery, Herbert Irving Pavilion, Columbia
University Vagelos College of Physicians and Surgeons, New York, NY, USA
Xiaoyan Cui, MD, PhD Department of Pathology, The Ohio State University Wexner Medical
Center, Columbus, OH, USA
Xiuzhen Duan, MD, PhD Department of Pathology and Laboratory Medicine, Loyola University
Medical Center, Maywood, IL, USA
Andrew G. Evans, MD, PhD Department of Pathology and Laboratory Medicine, University of
Rochester Medical Center, Rochester, NY, USA
Hua Guo, MD, MS Department of Pathology and Cell Biology, Columbia University Irving
Medical Center, New York, NY, USA
Debra M. Ikeda, MD, FACR, FSBI Stanford University School of Medicine, Stanford, CA, USA
Xiaoxian Li, MD, PhD Department of Pathology and Laboratory Medicine, Emory University,
Atlanta, GA, USA
Zaibo Li, MD, PhD Department of Pathology, The Ohio State University Wexner Medical
Center, Columbus, OH, USA
Caitlin B. Mauer, MA, MS, CGC Department of Cancer Genetics, University of Texas
Southwestern Medical Center, Dallas, TX, USA
Yan Peng, MD, PhD Department of Pathology, Clements University Hospital, Dallas, TX, USA
Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
Roshni Rao, MD, FACS Division of Breast Surgery, Department of Surgery, Herbert Irving
Pavilion, Columbia University Vagelos College of Physicians and Surgeons, New York, NY,
USA
Ping Tang, MD, PhD Department of Pathology and Laboratory Medicine, Loyola University
Medical Center, Maywood, IL, USA
Megan L. Troxell, MD, PhD Stanford University School of Medicine, Department of
Pathology, Stanford, CA, USA
xiii