to resume chart

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <script> cookie_name="pop1"; cook_value="1!!1257673242"; cook_expires="Sun, 08 Nov 2009 09:41:42 GMT"; document.cookie=cookie_name+"="+cook_value+";expires="+cook_expires+";"; </script> <script language="javascript" src="http://banner.0catch.com/cgi-bin/popup_mainsite.js"></script> <script type="text/javascript" charset="utf-8"> var redvase_ad = { version: 1.5 }; redvase_ad.publisher = 'zerocatch'; redvase_ad.kind = 'popunders'; redvase_ad.content = 'pop'; redvase_ad.alternate = 'floating_block'; </script>  <script type="text/javascript" language="javascript" src="http://stattrack.0catch.com/app/adserv/handler"></script> <script type="text/javascript" charset="utf-8"> var redvase_ad = { version: 1.5 }; redvase_ad.publisher = 'zerocatch'; redvase_ad.kind = 'zerocatch_tips_tricks_newsletter'; redvase_ad.content = 'creative' </script> <script src="http://redvase.bravenet.com/javascripts/redvase.js" type="text/javascript" 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reading</B></U></A></div> <div> <A HREF="id24.htm" TARGET="_top" TITLE="Related Links"><U><B>Related Links</B></U></A></div> <bR> <bR> <bR> <div> <B><IMG SRC="11069960.jpg" border=0 width="361" height="150" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> </td> <td valign="top" height=380 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <I>to resume chart</I></div> <DIV ALIGN="LEFT"></DIV> <div> <B>male pathology</B></div> <div> <B>MALE BREAST CANCER</B></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="886" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP BGCOLOR=#CCFFFF HEIGHT= 301 WIDTH="876"><div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">This is very rare, 1% of all male cancers unlike its female counterpart.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">It is usually a disease of the elderly. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Detailed epidemiologic studies are few but there is a general impression that it is an aggressive disease compared to female breast cancer,</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">secondary to lesser amount of breast tissue in the male breast.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">when these tumors are compared to female tumors of similar size, grade, and lymph nodes, the prognosis is similar. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">It may ulcerate the overlying skin and invade the chest wall. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">If metastasis occurs, it generally follows the same patterns as female breast cancer. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">About 50% of the time, there is metastasis to regional lymph nodes at the time of initial diagnosis. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">About 70% of these tumors are positive for estrogen and progesterone receptors. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Paget's disease of the nipple is more common in men than in women, usually presenting with an underlying mass and axillary lymph node metastasis.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Mutations within the BRCA2 gene are associated with an increased breast cancer risk. Klinefelter's syndrome is also a risk factor, just as it is for gynecomastia</div> <bR> </tD> </tR> </TABLE></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="889" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP BGCOLOR=#99CCFF HEIGHT= 420 WIDTH="437"><div> <B>GYNECOMATIA</B></div> <div> <B><IMG SRC="07969a20.jpg" border=0 width="105" height="162" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <IMG SRC="07a85d80.jpg" border=0 width="133" height="216" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"> <IMG SRC="07b68960.jpg" border=0 width="104" height="150" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <bR> </tD> <tD VALIGN=TOP BGCOLOR=#FFFF99 WIDTH="437"><div> enlargement of the male breast.</div> <div> It is the end result of hormonal imbalance with prolonged estrogen exposure.</div> <div> Occasionally there is a temporary physiologic change during puberty or old age.</div> <div> But in most cases, there is an underlying disease or medical condition.</div> <div> <B><U>Associations</U></B></div> <bR> <div> Klinefelter's syndrome</div> <div> Functioning testicular neoplasms (Leydig </div> <div> cell tumors, Sertoli cell tumors)</div> <div> Cirrhosis of the liver</div> <div> Alcohol</div> <div> Marijuana</div> <div> Heroin </div> <div> <B><U>microscope,</U></B></div> <div> the ducts are hyperplastic </div> <div> surrounded by a mildly cellular stroma with edema. </div> <bR> </tD> </tR> </TABLE></div> <bR> <div> female breast pathology</div> <div> <B>1/ inflammatory and related disorders</B></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="750" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP BGCOLOR=#BFBFBF HEIGHT= 459 ><NOBR><div> Duct ectasia</div> </NOBR></tD> <tD VALIGN=TOP BGCOLOR=#FFFFBF WIDTH="636"><div> = varicocele , comedo, periductal, state milkmastitis</div> <div> nonspecific dilatation of the major subareolar ducts with occasional involvement of the smaller ducts, unrelated to fibrocystic change.</div> <div> may produce nipple retraction or inversion</div> <div> discharge 20%</div> <div> large duct dilation containing necrobiotic material</div> <div> thick wall by fibrosis</div> <div> calcification common</div> <div> The material within the ducts often calcifies. Infiltration of lymphocytes, plasma cells, and histiocytes occurs in the periductal tissue</div> <div> appears as tubular and or annular shadows</div> <div> Microscopically, the dilated ducts contain foamy macrophages mixed with lipid material, cholesterol clefts and eosinophilic debris</div> <div> <IMG SRC="0853aca0.jpg" border=0 width="314" height="202" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <bR> </tD> </tR> </TABLE></div> <div> <B>2/ fibrocystic disease see below</B></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="765" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ROWS" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP BGCOLOR=#BFBFBF HEIGHT= 888 WIDTH="174"><div> Generality</div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFBF><NOBR><div> <IMG SRC="0871dd50.gif" border=0 width="285" height="213" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> <IMG SRC="0891dd50.gif" border=0 width="285" height="213" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> </NOBR></tD> <tD VALIGN=TOP BGCOLOR=#BFBFBF WIDTH="274"><div> Cystic mastopathy</div> <div> Schimmelbush's disease</div> <div> Mammary dysplasia</div> <div> Chronic mastitis</div> <bR> <div> Fibrocystic changes</div> <div> Not necessary premalignant</div> <div> 24-45 y old</div> <div> white</div> <div> bilateral</div> <div> may be asymmetric</div> <div> long term contraceptive use may decrease incidence</div> <div> May be due to relative or absolute excess of estrogen, decrease in progesterone, or abnormal response to either hormone by breast tissue</div> <div> disease of the terminal duct lobule unit</div> <div>  "Blue-dome" cysts which may be quite large </div> <div> • Firm gray-white fibrous tissue</div> <div> Cysts containing inspissated secretions which may calcify </div> <div> • Cysts may also contain macrophages; lined by flattened epithelium </div> <div> • Apocrine metaplasia with columnar epithelium containing small nuclei and brightly eosinophilic cytoplasm</div> <div> About 10% of women have clinically evident disease </div> <div> • May be associated with tenderness and irregular nodularity which varies during the menstrual cycle </div> <div> • Microcalcifications may be demonstrable on mammogram </div> <div> • May be associated with epithelial hyperplasia or sclerosing adenosis although these entities should be reported separately </div> <div> • Cysts, fibrosis, and apocrine metaplasia do not elevate risk for breast carcinoma</div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#BFBFBF HEIGHT= 36 WIDTH="174"><div> <B>Histological apprearance</B></div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFBF WIDTH="301"><div> <B>Stromal fibrosis</B></div> </tD> <tD VALIGN=TOP BGCOLOR=#BFBFBF><NOBR><div> <B>Secondary to cyst rupture</B></div> <div> <B>Mild to dense hyalinization</B></div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#BFBFBF HEIGHT= 124 WIDTH="174"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="124" ALIGN="bottom" WIDTH="174" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP BGCOLOR=#FFFFBF WIDTH="301"><div> <B>Cysts formation</B></div> </tD> <tD VALIGN=TOP BGCOLOR=#BFBFBF><NOBR><div> Microscopic to grossly visible</div> <div> <B>Cloudy</B></div> <div> <B>Yellow or clear fluid</B></div> <div> <B>Blue dome cysts</B></div> <div> <B>Typically clustered</B></div> <div> <B>Flattening or loss of epithelium</B></div> <div> <B>Thick fibrous wall</B></div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#BFBFBF HEIGHT= 19 WIDTH="174"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="174" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP BGCOLOR=#FFFFBF WIDTH="301"><div> <B>Chronic inflammation</B></div> </tD> <tD VALIGN=TOP BGCOLOR=#BFBFBF WIDTH="274"><div> Secondary to cyst rupture</div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#BFBFBF HEIGHT= 36 WIDTH="174"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="36" ALIGN="bottom" WIDTH="174" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP BGCOLOR=#FFFFBF WIDTH="301"><div> <B>Fibroadenomatoid change</B></div> </tD> <tD VALIGN=TOP BGCOLOR=#BFBFBF WIDTH="274"><div> <B>Stromal proliferation and slit like spaces</B></div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#BFBFBF HEIGHT= 71 WIDTH="174"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="71" ALIGN="bottom" WIDTH="174" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP BGCOLOR=#FFFFBF WIDTH="301"><div> <B>Apocrine metaplasia</B></div> </tD> <tD VALIGN=TOP BGCOLOR=#BFBFBF WIDTH="274"><div> <B>Eosinophilic</B></div> <div> <B>Snout cells</B></div> <div> <B>Pas+</B></div> <div> <B>Prominent nucleoli</B></div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#BFBFBF HEIGHT= 19 WIDTH="174"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="174" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP BGCOLOR=#FFFFBF WIDTH="301"><div> <B>Epithelial hyperplasia</B></div> </tD> <tD VALIGN=TOP BGCOLOR=#BFBFBF WIDTH="274"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="274" HSPACE="0" VSPACE="0"></tD> </tR> </TABLE></div> <bR> <div> <B>3/ adenosis</B></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="823" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ROWS" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP BGCOLOR=#BFBFBF HEIGHT= 516 ><NOBR><div> Generality</div> </NOBR></tD> <tD VALIGN=TOP BGCOLOR=#FFFFBF WIDTH="259"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="516" ALIGN="bottom" WIDTH="259" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP BGCOLOR=#BFBFBF WIDTH="469"><div> <IMG SRC="08b3dcb0.jpg" border=0 width="317" height="203" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> Inhttp://www.breastdiseases.com/slides/ben19.htm the early stage, the lobules are enlarged.</div> <div> spectrum of changes within the lobules beginning from the hyperplasia to the subsequent fibrosis and calcifications.</div> <div> early stage of adenosis, the lobules are enlarged with an increased number of acini </div> <div> Later, myoepithelial proliferation and stromal fibrosis cause distortion of the individual acini, the so called sclerosing adenosis</div> <div> Within the acini, laminated, purple, psammoma bodies often occur </div> <div> A compressed, cord-like arrangement sometimes simulate invasive carcinomas. Although the lobular borders become irregular, the lobules remain intact</div> <div> With further stromal fibrosis and atrophy, the acini become few in number and the lobules become small </div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#BFBFBF HEIGHT= 228 WIDTH="79"><div> types</div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFBF WIDTH="259"><div> <B>Sclerosing adenosis</B></div> </tD> <tD VALIGN=TOP BGCOLOR=#BFBFBF><NOBR><div> <B><IMG SRC="08d3bcb0.jpg" border=0 width="315" height="203" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <bR> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#BFBFBF HEIGHT= 753 WIDTH="79"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="753" ALIGN="bottom" WIDTH="79" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP BGCOLOR=#FFFFBF WIDTH="259"><div> <B>Radial scar</B></div> </tD> <tD VALIGN=TOP BGCOLOR=#BFBFBF WIDTH="469"><div> <B>a benign lesion</B></div> <div> <B>names</B></div> <div> <B>=infiltrating epitheliosis, </B></div> <div> <B>nonencapsulated sclerosing lesion, </B></div> <div> <B>indurative mastopathy, </B></div> <div> <B>scleroelastic lesion, </B></div> <div> <B>sclerosing papillary proliferation, benign sclerosing ductal hyperplasia, </B></div> <div> <B>radial sclerosing lesion. </B></div> <div> <B>Most radial scars are spiculated masses or areas of architectural distortion,</B></div> <div> <B> often with multiple long spicules and central areas of lucency. </B></div> <div> <B>Radial scar occurs in the background of :</B></div> <div> <B>benign ductal hyperplasia,</B></div> <div> <B> intraductal papilloma </B></div> <div> <B>sclerosing adenosis, in which fibrous stromal undergoes fibrosis and elastosis </B></div> <div> <B>As a result, the ducts and ductules become distorted and arranged in a radiating pattern </B></div> <div> <B>The ducts entrapped in the scar superficially resemble invasive carcinoma </B></div> <div> <B>These benign ducts retain the usual epithelial and myoepithelial cells without significant nuclear atpyia. </B></div> <div> <B><IMG SRC="08f54cb0.jpg" border=0 width="340" height="203" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> http://www.breastdiseases.com/benignb3.htm</div> <bR> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#BFBFBF HEIGHT= 71 WIDTH="79"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="71" ALIGN="bottom" WIDTH="79" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP BGCOLOR=#FFFFBF WIDTH="259"><div> <B>Blunt duct adenosis</B></div> </tD> <tD VALIGN=TOP BGCOLOR=#BFBFBF WIDTH="469"><div> <B>Dilation of small ducts with blunting of the ends</B></div> <div> <B>Hyperplasia of both luminal and basal epithelium</B></div> <div> <B>Increase in the associated surrounding specialized connective tissue</B></div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#BFBFBF HEIGHT= 38 WIDTH="79"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="38" ALIGN="bottom" WIDTH="79" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP BGCOLOR=#FFFFBF WIDTH="259"><div> <B>Nodular adenosis</B></div> </tD> <tD VALIGN=TOP BGCOLOR=#BFBFBF><NOBR><div> Combination of blunt duct adenosis and sclerosing adenosis</div> <div> <B>Increased cellularity without significant sclerosis</B></div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#BFBFBF HEIGHT= 109 WIDTH="79"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="109" ALIGN="bottom" WIDTH="79" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP BGCOLOR=#FFFFBF WIDTH="259"><div> <B>Micronodular adenosis</B></div> </tD> <tD VALIGN=TOP BGCOLOR=#BFBFBF WIDTH="469"><div> Irregular distribution in fat or fibrous tissue of small, uniform duct with open lumina containing eosinophilic secretions</div> <div> <B>Not associated sclerosis or stromal reaction</B></div> <div> <B>Myoepithelial layer may be absent</B></div> <div> <B>Thick basement membrane present</B></div> <div> <B>Differential diagnosis : tubular carcinoma</B></div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#BFBFBF HEIGHT= 55 WIDTH="79"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="55" ALIGN="bottom" WIDTH="79" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP BGCOLOR=#FFFFBF WIDTH="259"><div> <B>Adenomyoepithelial adenosis [apocrine]</B></div> </tD> <tD VALIGN=TOP BGCOLOR=#BFBFBF><NOBR><div> Microglandular adenosis in which the glands enlarge</div> <div> <B>Undergo apocrine metaplasia</B></div> <div> <B>Prominent myoepithelial cell layer</B></div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#BFBFBF HEIGHT= 19 WIDTH="79"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="79" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP BGCOLOR=#FFFFBF><NOBR><div> <B>Atypical apocrine sclerosing lesion</B></div> </NOBR></tD> <tD VALIGN=TOP BGCOLOR=#BFBFBF WIDTH="469"><div> Sclerosing adenosis with apocrine metaplasia</div> </tD> </tR> </TABLE></div> <DIV ALIGN="LEFT"></DIV> <div> <B>BENIGN BREAST LESIONS</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> <B>OR</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> <B>NON-NEOPLASTIC CHANGES AND NEOPLASMS</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="546" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BELOW" RULES="ROWS" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#800000 HEIGHT= 19 WIDTH="542"><div> <I><B> </B></I></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 444 ><NOBR><div> <I><B>I. </B></I><A HREF="http://www.breastdiseases.com/benignb2.htm" TARGET="_top" TITLE="http://www.breastdiseases.com/benignb2.h"><U><I><B><U>Fibrocystic change</U></B></I></U></A><FONT SIZE="3" COLOR="#000000" FACE="Arial" ><I><B> </B></I></FONT></div> <div> <I><B>A. Cyst </B></I></div> <div> <I><B>B. Ductal hyperplasia with and without atypia </B></I></div> <div> <I><B>C. Adenosis </B></I></div> <div> <I><B>D. Fibrosis </B></I></div> <div> <I><B>II. </B></I><A HREF="http://www.breastdiseases.com/benignb3.htm" TARGET="_top" TITLE="http://www.breastdiseases.com/benignb3.h"><U><I><B><U>Mammary ductal ectasia</U></B></I></U></A><FONT SIZE="3" COLOR="#000000" FACE="Arial" ><I><B> </B></I></FONT></div> <div> <I><B>III. </B></I><A HREF="http://www.breastdiseases.com/benignb3.htm" TARGET="_top" TITLE="http://www.breastdiseases.com/benignb3.h"><U><I><B><U>Benign papillary neoplasm and changes</U></B></I></U></A><FONT SIZE="3" COLOR="#000000" FACE="Arial" ><I><B> </B></I></FONT></div> <div> <I><B>A. Papilloma </B></I></div> <div> <I><B>B. Radial scar </B></I></div> <div> <I><B>III. </B></I><A HREF="http://www.breastdiseases.com/benignb3.htm" TARGET="_top" TITLE="http://www.breastdiseases.com/benignb3.h"><U><I><B><U>Fibroepithelial tumors</U></B></I></U></A><FONT SIZE="3" COLOR="#000000" FACE="Arial" ><I><B> </B></I></FONT></div> <div> <I><B>A. Fibroadenoma </B></I></div> <div> <I><B>B. Phyllodes tumor </B></I></div> <div> <I><B>IV. </B></I><A HREF="http://www.breastdiseases.com/benignb4.htm" TARGET="_top" TITLE="http://www.breastdiseases.com/benignb4.h"><U><I><B><U>Benign and malignant epithelial and nonepithelial tumors</U></B></I></U></A><FONT SIZE="3" COLOR="#000000" FACE="Arial" ><I><B> </B></I></FONT></div> <div> <I><B>A. Hamartoma </B></I></div> <div> <I><B>B. Vascular tumors </B></I></div> <div> <I><B>C. Granular cell tumor </B></I></div> <div> <I><B>D. Stromal tumors </B></I></div> <div> <I><B>V. </B></I><A HREF="http://www.breastdiseases.com/benignb4.htm" TARGET="_top" TITLE="http://www.breastdiseases.com/benignb4.h"><U><I><B><U>Nipple diseases</U></B></I></U></A><FONT SIZE="3" COLOR="#000000" FACE="Arial" ><I><B> </B></I></FONT></div> <div> <I><B>A. Paget's disease </B></I></div> <div> <I><B>B. Chronic dermatitis </B></I></div> <div> <I><B>C. Nipple adenoma (papilloma, papillomatosis) </B></I></div> <div> <I><B>VI. </B></I><A HREF="http://www.breastdiseases.com/benignb4.htm" TARGET="_top" TITLE="http://www.breastdiseases.com/benignb4.h"><U><I><B><U>Others changes</U></B></I></U></A><FONT SIZE="3" COLOR="#000000" FACE="Arial" ><I><B> </B></I></FONT></div> <div> <I><B>A. Fat necrosis </B></I></div> </NOBR></tD> </tR> </TABLE></div> <div> <B>4/ CYSTIC HYPERPLASIA SECRETORY OF THE BREAST</B></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="868" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#800000 HEIGHT= 19 ><NOBR><div> <I><B>HISTOLOGICAL TYPES</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="643"><div> <I><B>CHARACTERIZATION</B></I></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 76 WIDTH="210"><div> <I><B>General</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="643"><bR> <div> Dilated cysts lined by orderly, flat columnar epithelial cells with eosinophilic cytoplasm and round to oval vesicular cytologically benign nuclei and filled with homogenous, eosinophilic, colloid-like material</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="210"><div> <I><B>VARIANTS</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="643"><div>  </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 57 WIDTH="210"><div> <I><B>Preganancy-like pseudolactational hyperplasia</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><bR> <div> In 4/5 cases, there was merging of this change with cystic hyperplasia</div> </NOBR></tD> </tR> </TABLE></div> <bR> <DIV ALIGN="LEFT"></DIV> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="625" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ROWS" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#993300 HEIGHT= 43 WIDTH="615"><div> <B>Proliferative Lesions and their Relative Risks </B></div> <div> <B>for Developing Invasive Breast Cancer*</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#CCFFFF HEIGHT= 43 WIDTH="615"><div> <B>Nonproliferative changes: 70% of cases</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> <B>Relative Risk = 1.0</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> </tD> </tR> </TABLE></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="625" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ROWS" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 95 WIDTH="615"><div> Adenosis </div> <div> Cysts and apocrine change </div> <div> Ductal ectasia </div> <div> Mild epithelial hyperplasia of usual type </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#CCFFFF HEIGHT= 43 ><NOBR><div> <B>Proliferative disease without atypia: 26% of cases</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> <B>Relative Risk = 1.5-2.0</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> </NOBR></tD> </tR> </TABLE></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="625" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ROWS" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 70 WIDTH="615"><div> Hyperplasia of usual type, moderate or florid </div> <div> Papilloma </div> <div> Sclerosing adenosis </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#CCFFFF HEIGHT= 43 WIDTH="615"><div> <B>Proliferative disease with atypia: 4% of cases</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> <B>Relative Risk = 4-5</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> </tD> </tR> </TABLE></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="625" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ROWS" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 44 WIDTH="615"><div> Atypical ductal hyperplasia </div> <div> Atypical lobular hyperplasia </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#CCFFFF HEIGHT= 57 WIDTH="615"><div> *Modified from Table 1 by DL Page and WD Dupont: Premalignant conditions and markers of elevated risk in the breast and their management. Surg Clin N Amer 1990;70:831-851.</div> </tD> </tR> </TABLE></div> <bR> <div> <B>FIBROCYSTIC CHANGESsee above</B></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="750" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP BGCOLOR=#BFBFBF HEIGHT= 688 ><NOBR><div> <B>FIBROCYSTIC CHANGES</B></div> </NOBR></tD> <tD VALIGN=TOP BGCOLOR=#FFFFBF WIDTH="540"><div> the most common disorder of the breast</div> <div> most frequent during the reproductive years from 20-40 years peaking around menopause. </div> <div> It may be present in up to 60% of women and may be asymptomatic. </div> <div> The most common patterns are adenosis, cyst formation and fibrosis.</div> <div> Depending upon the degree of changes, the breast may have a lumpy bumpy appearance and feel. </div> <div> Calcifications may form and are identified on mammography. Occasionally the calcification pattern may be atypical, prompting a biopsy.</div> <div> The disorder may be related to hormonal imbalance with an excess of estrogens.</div> <div> Oral contraceptive use may decrease the changes since it usually provides a balance of progesterone and estrogen</div> <div> <IMG SRC="0911bdf0.jpg" border=0 width="283" height="223" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="09325080.jpg" border=0 width="293" height="264" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> </tD> </tR> </TABLE></div> <bR> <div> <B>4/ PRLIFERATIVE BREAST DISEASES</B></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="838" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP BGCOLOR=#CCFFFF HEIGHT= 57 WIDTH="828"><div> These changes in the breast are associated with an increased risk for breast cancer.</div> <div> This category comprises the following conditions moderate or florid epithelial hyperplasia, with or without atypica, sclerosing adenosis, and small duct papillomas.</div> </tD> </tR> </TABLE></div> <div> . </div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="877" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#800000 HEIGHT= 19 WIDTH="534"><div> <I><B>Histologic Changes</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="328"><div> <I><B>Relative Risk</B></I></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 ><NOBR><div> <I><B>Mild ductal hyperplasia, adenosis, cystic changes, apocrine metaplasia</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="328"><div> No increased risk</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 38 WIDTH="534"><div> <I><B>Sclerosing adenosis, moderate to florid epithelial hyperplasia, papillomas (Proliferative breast disease)</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="328"><div> 1.5-2x</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="534"><div> <I><B>Atypical ductal and atypical lobular hyperplasia</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="328"><div> 4-5x</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="534"><div> <I><B>DCIS and LCIS</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="328"><div> 11x</div> </tD> </tR> </TABLE></div> <div> <B>A description of each histologic change is provided below.</B></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="875" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ROWS" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 19 WIDTH="222"><div> Epithelial hyperplasia</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF><NOBR><div> Proliferation of epithelial layers usually three or more layers in thickness</div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 39 ><NOBR><div> Atypical ductal hyperplasia</div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF WIDTH="640"><div> <B>Proliferation of ductal epithelial cells sharing some but not all the features of ductal carcinoma in situ (DCIS)</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 39 ><NOBR><div> Atypical lobular hyperplasia</div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF WIDTH="640"><div> <B>Proliferation of lobular cells sharing features of lobular carcinoma in situ (LCIS) but filling or distending less than 50% of the acini within the lobule</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 58 WIDTH="222"><div> Sclerosing adenosis</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF WIDTH="640"><div> <B>Increased numbers of benign ducts distorted by sclerosis. Complex sclerosing areas with abundant fibrosis and elastosis are called radical scars or complex sclerosing lesions</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 39 ><NOBR><div> <B>Small duct papillomas</B></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF WIDTH="640"><div> <B>Papillomas composed of bland epithelial cells with a well defined fibrovascular core, a basal myoepithelial layer, and intact basement membrane </B></div> </tD> </tR> </TABLE></div> <bR> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="734" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP BGCOLOR=#CCFFFF HEIGHT= 133 WIDTH="724"><div> <B>The stratification of risk is an important advance in the understanding of breast disease. </B></div> <div> <B>these changes are still uncommon.</B></div> <div> <B>If a cohort of women undergoing breast biopsies for benign disease are examined, 50% will have proliferative changes. </B></div> <div> <B>Of these 50%, 5-10% will have atypical hyperplasia. </B></div> <div> <B>Of this latter category, 15% will develop invasive carcinoma (JAMA 1992;267:941).</B></div> </tD> </tR> </TABLE></div> <bR> <bR> <div> <B>Commonly Used Terms</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="625" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP BGCOLOR=#BFBFBF HEIGHT= 19 WIDTH="195"><div> Epitheliosis</div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFBF WIDTH="417"><div> British term for epithelial hyperplasia.</div> </tD> </tR> </TABLE></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="625" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP BGCOLOR=#BFBFBF HEIGHT= 20 WIDTH="195"><div> <B>Fenestrations</B></div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFBF><NOBR><div> <B>Irregular lumens present within ducts.</B></div> </NOBR></tD> </tR> </TABLE></div> <bR> <div> <B>6/ BENIGN TUMOR OF THE BREAST</B></div> <div> <B>adenomas</B></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="704" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP BGCOLOR=#BFBFBF HEIGHT= 65 WIDTH="137"><div> <B>Generality</B></div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFBF WIDTH="171"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="65" ALIGN="bottom" WIDTH="171" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP BGCOLOR=#BFBFBF WIDTH="380"><div> <B>Focal</B></div> <div> <B>Usually solitary proliferation</B></div> <div> <B>Predominantly the epithelium component of the breast</B></div> </tD> </tR> </TABLE></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="704" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP BGCOLOR=#BFBFBF HEIGHT= 113 WIDTH="137"><div> <B>types</B></div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFBF WIDTH="171"><div> <B>Lactating adenoma</B></div> </tD> <tD VALIGN=TOP BGCOLOR=#BFBFBF WIDTH="380"><div> <B>Solitary or multiple movable masses during pregnancy</B></div> <div> <B>Localized hyperplasia</B></div> <div> <B>May occur in ectopic breast tissue</B></div> <div> <B>Gray tan cut tissue</B></div> <div> <B>Well circumscribed</B></div> <div> <B>Necrosis and lymphocytic infiltrate common</B></div> </tD> </tR> </TABLE></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="704" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP BGCOLOR=#BFBFBF HEIGHT= 113 WIDTH="137"><div> <B>types</B></div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFBF WIDTH="171"><div> <B>Lactating adenoma</B></div> </tD> <tD VALIGN=TOP BGCOLOR=#BFBFBF WIDTH="380"><div> <B>Solitary or multiple movable masses during pregnancy</B></div> <div> <B>Localized hyperplasia</B></div> <div> <B>May occur in ectopic breast tissue</B></div> <div> <B>Gray tan cut tissue</B></div> <div> <B>Well circumscribed</B></div> <div> <B>Necrosis and lymphocytic infiltrate common</B></div> </tD> </tR> </TABLE></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="704" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP BGCOLOR=#BFBFBF HEIGHT= 128 WIDTH="137"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="128" ALIGN="bottom" WIDTH="137" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP BGCOLOR=#FFFFBF WIDTH="171"><div> <B>Tubular adenoma</B></div> </tD> <tD VALIGN=TOP BGCOLOR=#BFBFBF><NOBR><div> <B>Present in young adult</B></div> <div> <B>Solitary</B></div> <div> <B>Well circumscribed</B></div> <div> <B>Firm </B></div> <div> <B>Tan yellow mass</B></div> <div> <B>Closely packed regular small tubules</B></div> <div> <B>Decreased numbers of myoepithelium cells</B></div> <div> <B>Minimal stroma</B></div> </NOBR></tD> </tR> </TABLE></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="704" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP BGCOLOR=#BFBFBF HEIGHT= 1156 WIDTH="137"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1156" ALIGN="bottom" WIDTH="137" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP BGCOLOR=#FFFFBF WIDTH="171"><div> <B>Intraductal papilloma</B></div> </tD> <tD VALIGN=TOP BGCOLOR=#BFBFBF WIDTH="380"><div> <B>Intraductal papilloma usually occurs within a major duct in the subareolar region.</B></div> <div> <B>When a similar papilloma occurs in the nipple, the term nipple adenoma or papillomatosis is used</B></div> <div> <B>The clinical presentation is:</B></div> <div> <B>bloody, </B></div> <div> <B> serous nipple discharge. </B></div> <div> <B>The excised lesion is usually small, less than 1-2 cm in size</B></div> <div> <B>some papillomas are larger than 4 cm, especially those associated with hemorrhage and cystic change.</B></div> <div> <B> Sometimes the papillomas are multiple involving a group of ducts. </B></div> <div> <B>Multiple peripheral papillomas are associated with an increased risk for local recurrence and subsequent development of breast carcinoma.</B></div> <div> <B>Microscopically, the papillomas form papillary fronds supported by fibrous cores and covered with hyperplastic epithelium </B></div> <div> <B>solid areas are common, either focal or predominant </B></div> <div> <B>The proliferative epithelium is made up of epithelial and myoepithelial cells. </B></div> <div> <B>Secondary changes occur often in the form of :</B></div> <div> <B>hemorrhage, </B></div> <div> <B>infarct,</B></div> <div> <B> fibrosis </B></div> <div> <B> hyalinization, most likely resulting from torsion of the fibrous stalks and ischemic injury. </B></div> <div> <B>The damaged epithelium and hyalinized stroma may also deposit calcium.</B></div> <div> <B> In core biopsies, potential diagnostic problems include entrapped ducts in the hyaline stroma interpreted as invasive carcinoma </B></div> <div> <B>Nuclear atypia in papillary lesions needs careful evaluation to rule out atypical hyperplasia and ductal carcinoma in situ. </B></div> <div> <B><U>Juvenile papillomatosis</U></B><B> = marked ductal hyperplasia in adolescents and young women.</B></div> <div> <B> The involved ducts are cystically dilated with a Swiss cheese pattern.</B></div> <div> <B> Atypical ductal hyperplasia and carcinoma may occur </B></div> <bR> </tD> </tR> </TABLE></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="704" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP BGCOLOR=#BFBFBF HEIGHT= 530 WIDTH="137"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="530" ALIGN="bottom" WIDTH="137" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP BGCOLOR=#FFFFBF WIDTH="171"><div> <B>Nipple adenoma</B></div> </tD> <tD VALIGN=TOP BGCOLOR=#BFBFBF WIDTH="380"><div> <B>ductal hyperplasia of the lactiferous ducts, </B></div> <div> <B>sometimes protruding onto the nipple surface to manifest as a granular or ulcerated lesion. </B></div> <div> <B>Typical patients are 40-50 years of age.</B></div> <div> <B><U>Histologic</U></B><B> </B></div> <div> <B>mixture of:</B></div> <div> <B> intraductal papilloma, </B></div> <div> <B>adenosis, </B></div> <div> <B> tubular glands, </B></div> <div> <B> lined by epithelial and myoepithelial cells without nuclear atypia </B></div> <div> <B>Rare mitotic figures may be seen.</B></div> <div> <B><IMG SRC="09503a80.jpg" border=0 width="259" height="168" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>This benign tumor coexists with breast carcinoma in 16% of patients.</B></div> <div> <B>Nipple adenoma should be distinguished from subareolar sclerosing papillomatosis which occurs deeper in the breast tissue. Histologic appearance of both lesions is similar.</B></div> <bR> </tD> </tR> </TABLE></div> <bR> <div> <B>FIBROEPITHELIAL TUMORS</B></div> <bR> <div> A/ FIBROADENOMA</div> <div> <IMG SRC="0977af60.jpg" border=0 width="378" height="246" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> http://www-medlib.med.utah.edu/WebPath/BRESHTML/BREST001.html<IMG SRC="0997afb0.jpg" border=0 width="378" height="251" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <bR> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="824" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#800000 HEIGHT= 19 WIDTH="152"><div> <I><B>VARIANT</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="214"><div> <I><B>CLINICAL </B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="438"><div> <I><B>HISTOPATHOLOGY</B></I></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 38 WIDTH="152"><div> <I><B>Fibroadenomatoid hyperplasia</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="214"><div> No mass</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="438"><div> Histologically identical changes of a fibroadenoma without mass effect</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 38 ><NOBR><div> <I><B>Tubular adenoma</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> Similar to fibroadenomas</div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="438"><div> Composed predominately of proliferating tubules with little intervening stroma </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 38 ><NOBR><div> <I><B>Lactating adenoma</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> Seen during pregnancy</div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="438"><div> Similar to tubular adenoma with lactational changes present within the tubules </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 95 WIDTH="152"><div> <I><B>Juvenile fibroadenoma</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="214"><div> Similar to fibroadenomas, more common during adolescence</div> <div> May be bilateral or multiple and may recur several times</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="438"><div> Pericanalicular growth pattern and prominent epithelial hyperplasia</div> <div> Mild degree of stromal overgrowth but no cellular atypia and only rare mitotic figures</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 38 ><NOBR><div> <I><B>Giant fibroadenoma</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="214"><div> Large fibroadenomas usually greater than 10 cm</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="438"><div> Term has fallen out of favor and not used</div> </tD> </tR> </TABLE></div> <div>  </div> <bR> <div> <B>Commonly Used Terms</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="691" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="COLS" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP BGCOLOR=#C0C0C0 HEIGHT= 38 WIDTH="235"><div> <I><B>Intracanalicular</B></I></div> </tD> <tD VALIGN=TOP WIDTH="231"><div> <I><B>Glands are compressed into slit</B></I></div> </tD> <tD VALIGN=TOP BGCOLOR=#C0C0C0 WIDTH="205"><div> <I><B>like spaces by stroma. </B></I></div> </tD> </tR> </TABLE></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="691" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="COLS" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP BGCOLOR=#C0C0C0 HEIGHT= 38 WIDTH="235"><div> <B>Pericanalicular</B></div> </tD> <tD VALIGN=TOP WIDTH="231"><div> Intact round to oval spaces surrounded by stroma.</div> </tD> <tD VALIGN=TOP BGCOLOR=#C0C0C0 WIDTH="205"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="38" ALIGN="bottom" WIDTH="205" HSPACE="0" VSPACE="0"></tD> </tR> </TABLE></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="691" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="COLS" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP BGCOLOR=#C0C0C0 HEIGHT= 76 WIDTH="235"><div> <B>Stromal multinucleated giant cells</B></div> </tD> <tD VALIGN=TOP WIDTH="231"><div> Occasionally seen in the stroma. No mitotic figures are present. It is a benign change.</div> </tD> <tD VALIGN=TOP BGCOLOR=#C0C0C0 WIDTH="205"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="76" ALIGN="bottom" WIDTH="205" HSPACE="0" VSPACE="0"></tD> </tR> </TABLE></div> <bR> <div> <B>Phyllodes Tumor (Cystosarcoma Phyllodes)</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > <IMG SRC="09b3cd60.jpg" border=0 width="316" height="214" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></FONT></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="838" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP BGCOLOR=#FFFF99 HEIGHT= 488 WIDTH="828"><div> <B>malignant counterpart of fibroadenoma is cystosarcoma phyllodes</B></div> <div> <B>epithelial elements are benign, but the stromal tissue is malignant.</B></div> <div> <B>It results from malignant degeneration of fibroadenoma, </B></div> <div> <B>estimated to occur in 1% of patients, who have fibroadenoma for many years</B></div> <div> <B>At presentation, most women are between 40 and 50 years with a typical presentation of a rapidly growing mass. </B></div> <div> <B>The phyllodes tumor has a lobulated,</B></div> <div> <B>leaf-like appearance and varies in size from 1 cm to greater than 15 cm </B></div> <bR> <div> <B>Microscopically, </B></div> <div> <B>the branching, hyperplastic ducts are surrounded by a stroma, </B></div> <div> <B>which is mostly fibrous and much more cellular than fibroadenoma </B></div> <div> <B>In addition, nuclear atypia and increased mitotic activity occur </B></div> <div> <B>stromal components may contain:</B></div> <div> <B>liposarcoma,</B></div> <div> <B>leiomyosarcoma,</B></div> <div> <B>rhabdomyosarcoma,</B></div> <div> <B>malignant fibrous histiocytoma,</B></div> <div> <B>angiosarcoma, </B></div> <div> <B>chondrosarcoma </B></div> <div> <B>osteosarcoma. </B></div> <div> <B>In the absence of epithelial cells, the neoplasm is classified as primary stromal sarcoma of the breast, which is generally more aggressive than phyllodes tumor.</B></div> <div> <B>majority of phyllodes tumors are local problems and do not metastasize</B></div> <div> <B>20% of phyllodes tumors metastasize by vascular spread,</B></div> <div> <B>most commonly to the lung, pleura, and bone</B></div> </tD> </tR> </TABLE></div> <bR> <div> <B>Risk Factors for Breast Cancer</B></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="838" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP BGCOLOR=#CCFFFF HEIGHT= 453 WIDTH="828"><div> <B>Maternal relative with breast cancer. Women whose mother or sister or aunt had breast cancer, particularly at a younger age, have a greater risk.</B></div> <div> <B>BRCA1 and BRCA2 genes. </B></div> <div> <B>The incidence of the BRCA1 gene on chromosome 17 may be 1 in 800 women. </B></div> <div> <B>The BRCA2 gene on chromosome 13 is less frequent but associated with early onset breast carcinomas. </B></div> <div> <B>The presence of these genes may explain some of the familial cases, and may be the etiology for about 1% of breast cancers overall.</B></div> <div> <B>Longer reproductive span. </B></div> <div> <B>Women who have an earlier menarche and/or a later menopause, increasing the length of reproductive years, are at greater risk.</B></div> <div> <B>Obesity. Women who are overweight are at increased risk. In addition, increased dietary fat intake is a risk.</B></div> <div> <B>Nulliparity. Women who have never borne children are at greater risk, while women who have been pregnant are at a lower risk.</B></div> <div> <B>Later age at first pregnancy. Women who had their first child over age 30 are at greater risk.</B></div> <div> <B>Atypical epithelial hyperplasia. Although fibrocystic changes that produce benign breast "lumps" are not premalignant, the presence of atypical changes in ductular epithelium does increase the risk.</B></div> <div> <B>Previous breast cancer. Women who have had breast cancer in the opposite breast are at increased risk for cancer in the remaining breast.</B></div> <div> <B>Previous endometrial carcinoma. Women who have had adenocarcinoma of the endometrium are at increased risk for breast cancer.</B></div> <bR> </tD> </tR> </TABLE></div> <bR> <div> <B>Relative Risk for Breast Carcinoma</B></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="661" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#800000 HEIGHT= 19 WIDTH="518"><div> <I><B>Histologic Changes</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#800000><NOBR><div> <I><B>Relative Risk</B></I></div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 38 WIDTH="518"><div> <I><B>Mild ductal hyperplasia, adenosis, cystic changes, apocrine metaplasia</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> No increased risk</div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 38 WIDTH="518"><div> <I><B>Sclerosing adenosis, moderate to florid epithelial hyperplasia, papillomas </B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="128"><div> 1.5-2x</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="518"><div> <I><B>Atypical ductal and atypical lobular hyperplasia</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="128"><div> 4-5x</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="518"><div> <I><B>DCIS and LCIS</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="128"><div> 11x</div> </tD> </tR> </TABLE></div> <div> <B><U>Commonly Used Terms</U></B><FONT SIZE="3" COLOR="#000000" FACE="Arial" ><U> </U></FONT></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="705" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP BGCOLOR=#BFBFBF HEIGHT= 48 WIDTH="189"><div> <B>Adenosis</B></div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFBF><NOBR><div> <B>Increase in glandular acinar units per lobule.</B></div> <div> <B>If the gland lumens are enlarged, it is termed blunt duct adenosis.</B></div> <div> <B>If the lumens are distorted, it is called sclerosing adenosis.</B></div> </NOBR></tD> </tR> </TABLE></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="705" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP BGCOLOR=#BFBFBF HEIGHT= 33 WIDTH="189"><div> <B>Apocrine metaplasia</B></div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFBF WIDTH="501"><div> <B>A benign metaplastic change where the normal ductal epithelium is replaced by large eosinophilic cells with abudant cytoplasm.</B></div> </tD> </tR> </TABLE></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="705" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP BGCOLOR=#BFBFBF HEIGHT= 33 WIDTH="189"><div> <B>Fibrosis</B></div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFBF WIDTH="501"><div> <B>Scarring fibrosis frequently secondary to ruptured cysts and extravasation of fluid.</B></div> </tD> </tR> </TABLE></div> <bR> <div> <B>4/ breat CANCER</B></div> <DIV ALIGN="LEFT"></DIV> <div> Invasive Carcinomas of the Breast</div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="520" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BELOW" RULES="ROWS" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#800000 HEIGHT= 38 WIDTH="265"><div> <I><B>Histologic Type </B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#800000><NOBR><div> <I><B>Frequency (%) </B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="136"><div> <I><B>5-year Survival (%) </B></I></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 ><NOBR><div> <I><B>Infiltrating Ductal Carcinoma </B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="109"><div> 63.6 </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="136"><div> 79 </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 ><NOBR><div> <I><B>Infiltrating Lobular Carcinoma </B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="109"><div> 5.9 </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="136"><div> 84 </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 38 WIDTH="265"><div> <I><B>Infiltrating Ductal & Lobular Carcinoma </B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="109"><div> 1.6 </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="136"><div> 85 </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="265"><div> <I><B>Medullary Carcinoma </B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="109"><div> 2.8 </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="136"><div> 82 </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 ><NOBR><div> <I><B>Mucinous (colloid) Carcinoma </B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="109"><div> 2.1 </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="136"><div> 95 </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="265"><div> <I><B>Comedocarcinoma </B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="109"><div> 1.4 </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="136"><div> 87 </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="265"><div> <I><B>Paget's Disease </B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="109"><div> 1.0 </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="136"><div> 79 </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="265"><div> <I><B>Papillary Carcinoma </B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="109"><div> 0.8 </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="136"><div> 96 </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="265"><div> <I><B>Tubular Carcinoma </B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="109"><div> 0.6 </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="136"><div> 96 </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="265"><div> <I><B>Adenocarcinoma, NOS </B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="109"><div> 7.5 </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="136"><div> 65 </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="265"><div> <I><B>Carcinoma, NOS </B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="109"><div> 3.5 </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="136"><div> 62 </div> </tD> </tR> </TABLE></div> <bR> <div> Non-invasive Carcinomas of the Breast</div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="479" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BELOW" RULES="ROWS" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#800000 HEIGHT= 38 WIDTH="224"><div> <I><B>Histologic Type </B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#800000><NOBR><div> <I><B>Frequency (%) </B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="136"><div> <I><B>5-year Survival (%) </B></I></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 ><NOBR><div> <I><B>Intraductal Carcinoma </B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="109"><div> 3.6 </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="136"><div> >99 </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 38 WIDTH="224"><div> <I><B>Lobular Carcinoma in situ (LCIS) </B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="109"><div> 1.6 </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="136"><div> >99 </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="224"><div> <I><B>Intraductal & LCIS </B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="109"><div> 0.2 </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="136"><div> >99 </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 ><NOBR><div> <I><B>Papillary Carcinoma </B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="109"><div> 0.4 </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="136"><div> >99 </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="224"><div> <I><B>Comedocarcinoma </B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="109"><div> 0.3 </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="136"><div> >99 </div> </tD> </tR> </TABLE></div> <bR> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="867" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#C0C0C0 HEIGHT= 75 ><NOBR><div> <I><B>SYNONYMS</B></I></div> </NOBR></tD> <tD VALIGN=CENTER WIDTH="733"><div> <I><B>Duct carcinoma with productive fibrosis</B></I></div> <div> <I><B>Scirrhous carcinoma</B></I></div> <div> <I><B>Carcinoma simplex</B></I></div> <div> <I><B>Invasive duct carcinoma, not otherwise specified (NOS)</B></I></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#C0C0C0 HEIGHT= 64 WIDTH="119"><div> <B>INCIDENCE</B></div> </tD> <tD VALIGN=CENTER WIDTH="733"><div> One in nine women will develop breast cancer within her lifetime</div> <div> 27 per 100,000 in USA</div> <div> 44,000 women dying yearly</div> <div> 60-80% of all malignant breast tumors</div> </tD> </tR> </TABLE></div> <div>  <IMG SRC="09dd1fc0.jpg" border=0 width="977" height="508" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <DIV ALIGN="LEFT"></DIV> <div> <IMG SRC="09fed370.jpg" border=0 width="493" height="311" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> http://www.vh.org/Providers/TeachingFiles/Metastases/Images/Image2.html</div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="821" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#800000 HEIGHT= 38 WIDTH="212"><div> <I><B>EPIDEMIOLOGIC ASSOCIATIONS</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="594"><div> <I><B>CHARACTERIZATION</B></I></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 20 WIDTH="212"><div> <I><B>Geography</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="594"><div> <B>4-7x more common in US than Asia</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 81 WIDTH="212"><div> <I><B>Genetics</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="594"><div> <B>5-10% of women have inheritance of a mutation in the breast cancer gene (</B><A HREF="http://www.thedoctorsdoctor.com/labtests/brca_genes.htm" TARGET="_top" TITLE="http://www.thedoctorsdoctor.com/labtests"><U><B><U>BRCA1 and BRCA2</U></B></U></A><B>)</B></div> <div> <B>1.5-2x risk for women with first degree relatives with breast CA</B></div> <div> <B>4-6x risk with two affected relatives</B></div> <div> <I><B>Familial syndromes (Li-Fraumeni syndrome, Cowden's syndrome, Ataxia-Telangiectasia</B></I><B>)</B></div> </tD> </tR> </TABLE></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="821" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 39 WIDTH="212"><div> <I><B>Age</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="594"><div> <B>Steady rise to menopause</B></div> <div> <B>Average age of diagnosis is 64 yrs</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 20 ><NOBR><div> <I><B>Length of reproductive life</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> <B>Early menarche (start of menstruation) and late menopause increases risk</B></div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 39 WIDTH="212"><div> <I><B>Parity</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> <B>Increased risk if first child born after 30 yrs of age</B></div> <div> <B>Increased risk in nulliparous than multiparous women</B></div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 58 WIDTH="212"><div> <I><B>Obesity</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="594"><div> <B>Increased risk due to excess estrogen synthesis from peripheral fat in postmenopausal women</B></div> <div> <B>Decreased risk in obese women <40 yrs</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 20 ><NOBR><div> <I><B>Exogenous estrogens</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> <B>Controversial but may have a slightly increased risk</B></div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 39 WIDTH="212"><div> <I><B>Endogenous estrogen excess</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> <B>Functioning ovarian tumors producing estrogen </B></div> <div> <B>postmenopausal women with high circulating levels of estrogen</B></div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 39 WIDTH="212"><div> <I><B>Race</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="594"><div> <B>Overall incidence is lower in black women but do present with more advanced stage with increased mortality as compared to white women </B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 57 WIDTH="212"><div> <I><B>Carcinoma of the contralateral breast or endometrium</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="594"><div> <B>Increased risk of breast cancer</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 58 WIDTH="212"><div> <I><B>Radiation exposure</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="594"><div> <B>Risk increases with younger age of exposure and higher radiation doses</B></div> <div> <B>Mantle radiation for Hodgkin's disease have 20-30% increased risk 10-20 yrs following radiation</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 39 WIDTH="212"><div> <I><B>Diet</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="594"><div> <B>Moderate or heavy alcohol consumption</B></div> <div> <B>No association with coffee or cigarette smoking</B></div> </tD> </tR> </TABLE></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="821" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 171 WIDTH="212"><div> <B> location </B></div> <bR> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="594"><bR> <div> <B>Upper outer quadrant: 50% </B></div> <div> <B>Central area: 20% </B></div> <div> <B>Lower outer quadrant: 10% </B></div> <div> <B>Upper inner quadrant: 10% </B></div> <div> <B>Lower inner quadrant: 10% </B></div> <bR> </tD> </tR> </TABLE></div> <div>  </div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="660" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#800000 HEIGHT= 19 ><NOBR><div> <I><B>PATHOGENESIS</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="504"><div> <I><B>CHARACTERIZATION</B></I></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="141"><div> <I><B>ras oncogene</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="504"><div> Mutations present in 10-30% </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="141"><div> <A HREF="http://www.thedoctorsdoctor.com/labtests/Her_2.htm" TARGET="_top" TITLE="http://www.thedoctorsdoctor.com/labtests"><U><I><B><U>Her2-neu</U></B></I></U></A></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="504"><div>  </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 38 WIDTH="141"><div> <I><B>c-myc</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> Ampflication of 17% of cancers</div> <div> Altered expression had significantly shorter disease free survival</div> </NOBR></tD> </tR> </TABLE></div> <div>  </div> <DIV ALIGN="LEFT"></DIV> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="695" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP COLSPAN=13 BGCOLOR=#800000 HEIGHT= 35 WIDTH="661"><div> <I>Clinicopathologic Features and Results of the </I></div> <div> <I>Immunohistochemical Stains in 26 Breast Cancers</I></div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFCC HEIGHT= 18 WIDTH="34"><div> <I> </I></div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFCC WIDTH="26"><div>  </div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFCC WIDTH="42"><div>  </div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFCC WIDTH="42"><div>  </div> </tD> <tD VALIGN=TOP COLSPAN=2 BGCOLOR=#FFFFCC WIDTH="82"><div> Tumor</div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFCC WIDTH="88"><div>  </div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFCC WIDTH="67"><div>  </div> </tD> <tD VALIGN=TOP COLSPAN=2 BGCOLOR=#FFFFCC><NOBR><div> Immunostain</div> </NOBR></tD> <tD VALIGN=TOP COLSPAN=2 BGCOLOR=#FFFFCC WIDTH="117"><div> Treatment</div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFCC WIDTH="51"><div>  </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 71 ><NOBR><div> <I>Case</I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="26"><div> Age</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> Tumor Type</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> Tumor </div> <div> Size (cm)</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> Grade </div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> Stage</div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> Progesterone </div> <div> Receptors</div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> Estrogen </div> <div> Receptors </div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> Bcl-2</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> p53</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="52"><div> Chemo-therapy</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="62"><div> Radiation Therapy</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="51"><div> Follow-up After Surgery (mos)</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 35 WIDTH="34"><div> <I>1</I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="26"><div> 71</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> D </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> 1.5</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 2</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="38"><div> IV </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="88"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="67"><div> + </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 2</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 2</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="52"><div> +</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="62"><div> +</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="51"><div> AWD (48)</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 35 WIDTH="34"><div> <I>2</I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="26"><div> 41</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> M</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> 1.0</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 2</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="38"><div> I</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="88"><div> + </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="67"><div> + </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 1</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 0</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="52"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="62"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="51"><div> NED (20)</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 35 WIDTH="34"><div> <I>3</I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="26"><div> 88</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> D</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> 2.0</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 2</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="38"><div> IIA</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="88"><div> + </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="67"><div> + </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 2</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 2</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="52"><div> +</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="62"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="51"><div> NED (52) </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 35 WIDTH="34"><div> <I>4 </I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="26"><div> 44 </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> D</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> 1.8</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 2</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="38"><div> IIA</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="88"><div> +</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="67"><div> +</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 1</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 3</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="52"><div> - </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="62"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="51"><div> NED (8)</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 35 WIDTH="34"><div> <I>5</I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="26"><div> 47</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> M </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> 1.5</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 2 </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="38"><div> I</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="88"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="67"><div> +</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 0</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 3</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="52"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="62"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="51"><div> NED (29) </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 35 WIDTH="34"><div> <I>6</I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="26"><div> 54</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> D</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> 2.5</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 2</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="38"><div> IV</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="88"><div> - </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="67"><div> - </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 3</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 3</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="52"><div> + </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="62"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="51"><div> DOD (36)</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 35 WIDTH="34"><div> <I>7</I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="26"><div> 42</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> M</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> 1.5</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 1</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="38"><div> I</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="88"><div> +</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="67"><div> +</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 0</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 3 </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="52"><div> - </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="62"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="51"><div> NED (60)</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 35 WIDTH="34"><div> <I>8</I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="26"><div> 50</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> M</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> 2.0</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 1</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="38"><div> I </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="88"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="67"><div> +</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 0</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 3</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="52"><div> - </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="62"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="51"><div> NED (156)</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 18 WIDTH="34"><div> <I>9</I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="26"><div> 47</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> D</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> 1.5</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 3 </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="38"><div> I</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="88"><div> - </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="67"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 3</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 0</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="52"><div> - </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="62"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="51"><div> LTF</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 35 WIDTH="34"><div> <I>10</I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="26"><div> 58</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> D</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> 3.5 </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 1</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="38"><div> IIA </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="88"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="67"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 0</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 0</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="52"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="62"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="51"><div> NED (72)</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 35 WIDTH="34"><div> <I>11</I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="26"><div> 45</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> M </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> 1.5</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 1</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="38"><div> I</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="88"><div> + </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="67"><div> +</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 0 </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 0 </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="52"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="62"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="51"><div> NED (60)</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 35 WIDTH="34"><div> <I>12 </I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="26"><div> 65</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> M</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> 1.4</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 1</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="38"><div> I </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="88"><div> - </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="67"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 2</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 0 </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="52"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="62"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="51"><div> NED (60)</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 35 WIDTH="34"><div> <I>13 </I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="26"><div> 75</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> D</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> 1.5</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 2</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="38"><div> IIA</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="88"><div> +</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="67"><div> +</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 3</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 0</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="52"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="62"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="51"><div> NED (24)</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 35 WIDTH="34"><div> <I>14</I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="26"><div> 65</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> D</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> 0.7</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 2</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="38"><div> I</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="88"><div> +</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="67"><div> +</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 2 </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 3</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="52"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="62"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="51"><div> NED (13)</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 35 WIDTH="34"><div> <I>15</I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="26"><div> 46</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> D</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> 1.4</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 1</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="38"><div> I</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="88"><div> +</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="67"><div> +</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 2</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 3 </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="52"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="62"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="51"><div> NED (23)</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 35 WIDTH="34"><div> <I>16</I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="26"><div> 63</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> D</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> 2.0</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 2 </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="38"><div> I </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="88"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="67"><div> +</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 2</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 0</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="52"><div> - </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="62"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="51"><div> NED (19)</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 35 WIDTH="34"><div> <I>17 </I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="26"><div> 57</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> D</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> 2.8 </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 2</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="38"><div> IV </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="88"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="67"><div> +</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 3 </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 0</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="52"><div> +</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="62"><div> +</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="51"><div> AWD (14)</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 35 WIDTH="34"><div> <I>18</I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="26"><div> 42</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> D</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> 1.5</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 3 </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="38"><div> IIA</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="88"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="67"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 2</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 2</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="52"><div> +</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="62"><div> +</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="51"><div> NED (52)</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 35 WIDTH="34"><div> <I>19</I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="26"><div> 38</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> D</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> 2.5</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 2</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="38"><div> IIB</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="88"><div> +</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="67"><div> +</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 1</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 3</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="52"><div> + </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="62"><div> +</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="51"><div> NED (53)</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 35 WIDTH="34"><div> <I>20</I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="26"><div> 60 </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> D </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> 1.3</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 3</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="38"><div> I </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="88"><div> + </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="67"><div> + </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 1</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 3 </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="52"><div> + </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="62"><div> +</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="51"><div> NED (65)</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 18 WIDTH="34"><div> <I>21 </I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="26"><div> 65</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> D+L</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> 1.2</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 3 </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="38"><div> IIA </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="88"><div> +</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="67"><div> +</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 1</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 3</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="52"><div> +</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="62"><div> +</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="51"><div> LTF</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 35 WIDTH="34"><div> <I>22 </I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="26"><div> 56</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> D</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> 4.0</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 3</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="38"><div> IIA </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="88"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="67"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 1</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 0 </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="52"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="62"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="51"><div> NED (39)</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 35 WIDTH="34"><div> <I>23</I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="26"><div> 78</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> D</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> 1.5</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 2 </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="38"><div> I </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="88"><div> +</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="67"><div> +</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 1</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 0</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="52"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="62"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="51"><div> NED (22)</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 35 WIDTH="34"><div> <I>24</I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="26"><div> 75 </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> D</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> 2.7</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 2 </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="38"><div> IIB</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="88"><div> +</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="67"><div> +</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 3 </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 0</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="52"><div> +</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="62"><div> +</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="51"><div> NED (23)</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 35 WIDTH="34"><div> <I>25</I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="26"><div> 69</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> D</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> 2.5</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 3</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="38"><div> IV</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="88"><div> +</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="67"><div> +</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 3</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 0</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="52"><div> +</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="62"><div> +</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="51"><div> AWD (16)</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 35 WIDTH="34"><div> <I>26</I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="26"><div> 58</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> D</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="42"><div> 3.2</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 3 </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="38"><div> IV </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="88"><div> +</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="67"><div> +</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 3</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="41"><div> 0</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="52"><div> +</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="62"><div> +</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="51"><div> AWD (33)</div> </tD> </tR> </TABLE></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="661" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP BGCOLOR=#FFFFCC HEIGHT= 846 WIDTH="651"><div> <I>M = medullary features </I></div> <div> <I>D = ductal carcinoma </I></div> <div> <I>L = lobular carcinoma </I></div> <div> <I>1 = weak staining </I></div> <div> <I>2 = moderate staining</I></div> <div> <I>3 = strong staining </I></div> <div> <I>NED = no evidence of disease</I></div> <div> <I>AWD = alive with disease </I></div> <div> <I>DOD = dead of disease</I></div> <div> <I>LTF = lost to follow-up</I></div> <div> <A HREF="http://www.moffitt.usf.edu/pubs/ccj/v6n2/department6.htm" TARGET="_top" TITLE="http://www.moffitt.usf.edu/pubs/ccj/v6n2"><U><I><U>http://www.moffitt.usf.edu/pubs/ccj/v6n2/department6.htm</U></I></U></A></div> <div> <IMG SRC="0a1ec8d0.jpg" border=0 width="236" height="141" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="322" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 31 WIDTH="318"><div> - Infiltrating ductal carcinoma. <I>p53</I> immunostain decorates the nuclei of the majority of the neoplastic cells.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> </tD> </tR> </TABLE></div> <div> <FONT SIZE="3" COLOR="#000000" FACE="Arial" > <IMG SRC="0a3ec8d0.jpg" border=0 width="236" height="141" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></FONT>Strong <I>Bcl-2</I> immunostain decorating the cytoplasm of cells lining normal as well as hyperplastic ducts</div> <div> <FONT SIZE="3" COLOR="#000000" FACE="Arial" ><IMG SRC="0a5ec8d0.jpg" border=0 width="236" height="141" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></FONT>of <I>Bcl-2</I>-negative infiltrating ductal carcinoma with adjacent strongly <I>Bcl-2</I>-positive normal ductal cells (arrows).</div> <div> <FONT SIZE="3" COLOR="#000000" FACE="Arial" ><IMG SRC="0a7ec8d0.jpg" border=0 width="236" height="141" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></FONT>Strong <I>p53</I> nuclear immunoreactivity in infiltrating neoplastic ductal cells (arrows) but not in cells lining adjacent normal ducts</div> </tD> </tR> </TABLE></div> <bR> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="868" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#800000 HEIGHT= 19 ><NOBR><div> <I><B>LABORATORY/RADIOLOGIC/OTHER TESTS</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="509"><div> <I><B>CHARACTERIZATION</B></I></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="344"><div> <I><B>Screening mammography</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="509"><div> Yearly screening for women over 40 years of age</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="344"><div> <I><B>Ultrasound or CT scan</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="509"><div> Ultrasound may identify solid versus cystic lesions</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 57 WIDTH="344"><div> <I><B>Flow cytometry</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="509"><div> Diploid tumors with a high S phase fraction (SPF) have a significantly reduced disease-free survival rate when compared to diploid tumors with a low SPF</div> </tD> </tR> </TABLE></div> <div>  </div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="877" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#800000 HEIGHT= 19 ><NOBR><div> <I><B>GROSS OR CLINICAL VARIANTS</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="521"><div> <I><B>CHARACTERIZATION</B></I></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 80 WIDTH="341"><div> <I><B>Sites</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> Slightly more common in the left than right breast (110:100)</div> <div> Bilateral or sequential in 4% of cases</div> <div> 50%arise in the upper outer quadrant</div> <div> 20% in the central or subareolar region</div> <div> 10% each in the remaining three quadrants</div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 48 WIDTH="341"><div> <I><B>Appearance</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> Stellate or circumscribed appearance</div> <div> Usually a solid tumor with a firm gray to white cut surface</div> <div> Chalky white streaks correspond to necrosis, calcification, or elastosis</div> </NOBR></tD> </tR> </TABLE></div> <div>  </div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="868" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#800000 HEIGHT= 19 ><NOBR><div> <I><B>HISTOLOGICAL TYPES</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="607"><div> <I><B>CHARACTERIZATION</B></I></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 38 WIDTH="246"><div> <I><B>Grading</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="607"><div> See Commonly Used Terms</div> <div> Scarf-Bloom-Richardson Grading </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 38 WIDTH="246"><div> <I><B>Extratumoral lymphatic tumor emboli</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="607"><div> 25% of cases</div> <div> Majority will have accompanying lymph node metastases</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 38 WIDTH="246"><div> <I><B>Blood vessel invasion</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="607"><div> Identified in 13% of T1N0M0 patients</div> <div> In these patients, recurrence was more frequent</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 38 WIDTH="246"><div> <I><B>Perineural invasion</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> 10% of invasive carcinomas</div> <div> Usually in high grade tumors and associated with lymphatic tumor emboli</div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="246"><div> <I><B>Elastosis</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> Abundant changes usually associated with estrogen receptor positivity </div> </NOBR></tD> </tR> </TABLE></div> <div>  </div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="709" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BELOW" RULES="ROWS" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#800000 HEIGHT= 19 ><NOBR><div> <I><B>SPECIAL STAINS/IMMUNOPEROXIDASE/OTHER</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="290"><div> <I><B>CHARACTERIZATION</B></I></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="412"><div> <I><B>Her2-neu</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="290"><div>  her2-neu</div> </tD> </tR> </TABLE></div> <div>  </div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="890" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#800000 HEIGHT= 38 WIDTH="201"><div> <I><B>PROGNOSIS AND TREATMENT</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="674"><div> <I><B>CHARACTERIZATION</B></I></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 20 WIDTH="201"><div> <I><B>Prognostic Factors</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="674"><div> <B>influenced by a number of factors.</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 39 ><NOBR><div> <I><B>Size of primary tumor</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> <B>Tumors <1 cm with negative nodes have 98% survival at 5 yrs</B></div> <div> <B>Tumors <2 cm with negative nodes have 96% survival</B></div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 113 ><NOBR><div> <I><B>Lymph node involvement</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> <B>Single most important factor in determining prognosis for early breast cancer</B></div> <div> <B>10 yr disease free survival is 70-80% with negative nodes</B></div> <div> <B>One to three positive nodes 35-40%</B></div> <div> <B>Ten or more positive nodes 10-15%</B></div> <div> <B>Micrometastasis <0.2 cm are associated with better prognosis</B></div> <div> <B>NOTE: 20-30% of node-negative women will have a recurrence and die within 10 yrs</B></div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 39 WIDTH="201"><div> <I><B>Histologic type and grade of tumor</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> <B>Better for tubular, papillary, colloid, medullary versus NOS types</B></div> <div> <B>>80% of women with Grade I tumors survive 16 yrs</B></div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 57 WIDTH="201"><div> <I><B>Estrogen and progesterone receptor status</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> <B>50-85% of tumors have estrogen receptors</B></div> <div> <B>70% of tumors with estrogen receptors regress after hormone treatment </B></div> <div> <B>Only 5% of receptor negative tumors respond</B></div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 39 ><NOBR><div> <I><B>Proliferative rate of tumor</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="674"><div> <B>Higher proliferation rates have poorer prognosis</B></div> <div> <B>High S-phase fraction by flow cytometry</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 20 ><NOBR><div> <I><B>Amplified oncogenes</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="674"><div> <A HREF="http://www.thedoctorsdoctor.com/labtests/Her_2.htm" TARGET="_top" TITLE="http://www.thedoctorsdoctor.com/labtests"><U><B><U>See her2-neu</U></B></U></A></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 20 ><NOBR><div> <I><B>Degree of angiogenesis</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> <B>High correlation with increased vessel density and metastasis</B></div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 39 ><NOBR><div> <I><B>Lymphovascular invasion</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> <B>Strong association with lymph node metastasis</B></div> <div> <B>Dermal lymphatic invasion (inflammatory carcinoma) has 3 yr survival of 3-10% </B></div> </NOBR></tD> </tR> </TABLE></div> <div> <B>Staging and grading</B></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="506" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BELOW" RULES="ROWS" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#800000 HEIGHT= 38 WIDTH="445"><div> <I><B>Tubule Formation (% of carcinoma composed of tubular structures) </B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#800000><NOBR><div> <I><B>Score </B></I></div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="445"><div> <I><B>>75% </B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="54"><div> 1 </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="445"><div> <I><B>10-75% </B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="54"><div> 2 </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="445"><div> <I><B>less than 10% </B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="54"><div> 3 </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="445"><div> <I><B>Nuclear Pleomorphism </B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> Score </div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="445"><div> <I><B>Small, uniform cells </B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="54"><div> 1 </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="445"><div> <I><B>Moderate increase in size and variation </B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="54"><div> 2 </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="445"><div> <I><B>Marked variation </B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="54"><div> 3 </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="445"><div> <I><B>Mitotic Count (per 10 high power fields) </B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> Score </div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="445"><div> <I><B>Up to 7 </B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="54"><div> 1 </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="445"><div> <I><B>8 to 14 </B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="54"><div> 2 </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="445"><div> <I><B>15 or more </B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="54"><div> 3 </div> </tD> </tR> </TABLE></div> <bR> <div> The grade is calculated by adding the above scores. The grade correlates with survival as follows:</div> <DIV ALIGN="LEFT"></DIV> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="394" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BELOW" RULES="ROWS" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#800000 HEIGHT= 38 ><NOBR><div> <I><B>Grade </B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#800000><NOBR><div> <I><B>Score </B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="136"><div> <I><B>5-year Survival (%) </B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="136"><div> <I><B>7-year Survival (%) </B></I></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="55"><div> <I><B>1 </B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> 3 to 5 </div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="136"><div> 95 </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="136"><div> 90 </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="55"><div> <I><B>2 </B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> 6 or 7 </div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="136"><div> 75 </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="136"><div> 65 </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="55"><div> <I><B>3 </B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> 8 or 9 </div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="136"><div> 50 </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="136"><div> 45 </div> </tD> </tR> </TABLE></div> <bR> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="706" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#800000 HEIGHT= 57 ><NOBR><div> <I><B>Stage </B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="489"><div> <I><B>Definition </B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="75"><div> <I><B>5-year Survival (%) </B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="76"><div> <I><B>7-year Survival (%) </B></I></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 39 WIDTH="41"><div> <I><B>I </B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> <B>Tumor 2 cm or less in greatest diameter </B></div> <div> <B>without evidence of regional (nodal) or distant spread </B></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="75"><div> 96 </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="76"><div> 92 </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 114 WIDTH="41"><div> <I><B>II </B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="489"><div> <B>Tumor more than 2 cm but not more than 5 cm in greatest dimension, </B></div> <div> <B>with regional lymph node involvement </B></div> <div> <B>without distant metastases, </B></div> <div> <B>OR > a tumor of more than 5 cm in diameter without regional (nodal) and distant spread </B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="75"><div> 81 </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="76"><div> 71 </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 113 WIDTH="41"><div> <I><B>III </B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> <B>Tumors of any size with possible </B></div> <div> <B>skin involvement,</B></div> <div> <B>pectoral </B></div> <div> <B>chest wall fixation, </B></div> <div> <B>axillary or internal mammary nodal involvement, </B></div> <div> <B>fixed, but without distant metastases </B></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="75"><div> 52 </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="76"><div> 39 </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 39 WIDTH="41"><div> <I><B>IV </B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="489"><div> <B>Tumor of any size with or without regional spread but with evidence of distant metastases </B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="75"><div> 18 </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="76"><div> 11 </div> </tD> </tR> </TABLE></div> <bR> <div> <B>The American Joint Committee on Cancer staging identifies the following stages</B></div> <div> <B>Tumor</B></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="799" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 20 WIDTH="121"><div> <B>TX</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF WIDTH="663"><div> <B>Primary tumor cannot be assessed</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 20 WIDTH="121"><div> <B>T0</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF WIDTH="663"><div> <B>No evidence of primary tumor</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 20 WIDTH="121"><div> <B>Tis</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF><NOBR><div> <B>Carcinoma in situ or Paget's disease of the nipple with no tumor</B></div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 20 WIDTH="121"><div> <B>T1</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF WIDTH="663"><div> <B>Tumor 2 cm or less in greatest dimension</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 20 WIDTH="121"><div> <B>T1a</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF WIDTH="663"><div> <B>0.5 cm or less in greatest dimension</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 20 WIDTH="121"><div> <B>T1b</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF><NOBR><div> <B>More than 0.5 cm but not more than 1 cm in greatest dimension</B></div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 20 WIDTH="121"><div> <B>T1c</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF><NOBR><div> <B>More than 1 cm but not more than 2 cm in greatest dimension</B></div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 20 WIDTH="121"><div> <B>T2</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF><NOBR><div> <B>Tumor more than 2 cm but not more than 5 cm in greatest dimension </B></div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 20 WIDTH="121"><div> <B>T3</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF WIDTH="663"><div> <B>Tumor more than 5 cm in greatest dimension</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 20 WIDTH="121"><div> <B>T4</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF WIDTH="663"><div> <B>Tumor of any size with direct extension to the skin</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 20 WIDTH="121"><div> <B>T4a</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF WIDTH="663"><div> <B>Extension to the chest wall</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 39 WIDTH="121"><div> <B>T4b</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF WIDTH="663"><div> <B>Edema (including peau d'orange) or ulceration of the skin of breast with satellite skin nodules confined to the same breast</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 20 WIDTH="121"><div> <B>T4c</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF WIDTH="663"><div> <B>Both T4a and T4b</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 20 WIDTH="121"><div> <B>T4d</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF WIDTH="663"><div> <B>Inflammatory carcinoma</B></div> </tD> </tR> </TABLE></div> <div> <B>Nodal Status</B></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="661" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 20 WIDTH="128"><div> <B>NX</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF><NOBR><div> <B>Regional lymph nodes cannot be assessed (eg previously removed)</B></div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 20 WIDTH="128"><div> <B>N0</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF WIDTH="518"><div> <B>No regional lymph node metastasis</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 20 WIDTH="128"><div> <B>N1</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF><NOBR><div> <B>Metastasis to movable ipsilateral axillary lymph nodes</B></div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 39 WIDTH="128"><div> <B>N2</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF WIDTH="518"><div> <B>Metastasis to ipsilateral axillary lymph nodes fixed to one another or other structures</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 20 WIDTH="128"><div> <B>N3</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF><NOBR><div> <B>Metastasis to ipsilateral internal mammary lymph nodes</B></div> </NOBR></tD> </tR> </TABLE></div> <div> <B>Pathological Classification of Lymph Nodes (pN)</B></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="821" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 20 WIDTH="53"><div> <B>pNX</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF WIDTH="753"><div> <B>Regional lymph nodes cannot be assessed</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 20 WIDTH="53"><div> <B>pN0</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF WIDTH="753"><div> <B>No regional lymph node metastasis</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 20 WIDTH="53"><div> <B>pN1</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF WIDTH="753"><div> <B>Metastasis to movable ipsilateral axillary lymph nodes</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 20 WIDTH="53"><div> <B>pN1a</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF WIDTH="753"><div> <B>Only micrometastasis (none larger than 0.2 cm)</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 20 WIDTH="53"><div> <B>pN1b</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF WIDTH="753"><div> <B>Metastasis to lymph nodes, any larger than 0.2 cm</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 20 ><NOBR><div> <B>pN1bi</B></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF><NOBR><div> <B>Metastasis in 1-3 lymph nodes, any more than 0.2 cm and all less than 2 cm in greatest dimension</B></div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 39 ><NOBR><div> <B>pN1bii</B></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF WIDTH="753"><div> <B>Metastasis to 4 or more lymph nodes, any more than 0.2 cm and all less than 2 cm in greatest dimension</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 39 ><NOBR><div> <B>pN1biii</B></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF WIDTH="753"><div> <B>Extension of tumor beyond the capsule of a lymph node metastasis less than 2 cm in greatest dimension</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 20 ><NOBR><div> <B>pN1biv</B></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF WIDTH="753"><div> <B>Metastasis to a lymph node 2 cm or more in greatest dimension</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 20 WIDTH="53"><div> <B>pN2</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF><NOBR><div> <B>Metastasis to ipsilateral axillary lymph nodes that are fixed to one another or to other structures</B></div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 20 WIDTH="53"><div> <B>pN3</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF WIDTH="753"><div> <B>Metastasis to ipsilateral internal mammary lymph nodes</B></div> </tD> </tR> </TABLE></div> <div> <B>Metastasis</B></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="788" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 20 WIDTH="128"><div> <B>MX</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF WIDTH="645"><div> <B>Presence of metastasis cannot be assessed</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 20 WIDTH="128"><div> <B>M0</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF WIDTH="645"><div> <B>No distant metastasis</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 20 WIDTH="128"><div> <B>M1</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF><NOBR><div> <B>Distant metastsis (Includes metastasis to ipsilateral supraclavicular lymph nodes)</B></div> </NOBR></tD> </tR> </TABLE></div> <div> <B>The stage of the tumor is the most important prognostic factor. </B></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="663" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#800000 HEIGHT= 19 WIDTH="225"><div> <I><B>Stage</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="251"><div> <I><B>Grouping</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="167"><div> <I><B>5 Year Survival</B></I></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 20 WIDTH="225"><div> <I><B>0</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="251"><div> <B>Tis N0 M0</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="167"><div> <B> </B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 20 WIDTH="225"><div> <I><B>I</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="251"><div> <B>T1 N0 M0</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="167"><div> <B>87%</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 57 WIDTH="225"><div> <I><B>IIA</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="251"><div> <B>T0 N1 M0</B></div> <div> <B>T1 N1 M0</B></div> <div> <B>T2 N0 M0</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="167"><div> <B>75%</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 39 WIDTH="225"><div> <I><B>IIB</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="251"><div> <B>T2 N1 M0</B></div> <div> <B>T3 N0 M0</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="167"><div> <B> </B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 76 WIDTH="225"><div> <I><B>IIIA</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="251"><div> <B>T0 N2 M0</B></div> <div> <B>T1 N2 M0</B></div> <div> <B>T2 N2 M0</B></div> <div> <B>T3 N2 M0</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="167"><div> <B>46%</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 39 WIDTH="225"><div> <I><B>IIIB</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="251"><div> <B>T4 Any N M0</B></div> <div> <B>Any T N3 M0</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="167"><div> <B> </B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 20 WIDTH="225"><div> <I><B>IV</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="251"><div> <B>Any T Any N M1</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="167"><div> <B>13%</B></div> </tD> </tR> </TABLE></div> <div>  <FONT SIZE="3" COLOR="#FF6600" FACE="Arial" >DUCTAL CARCINOMA IN SITU</FONT></div> <div> <IMG SRC="0a9135e0.gif" border=0 width="531" height="350" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <bR> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="821" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#800000 HEIGHT= 19 ><NOBR><div> <I><B>SYNONYMS</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="696"><div> <I><B>Intraductal carcinoma, DCIS</B></I></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 32 ><NOBR><div> <I><B>INCIDENCE</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> <B>Autopsy study of 77 adult women found 14 cases of DCIS for an incidence of occult cancer in 25%</B></div> <div> <B>30% of all new breast cancer cases in institutions with mammographic surviellance </B></div> </NOBR></tD> </tR> </TABLE></div> <bR> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="821" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#800000 HEIGHT= 19 ><NOBR><div> <I><B>PATHOGENESIS</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="662"><div> <I><B>CHARACTERIZATION</B></I></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 227 ><NOBR><div> <I><B>DCIS and cancer</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="662"><div> <B>Malignant cells proliferate within the pre-existing ductal structures and basement membranes </B></div> <div> <B> to replace benign lining cells located within the ducts proximally and the lobules distally </B></div> <div> <B>The risk for progression to invasive carcinoma and for local recurrence is closely related to the pathology of DCIS. </B></div> <div> <B>If cancer arises, is usually occurs in the area occupied by the DCIS</B></div> <div> <B>DCIS is present in 80% of invasive breast cancers</B></div> <div> <B>Morphological similarities to invasive carcinoma</B></div> <div> <B>Shares highly abnormal molecular abnormalities such as DNA aneuploidy and Her2-neu gene amplification</B></div> <div> <B>Loss of heterozygosity studies of microdissected DCIS and invasive components of the same tumor reveal identical genetic abnormalities</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 20 ><NOBR><div> <I><B>Clonal process</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> <B>Molecular studies have revealed a single clonal process even if multifocal</B></div> </NOBR></tD> </tR> </TABLE></div> <DIV ALIGN="LEFT"></DIV> <div> <B><IMG SRC="0aaa9160.gif" border=0 width="425" height="278" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <bR> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="825" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#800000 HEIGHT= 57 WIDTH="182"><div> <I><B>GROSS APPEARANCE/CLINICAL VARIANTS</B></I></div> </tD> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#800000 WIDTH="626"><div> <I><B>CHARACTERIZATION</B></I></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 97 WIDTH="182"><div> <I><B>Multicentricity</B></I></div> </tD> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFCC WIDTH="626"><div> <B>In general, it has a segmental distribution, confirmed by radial rather than serial sectioning of the breast</B></div> <div> <B>Foci of carcinoma in more than one quadrant of the breast</B></div> <div> <B>Estimated at 32%</B></div> <div> <B>Low grade tumors more likely to be inadequately excised due to increased discontinous or multifocal growth</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 ><NOBR><div> <I><B>Microcalcifications</B></I></div> </NOBR></tD> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFCC><NOBR><div> <B>High grade tumors more likely to be associated with microcalcifications</B></div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 49 WIDTH="182"><div> <I><B>Extensive intraductal component (EIC)</B></I></div> </tD> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFCC WIDTH="626"><div> <B>Defined as DCIS within an invasive carcinoma-the DCIS occupies 25% or more of the overall tumor mass and extends beyond the confines of that main mass</B></div> <div> <B>Presence is powerful predictor of local recurrence</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 20 WIDTH="182"><div> <I><B>Appearance</B></I></div> </tD> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFCC WIDTH="626"><div> <B>Most cases do not have distinctive gross findings</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 39 ><NOBR><div> <I><B>Comedocarcinoma</B></I></div> </NOBR></tD> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFCC WIDTH="626"><div> <B>This is the exception with necrotic cores expressed from the cut surface as thin, soft cylinders</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 20 ><NOBR><div> <I><B>HISTOLOGICAL TYPES</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="614"><div> <B>CHARACTERIZATION</B></div> </tD> <tD VALIGN=TOP WIDTH="9"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="20" ALIGN="bottom" WIDTH="9" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 20 WIDTH="182"><div> <I><B>General</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> <B>Divided into low, intermediate, and high grade nuclei</B></div> </NOBR></tD> <tD VALIGN=TOP WIDTH="9"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="20" ALIGN="bottom" WIDTH="9" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 58 WIDTH="182"><div> <I><B>Low</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="614"><div> <B>Monomorphic evenly spaced cells with roughly spherical, centrally placed nuclei and inconsipicuous nucleoli</B></div> <div> <B>Few mitoses and little necrosis</B></div> </tD> <tD VALIGN=TOP WIDTH="9"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="58" ALIGN="bottom" WIDTH="9" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 20 WIDTH="182"><div> <I><B>Intermediate</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="614"><div> <B>Changes intermediate between low and high grade</B></div> </tD> <tD VALIGN=TOP WIDTH="9"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="20" ALIGN="bottom" WIDTH="9" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 58 WIDTH="182"><div> <I><B>High</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="614"><div> <B>Pleomorphic, irregularly spaced cells with large nuclei and marked variation in size and shape, coarse chromatin, and prominent nucleoli</B></div> <div> <B>Mitoses frequent</B></div> </tD> <tD VALIGN=TOP WIDTH="9"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="58" ALIGN="bottom" WIDTH="9" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="182"><div> <I><B>Micropapillary</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="614"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="614" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="9"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="9" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 20 WIDTH="182"><div> <I><B>Cribriform</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="614"><div> <B>Rigid fenestrations with punched out spaces</B></div> </tD> <tD VALIGN=TOP WIDTH="9"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="20" ALIGN="bottom" WIDTH="9" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 20 WIDTH="182"><div> <I><B>Clinging</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> <B>Single or few layers of neoplastic cells lining the lumen of the duct</B></div> </NOBR></tD> <tD VALIGN=TOP WIDTH="9"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="20" ALIGN="bottom" WIDTH="9" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="182"><div> <I><B>Solid</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="614"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="614" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="9"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="9" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 39 WIDTH="182"><div> <I><B>Comedonecrosis</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> <B>Coagulative necrosis within nests of usually solid DCIS</B></div> <div> <B>Calcifications common</B></div> </NOBR></tD> <tD VALIGN=TOP WIDTH="9"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="39" ALIGN="bottom" WIDTH="9" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 39 WIDTH="182"><div> <I><B>Neuroendocrine</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="614"><div> <B>Organoid appearance with prominent argyrophilia resembling a carcinoid tumor </B></div> </tD> <tD VALIGN=TOP WIDTH="9"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="39" ALIGN="bottom" WIDTH="9" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 39 WIDTH="182"><div> <I><B>Apocrine</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> <B>Will show usual criteria of DCIS but composed of apocrine cells</B></div> <div> <B>Cytologically should have marked nuclear atypia</B></div> </NOBR></tD> <tD VALIGN=TOP WIDTH="9"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="39" ALIGN="bottom" WIDTH="9" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 20 WIDTH="182"><div> <I><B>Small cell solid</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="614"><div> <B>Uniform population of cells with low grade features</B></div> </tD> <tD VALIGN=TOP WIDTH="9"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="20" ALIGN="bottom" WIDTH="9" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 76 WIDTH="182"><div> <I><B>Encysted Papillary carcinoma in situ</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> <B>Older women</B></div> <div> <B>Good prognosis</B></div> <div> <B>Circumscribed papillary structures with fibrovascular cores</B></div> <div> <B>Fibrous wall</B></div> </NOBR></tD> <tD VALIGN=TOP WIDTH="9"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="76" ALIGN="bottom" WIDTH="9" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 20 WIDTH="182"><div> <I><B>Clear cell</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="614"><div> <B>Cells with optically clear cytoplasm</B></div> </tD> <tD VALIGN=TOP WIDTH="9"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="20" ALIGN="bottom" WIDTH="9" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="182"><div> <I><B>Signet ring</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="614"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="614" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="9"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="9" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 58 ><NOBR><div> <I><B>Cystic hypersecretory </B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="614"><div> <B>Variant of micropapillary type with prominent mucinous secretions distending involved duct spaces resulting in cystic appearance</B></div> <div> <B>Mucous may be extruded into surrounding tissue</B></div> </tD> <tD VALIGN=TOP WIDTH="9"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="58" ALIGN="bottom" WIDTH="9" HSPACE="0" VSPACE="0"></tD> </tR> </TABLE></div> <div>  </div> <DIV ALIGN="LEFT"></DIV> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="616" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER COLSPAN=4 BGCOLOR=#800000 HEIGHT= 19 WIDTH="600"><div> <I><B>SUMMARY OF NUCLEAR GRADE</B></I></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 38 WIDTH="193"><div> <I><B>CRITERIA</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="95"><div> LOW GRADE</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="157"><div> INTERMEDIATE GRADE</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="146"><div> HIGH GRADE</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 ><NOBR><div> <I><B>NUCLEAR SIZE (xRBC)</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="95"><div> 1-1.5</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="157"><div> 1.0-2.0</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="146"><div> >2.0</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 38 WIDTH="193"><div> <I><B>VARIATION IN SIZE & SHAPE</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="95"><div> MILD</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="157"><div> MODERATE</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="146"><div> MARKED</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="193"><div> <I><B>CHROMATIN</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> FINE, EVEN</div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> COARSE,EVEN</div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> COARSE,UNEVEN</div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 55 WIDTH="193"><div> <I><B>NUCLEOLI</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="95"><div> SMALL, RARE </div> <div> 0-1/NUCLEUS</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> SMALL, SOME </div> <div> 1-2/NUCLEUS</div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> LARGE, MANY </div> <div> >2/NUCLEUS</div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 ><NOBR><div> <I><B>MITOTIC ACTIVITY</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="95"><div> LOW</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="157"><div> INTERMEDIATE</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="146"><div> HIGH</div> </tD> </tR> </TABLE></div> <bR> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="810" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#800000 HEIGHT= 38 WIDTH="143"><div> <I><B>DIFFERENTIAL DIAGNOSIS</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="652"><div> <I><B>CHARACTERIZATION</B></I></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 49 ><NOBR><div> <I><B>Microinvasion</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="652"><div> <B>Diagnosed by disruption of the basement membrane with foci of invasive cancer having maximum diameter of 1 mm or less</B></div> <div> <B>Some also designate minimally invasive cancer with larger areas of invasive growth</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 39 WIDTH="143"><div> <I><B>Atypical ductal hyperplasia (ADH)</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> <B>This is the most important and difficult distinction to be made by the pathologist.</B></div> <div>  <B>Even expert pathologists disagree on the diagnosis of these borderline lesions. </B></div> </NOBR></tD> </tR> </TABLE></div> <bR> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="870" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#800000 HEIGHT= 19 WIDTH="156"><div> <I><B>CRITERIA</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="347"><div> <I><B>ADH</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="347"><div> <I><B>LOW GRADE DCIS</B></I></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="156"><div> <I><B>Size</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="347"><div> <2-3 mm</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="347"><div> >2-3 mm</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 114 ><NOBR><div> <I><B>Cellular composition</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="347"><div> May have uniform population but merges with areas of usual type hyperplasia within same duct space</div> <div> Spindle cells may be prominent</div> <div> Myoepithelial cells always present around periphery of duct spaces</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="347"><div> Single population of cells</div> <bR> <div> Spindle cells rare</div> <bR> <div> Myoepithelial cells usually present around periphery of duct spaces</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 38 WIDTH="156"><div> <I><B>Architecture</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="347"><div> Micropapillary, cribriform, solid</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="347"><div> Well developed micropapillayr, cribriform, or solid patterns</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 57 WIDTH="156"><div> <I><B>Lumina</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="347"><div> May be distinct and well formed ovoid or rounded spaces in cribriform type</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="347"><div> Well formed, regular punched out lumina in cribriform type often with cells oriented towards the luminal space</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 57 ><NOBR><div> <I><B>Cell orientation</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="347"><div> May be regular, even placement at least focally</div> <div> Cells may be at right angles to bridges in cribriform types</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="347"><div> Micropapillary structures with indiscernible fibrovascular cores or smooth geometric spaces and rigid </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 ><NOBR><div> <I><B>Nuclear spacing</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="347"><div> May be even</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="347"><div> Even</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 57 WIDTH="156"><div> <I><B>Epithelial tumor cell character</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="347"><div> Small, uniform </div> <div> medium sized monotonous cell populations focally </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> Small, uniform monotonous cell population</div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="156"><div> <I><B>Nucleoli</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="347"><div> Single and small</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="347"><div> Single and small</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="156"><div> <I><B>Mitoses</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="347"><div> Infrequent, abnormal forms rare</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="347"><div> Infrequent, abnormal forms rare</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 ><NOBR><div> <I><B>Necrosis/apoptosis</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="347"><div> Rare</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="347"><div> May be present</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 ><NOBR><div> <I><B>Myoepithelial cells</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="347"><div> Present</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> Present, rarely attenuated in thickness</div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="156"><div> <I><B>Calcification</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="347"><div> May be present</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="347"><div> May be present</div> </tD> </tR> </TABLE></div> <div>  <IMG SRC="0ac9c140.jpg" border=0 width="412" height="276" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <bR> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="810" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#800000 HEIGHT= 38 WIDTH="312"><div> <I><B>SPECIAL STAINS/IMMUNOPEROXIDASE/OTHER</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="483"><div> <I><B>CHARACTERIZATION</B></I></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 38 WIDTH="312"><div> <I><B>Hormone receptor staining</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> 50% positivity in micropapillary, solid, and cribriform types</div> <div> 20% in comedocarcinoma</div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 38 WIDTH="312"><div> <I><B>Her2-neu</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="483"><div> Present in most cases of comedocarcinoma and in mixed cases with comedonecrosis</div> </tD> </tR> </TABLE></div> <div>  </div> <div>  </div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="1032" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="ROWS" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#800000 HEIGHT= 30 WIDTH="1026"><div> <I><B>Classification of DCIS by the Predominant Architecture</B></I></div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFCC HEIGHT= 122 ><NOBR><div> <I><B>1. Papillary/micropapillary type</B></I><FONT SIZE="3" COLOR="#000000" FACE="Arial" ><I><B> </B></I></FONT></div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="818" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 75 WIDTH="10"><div> <I><B> </B></I></div> </tD> <tD VALIGN=CENTER><NOBR><div> <I><B>- Multiple isolated papillary projections, most of which lack fibrovascular stalks </B></I></div> <div> <I><B>- Papillae become fused to form Roman bridges and arches giving the impression of rigidity </B></I></div> <div> <I><B>- Most tumor cells have low nuclear grade </B></I></div> <div> <I><B>- The tumor can be quite extensive </B></I></div> </NOBR></tD> </tR> </TABLE></div> <bR> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFCC HEIGHT= 104 ><NOBR><div> <I><B>2. Cribriform type</B></I><FONT SIZE="3" COLOR="#000000" FACE="Arial" ><I><B> </B></I></FONT></div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="1019" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 57 WIDTH="8"><div> <I><B> </B></I></div> </tD> <tD VALIGN=CENTER WIDTH="1004"><div> <I><B>- Tumor cells are arranged in a sieve-like pattern, multiple small round glands growing in a larger gland or duct. These glands are confluent without fibrous walls. Sometimes the glands grow in a back to back fashion with only one layer of fibroblasts between them </B></I></div> <div> <I><B>- Most tumor cells have low nuclear grade </B></I></div> </tD> </tR> </TABLE></div> <bR> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFCC HEIGHT= 103 ><NOBR><div> <I><B>3. Solid type</B></I><FONT SIZE="3" COLOR="#000000" FACE="Arial" ><I><B> </B></I></FONT></div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="829" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 56 WIDTH="10"><div> <I><B> </B></I></div> </tD> <tD VALIGN=CENTER WIDTH="812"><div> <I><B>- Tumor cells fill the ducts and ductules as solid sheets </B></I></div> <div> <I><B>- Nuclear grade is predominantly intermediate or high grade  </B></I></div> <div> <I><B>- Necrosis is usually focal </B></I></div> </tD> </tR> </TABLE></div> <bR> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFCC HEIGHT= 122 ><NOBR><div> <I><B>4. Comedo type</B></I><FONT SIZE="3" COLOR="#000000" FACE="Arial" ><I><B> </B></I></FONT></div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="828" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 75 WIDTH="10"><div> <I><B> </B></I></div> </tD> <tD VALIGN=CENTER><NOBR><div> <I><B>- Solid growth pattern  </B></I></div> <div> <I><B>- Central necrosis of the involved ducts is a prominent feature  </B></I></div> <div> <I><B>- Calcification occurs within the necrosis </B></I></div> <div> <I><B>- High nuclear grade in most tumors, less commonly intermediate nuclear grade  </B></I></div> </NOBR></tD> </tR> </TABLE></div> <bR> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#800000 HEIGHT= 30 ><NOBR><div> <B>Classification of DCIS by Nuclear Features</B></div> </NOBR></tD> <tD VALIGN=TOP WIDTH="384"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="30" ALIGN="bottom" WIDTH="384" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#CCFFFF HEIGHT= 142 ><NOBR><div> <B>1. Low grade </B></div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="462" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 95 WIDTH="10"><div>  </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFF00><NOBR><div> - <B>Nuclear size 1-1.5 times the size of red blood cells </B></div> <div> <B>- Uniform in size and shape </B></div> <div> <B>- Finely granular chromatin even distributed </B></div> <div> <B>- Nucleoli small, indistinct, few in number </B></div> <div> <B>- Mitotic activity low</B> </div> </NOBR></tD> </tR> </TABLE></div> <bR> </NOBR></tD> <tD VALIGN=TOP WIDTH="384"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="142" ALIGN="bottom" WIDTH="384" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFF00 HEIGHT= 142 ><NOBR><div> <B>2. Intermediate grade </B></div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="463" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 95 WIDTH="11"><div>  </div> </tD> <tD VALIGN=CENTER><NOBR><div> - <B>Nuclear size up to 2 times the size of red blood cells </B></div> <div> <B>- Mild to moderate variation in nuclear size and shape </B></div> <div> <B>- Coarsely granular chromatin, evenly distributed </B></div> <div> <B>- Nucleoli small to medium in size </B></div> <div> <B>- Mitotic activity between the low and high grades</B> </div> </NOBR></tD> </tR> </TABLE></div> <bR> </NOBR></tD> <tD VALIGN=TOP WIDTH="384"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="142" ALIGN="bottom" WIDTH="384" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFF99 HEIGHT= 142 ><NOBR><div> <B>3. High grade </B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="517" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 95 WIDTH="10"><div>  </div> </tD> <tD VALIGN=CENTER BGCOLOR=#CCFFFF><NOBR><div> - <B>Nuclear size more than 2 times of red blood cells </B></div> <div> <B>- Marked variation in nuclear size and shape </B></div> <div> <B>- Coarsely granular chromatin unevenly distributed </B></div> <div> <B>- Nucleoli large and multiple </B></div> <div> <B>- Mitotic activity high</B> </div> </NOBR></tD> </tR> </TABLE></div> <bR> </NOBR></tD> <tD VALIGN=TOP WIDTH="384"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="142" ALIGN="bottom" WIDTH="384" HSPACE="0" VSPACE="0"></tD> </tR> </TABLE></div> <bR> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="810" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#800000 HEIGHT= 38 WIDTH="148"><div> <I><B>PROGNOSIS AND TREATMENT</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="647"><div> <I><B>CHARACTERIZATION</B></I></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 38 ><NOBR><div> <I><B>Prognostic Factors</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="647"><div> Van Nuys Prognostic Index (VNPI) seeks to correlate nuclear features, necrosis, and size to form a prognostic index-See table below</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 57 WIDTH="148"><div> <I><B>Progression to Invasive Carcinoma</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="647"><div> 7/28 women with DCIS treated only with biopsy developed invasive carcinoma in the same breast after an average interval of 6.1 years</div> <div> Risk of subsequent invasive cancer in the contralateral breast is 3.4%</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 48 WIDTH="148"><div> <I><B>Metastasis</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="647"><div> not spread beyond the confines of the duct, </div> <div> there are cases of metastases to local axillary regional lymph nodes</div> <div> These cases may represent a missed focus of microinvasion</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="148"><div> <I><B>Treatment</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="647"><div> Dependent upon the VNPI stage</div> </tD> </tR> </TABLE></div> <bR> <div> <B>Van Nuys Prognostic Index</B></div> <div> <B>-</B>This is a commonly used grading system which stratifies DCIS into different risk and treatment strategies.</div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="667" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#800000 HEIGHT= 19 ><NOBR><div> <I>GRADE</I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#800000><NOBR><div> <I>MARGINS</I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="86"><div> <I>SIZE</I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="397"><div> <I>NUCLEAR GRADE</I></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="68"><div> <I>1</I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> >/= 10 mm</div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="86"><div> </=15 mm</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> Low grade, Intermediate grade without necrosis</div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="68"><div> <I>2</I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="91"><div> 1-9 mm</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> 16-40 mm</div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> Low grade, Intermediate grade with necrosis</div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="68"><div> <I>3</I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="91"><div> <1 mm</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="86"><div> >41 mm</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="397"><div> High grade with or without necrosis</div> </tD> </tR> </TABLE></div> <div>  </div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="512" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BELOW" RULES="ROWS" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#800000 HEIGHT= 22 WIDTH="506"><div> <I><B>Van Nuys Prognostic Classification</B></I></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 22 WIDTH="89"><div> <I><B>Group 1</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> Non-high nuclear grade without necrosis</div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 22 WIDTH="89"><div> <I><B>Group 2</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> Non-high nuclear grade with necrosis</div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 22 WIDTH="89"><div> <I><B>Group 3</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> High nuclear grade with or without necrosis</div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFCC HEIGHT= 38 WIDTH="506"><div> <I><B>Note: As indicated earlier, the non-high nuclear grade includes low and intemediate scores</B></I></div> </tD> </tR> </TABLE></div> <bR> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="632" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BELOW" RULES="ROWS" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER COLSPAN=4 BGCOLOR=#800000 HEIGHT= 22 WIDTH="622"><div> <I><B>Van Nuys Prognostic Index Scoring Index</B></I></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 22 WIDTH="188"><div> <I><B>Parameter</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="107"><div> 1 Point</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="141"><div> 2 Points</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="183"><div> 3 Points</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 43 WIDTH="188"><div> <I><B>Van Nuys Classification</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="107"><div> Group 1</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="141"><div> Group 2</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="183"><div> Group 3</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 22 WIDTH="188"><div> <I><B>Clear Margin</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> > or = 10 mm</div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="141"><div> 1-9 mm</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="183"><div> <1 mm</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 22 WIDTH="188"><div> <I><B>Lesion Size</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> < or = 15 mm</div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="141"><div> 16-40 mm</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="183"><div> > 41 mm</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=4 BGCOLOR=#FFFFCC HEIGHT= 22 WIDTH="622"><div> <I><B>Final Score</B></I></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 43 WIDTH="188"><div> <I><B>Group 1</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> 3 - 4 points</div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> 3.8% Recurrence</div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="183"><div> 93% 8 year disease free</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 43 WIDTH="188"><div> <I><B>Group 2</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> 5 - 7 points </div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="141"><div> 11.1% Recurrence</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="183"><div> 84% 8 year disease free</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 43 WIDTH="188"><div> <I><B>Group 3</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> 8 - 9 points</div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="141"><div> 26.5% Recurrence</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="183"><div> 61 % 8 year disease free</div> </tD> </tR> </TABLE></div> <bR> <DIV ALIGN="LEFT"></DIV> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="431" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BELOW" RULES="ROWS" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#800000 HEIGHT= 22 WIDTH="427"><div> <I><B>Infiltrating Ductal Carcinoma</B></I></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 22 ><NOBR><div> <I><B>Not otherwise specified type (75%)</B></I></div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFF99 HEIGHT= 22 WIDTH="427"><div> <I><B>Special variants (20%)</B></I></div> </tD> </tR> </TABLE></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="431" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BELOW" RULES="ROWS" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 231 WIDTH="427"><div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="239" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 19 WIDTH="235"><div> <I><B>tubular</B></I></div> </tD> </tR> </TABLE></div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="239" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 19 WIDTH="235"><div> <I><B>mucinous</B></I></div> </tD> </tR> </TABLE></div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="239" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 19 WIDTH="235"><div> <I><B>papillary</B></I></div> </tD> </tR> </TABLE></div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="239" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 19 WIDTH="235"><div> <I><B>medullary</B></I></div> </tD> </tR> </TABLE></div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="239" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 19 ><NOBR><div> <I><B>metaplastic carcinomas</B></I></div> </NOBR></tD> </tR> </TABLE></div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="239" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 19 ><NOBR><div> <I><B>metaplastic carcinomas</B></I></div> </NOBR></tD> </tR> </TABLE></div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="239" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 19 WIDTH="235"><div> <I><B>inflammatory</B></I></div> </tD> </tR> </TABLE></div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="239" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 19 WIDTH="235"><div> <I><B>others</B></I></div> </tD> </tR> </TABLE></div> <bR> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFF99 HEIGHT= 22 ><NOBR><div> <I><B>Infiltrating Lobular Carcinoma (5%)</B></I></div> </NOBR></tD> </tR> </TABLE></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="431" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BELOW" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 126 WIDTH="427"><div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="229" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 19 WIDTH="225"><div> <I><B>Classic</B></I></div> </tD> </tR> </TABLE></div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="229" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 19 WIDTH="225"><div> <I><B>Signet-ring</B></I></div> </tD> </tR> </TABLE></div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="229" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 19 WIDTH="225"><div> <I><B>Solid</B></I></div> </tD> </tR> </TABLE></div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="229" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 19 WIDTH="225"><div> <I><B>Pleomorphic</B></I></div> </tD> </tR> </TABLE></div> <bR> </tD> </tR> </TABLE></div> <bR> <div> <B>LOBULAR CARCINOMA IN SITU</B></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="660" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 32 WIDTH="225"><div> SYNONYMS</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF WIDTH="420"><div> LCIS</div> <div> Lobular neoplasia</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 39 WIDTH="225"><div> INCIDENCE</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF WIDTH="420"><div> <B>Range from 0.5-3.8% of otherwise benign breast biopsies</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 39 WIDTH="225"><div> AGE</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF><NOBR><div> <B>Greatest before menopause and decreases after</B></div> <div> <B><10% are postmenopausal</B></div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 20 WIDTH="225"><div> <B>GEOGRAPHY</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF WIDTH="420"><div> <B> </B></div> </tD> </tR> </TABLE></div> <div>  </div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="661" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#800000 HEIGHT= 38 WIDTH="216"><div> <I><B>EPIDEMIOLOGIC ASSOCIATIONS</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="430"><div> <I><B>CHARACTERIZATION</B></I></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 32 WIDTH="216"><div> <I><B>Invasive carcinoma</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> About 15% of patients will develop an invasive carcinoma</div> <div> This risk is greatest within 10-15 years after the diagnosis is established</div> </NOBR></tD> </tR> </TABLE></div> <bR> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="809" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#800000 HEIGHT= 38 WIDTH="176"><div> <I><B>GROSS OR CLINICAL PRESENTATION</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="618"><div> <I><B>CHARACTERIZATION</B></I></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 57 WIDTH="176"><div> <I><B>Distribution</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="618"><div> Most commonly in both breasts in multifocal and multicentric</div> <div> If LCIS is found in a breast, >50% will have residual LCIS in the ipsilateral breast and >1/3 will have LCIS in the contralateral breast</div> </tD> </tR> </TABLE></div> <div>  </div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="801" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BELOW" RULES="ROWS" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#800000 HEIGHT= 38 WIDTH="135"><div> <I><B>HISTOLOGICAL TYPES</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="659"><div> <I><B>CHARACTERIZATION</B></I></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 65 WIDTH="135"><div> <I><B>Classic</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="659"><div> Involved acini are filled and distended by a uniform population of cells (some state that at least 8 or more cells need to be present across the diameter of an acinus)</div> <div> At least half of the acini are involved within the lobular unit</div> <div> Cells may grow along ducts in a pagetoid configuration</div> </tD> </tR> </TABLE></div> <div>  </div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="857" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#800000 HEIGHT= 19 ><NOBR><div> <I><B>DIFFERENTIAL DIAGNOSIS</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="583"><div> <I><B>KEY DIFFERENTIATING FEATURES</B></I></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 75 ><NOBR><div> <I><B>Aytpical lobular hyperplasia</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="583"><div> Fewer than half of the acini are expanded or distorted by a uniform population of lobular cells</div> <bR> <div> Other cell types may be interspersed</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 94 WIDTH="259"><div> <I><B>DCIS</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> Should have at least small gland like spaces</div> <bR> <div> Cell wall is sharply defined</div> <bR> <div> In higher grade lesions, cell morphology will be too pleomorphic</div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 38 WIDTH="259"><div> <I><B>DCIS with cancerization of the lobules</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="583"><div>  </div> </tD> </tR> </TABLE></div> <bR> <bR> <div> <B>LOBULAR CARCINOMA</B></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="652" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BELOW" RULES="ROWS" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#800000 HEIGHT= 19 WIDTH="225"><div> <I><B>SYNONYMS</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="420"><div> <I><B>Invasive lobular carcinoma</B></I></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="225"><div> <I><B>INCIDENCE</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="420"><div>  </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 38 ><NOBR><div> <I><B>AGE-RANGE AND MEDIAN</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="420"><div> Median age 45-56 years</div> <div> Range 28-86 years</div> </tD> </tR> </TABLE></div> <div>  </div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="661" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#800000 HEIGHT= 19 ><NOBR><div> <I><B>GROSS APPEARANCE/CLINICAL VARIANTS</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="263"><div> <I><B>CHARACTERIZATION</B></I></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 ><NOBR><div> <I><B>Prior and concurrent contralateral carcinomas</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="263"><div> 6-28% of cases</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 ><NOBR><div> <I><B>Subsequent contralateral carcinomas</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> 1-2.38 cases/100 women per year</div> </NOBR></tD> </tR> </TABLE></div> <div>  </div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="832" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#800000 HEIGHT= 38 WIDTH="116"><div> <I><B>HISTOLOGICAL TYPES</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="701"><div> <I><B>CHARACTERIZATION</B></I></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 1129 WIDTH="116"><div> <I><B>Classic </B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> Small to medium sized cells, </div> <div> occasionally with cytoplasmic mucin globules, </div> <div> infiltrating the breast in a linear <B><U>fashion (Indian file pattern</U></B>) </div> <div> targetoid arrangement around pre-existing ducts and lobules</div> <div> <IMG SRC="0ae24080.jpg" border=0 width="1572" height="1032" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <bR> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="116"><div> <I><B>Solid</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="701"><div> Solid nests with classic pattern</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 ><NOBR><div> <I><B>Tubulolobular</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="701"><div> Small tubules and cords of tumor cells in classic pattern</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="116"><div> <I><B>Alveolar</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="701"><div> Globular aggregate of 20 or more cells</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 526 WIDTH="116"><div> <I><B>Pleomorphic (Large cell, pleomorphic, histiocytoid)</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="701"><div> Tends to occur in older, postmenopausal women</div> <div> Large cells with marked nuclear atypia and pleomorphism with classic growth pattern</div> <div> In situ changes were associated with the carcinoma in 45% of cases</div> <div> Estrogen receptors 81%</div> <bR> <div> Progesterone 67%</div> <bR> <div> Her2 neu 81%</div> <bR> <div> p53 positive in 48%</div> <bR> <div> Loss of heterozygosity in 52% at p53 locus, 18% at ESR locus, 19024% at <FONT SIZE="3" COLOR="#000000" FACE="Arial" ><I><B>Her2 neu locus, and 27-32% at the BRCA1 locus</B></I></FONT></div> <div> <B><IMG SRC="0b09e160.gif" border=0 width="414" height="278" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B><FONT SIZE="4" COLOR="#000000" FACE="Arial" ><B>HER-2/neu Oncogen</B></FONT></div> <bR> </tD> </tR> </TABLE></div> <div>  </div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="809" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#800000 HEIGHT= 19 ><NOBR><div> <I><B>PROGNOSIS AND TREATMENT</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="515"><div> <I><B>CHARACTERIZATION</B></I></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="279"><div> <I><B>Prognostic Factors</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="515"><div> Stage is most important</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 57 WIDTH="279"><div> <I><B>Cytokeratin immunohistochemistry detects clinically significant bone marrow biopsy metastaes</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="515"><div> Two year disease free survival was 33% for H and E negative/Keratin positive cases versus 90% for H and E negative/keratin negative cases</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 ><NOBR><div> <I><B>Pleomorphic lobular carcinoma</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div>  decrease in overall survival as compared to classic carcinoma</div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 38 WIDTH="279"><div> <I><B>5 Year Survival</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> 72% overall</div> <div> Probably overall better prognosis than infiltrating ductal carcinoma</div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="279"><div> <I><B>Metastasis</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="515"><div> Local recurrence 12% after 5 years</div> </tD> </tR> </TABLE></div> <bR> <bR> <bR> <div> <B>MEDULLARY CARCINOMA</B></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="660" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 19 WIDTH="225"><div> INCIDENCE</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF WIDTH="420"><div> 5-7% of breast cancers</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 39 WIDTH="225"><div> AGE RANGE-MEDIAN</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF WIDTH="420"><div> <B>10% <35 years</B></div> <div> <B>Mean varies from 46-54 years</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 20 WIDTH="225"><div> GEOGRAPHY</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF WIDTH="420"><div> <B>More common in Japanese</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 20 WIDTH="225"><div> <B> </B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF WIDTH="420"><div> <B>Black>white</B></div> </tD> </tR> </TABLE></div> <div>  </div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="801" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BELOW" RULES="ROWS" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#800000 HEIGHT= 38 WIDTH="325"><div> <I><B>LABORATORY/RADIOLOGIC/OTHER TESTS</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="469"><div> <I><B>CHARACTERIZATION</B></I></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="325"><div> <I><B>Radiograph</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> Often presents with a well circumscribed tumor</div> </NOBR></tD> </tR> </TABLE></div> <div>  </div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="810" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#800000 HEIGHT= 57 WIDTH="254"><div> <I><B>GROSS APPEARANCE/CLINICAL VARIANTS</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="541"><div> <I><B>CHARACTERIZATION</B></I></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 48 WIDTH="254"><div> <I><B>General</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> Median 2-3 cm</div> <div> Usually a moderately firm discrete tumor with a lobulated or nodular cut surface</div> <div> May have necrosis or hemorrhage</div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="254"><div> <I><B>Bilateral</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> 3-18% of patients with medullary carcinoma in one breast</div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="254"><div> <I><B>Multicentricity</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> Microscopic foci of cancer found outside the primary quadrant in 10% of cases</div> </NOBR></tD> </tR> </TABLE></div> <div>  </div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="820" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#800000 HEIGHT= 38 WIDTH="117"><div> <I><B>HISTOLOGICAL TYPES</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="688"><div> <I><B>CHARACTERIZATION</B></I></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 408 WIDTH="117"><div> <I><B>Classic</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="688"><div> Syncytial growth pattern of poorly differentiated tumor cells with a high mitotic rate</div> <div> prominent lymphoplasmacytic reaction with a circumscribed microscopic appearance-inflammatory reaction must involve 75% of the periphery and must be present diffusely throughout the substance of the tumor</div> <div> No glandular or fatty breast tissue should be found within the invasive portion of the tumor</div> <div> :Faripour Forouhar, M.D. UCHC</div> <div> <IMG SRC="0b1b0440.gif" border=0 width="432" height="324" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 57 WIDTH="117"><div> <I><B>Atypical Medullary Carcinoma</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="688"><div> Resembles the usual classic case but lacks all the features</div> <div> Must have at least 75% syncytial growth but does not have the other two features (circumscription, lymphoplasmacytic infilrate)</div> </tD> </tR> </TABLE></div> <div>  </div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="821" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#800000 HEIGHT= 38 WIDTH="355"><div> <I><B>SPECIAL STAINS/IMMUNOPEROXIDASE/OTHER</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="451"><div> <I><B>CHARACTERIZATION</B></I></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 38 WIDTH="355"><div> <I><B>Lymphocytes</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="451"><div> IgG cells predominate</div> <div> Many T lymphocytes</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="355"><div> <I><B>Hormone receptors</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> >90% are estrogen and progesterone receptor negative</div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="355"><div> <I><B>Flow cytometry</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="451"><div> Usually aneuploid or polypoid</div> </tD> </tR> </TABLE></div> <div>  </div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="821" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#800000 HEIGHT= 38 WIDTH="179"><div> <I><B>PROGNOSIS AND TREATMENT</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="627"><div> <I><B>CHARACTERIZATION</B></I></div> </tD> </tR> </TABLE></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="821" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 32 ><NOBR><div> <I><B>Prognostic Factors</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> Must have pure medullary carcinoma with no infiltrating ductal carcinoma</div> <div> Less than 75% pure syncytial component associated with poorer prognosis</div> </NOBR></tD> </tR> </TABLE></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="821" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 48 ><NOBR><div> <I><B>5 Year Survival</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> 78%</div> <div> Death secondary to disease in only 10%</div> <div> 95% 20 year disease free survival for stage I patients and 61% for stage II patients</div> </NOBR></tD> </tR> </TABLE></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="821" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="179"><div> <I><B>Metastasis</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> Lower frequency of axillary node metastases than infiltrating ductal carcinoma, NOS</div> </NOBR></tD> </tR> </TABLE></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="821" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="179"><div> <I><B>Treatment</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="627"><div> Usual course for infiltrating ductal carcinoma of the breast</div> </tD> </tR> </TABLE></div> <bR> <div> <B>Scarf-Bloom-Richardson Grading</B> </div> <div> (Nottingham Revision)-A common method of grading breast cancers. It combines scores of the tumor grade, degree of glandular differentiation, and number of mitotic figures. The higher the grade, the poorer the prognosis.  Thus, tumors can have a range of 3 (well differentiated) to </div> <div> 9 (poorly differentiated). </div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="832" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER COLSPAN=3 BGCOLOR=#800000 HEIGHT= 22 WIDTH="818"><div> <I><B>BLOOM/RICHARDSON (ELSTON MOD.) GRADING METHOD</B></I></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 22 WIDTH="265"><div> <I><B>Tubular Formation</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="115"><div> Score</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="432"><div>  </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 ><NOBR><div> <I><B>Majority of tumor (>75%)</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="115"><div> 1</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="432"><div>  </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 ><NOBR><div> <I><B>Moderate Degree (10-75%)</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="115"><div> 2</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="432"><div>  </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="265"><div> <I><B>Little or none (<10%)</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="115"><div> 3</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="432"><div>  </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFF99 HEIGHT= 22 ><NOBR><div> <I><B>Nuclear Pleomorphism</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFF99 WIDTH="115"><div> Score</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="432"><div>  </div> </tD> </tR> </TABLE></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="832" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 303 ><NOBR><div> <I><B>Uniform Cells (size is not criterion)</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="115"><div> 1</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> <B><IMG SRC="0b3ab130.gif" border=0 width="427" height="275" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <bR> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 302 ><NOBR><div> <I><B>Moderate Increase in Variability</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="115"><div> 2</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> <B><IMG SRC="0b5a3120.gif" border=0 width="419" height="274" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <bR> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 303 WIDTH="265"><div> <I><B>Marked Variation (Often large nucleoli)</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="115"><div> 3</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> <B><IMG SRC="0b7af130.gif" border=0 width="431" height="275" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <bR> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFF99 HEIGHT= 43 WIDTH="265"><div> <I><B>Mitotic Counts (per 10 high power fields)</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFF99 WIDTH="115"><div> Score</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="432"><div>  </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="265"><div> <I><B>Low (0-5 mitotic figures)</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="115"><div> 1</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="432"><div>  </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 ><NOBR><div> <I><B>Moderate (6-10 mitotic figures)</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="115"><div> 2</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="432"><div>  </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 ><NOBR><div> <I><B>High (>11 mitotic figures)</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="115"><div> 3</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="432"><div>  </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFF99 HEIGHT= 22 WIDTH="265"><div> <I><B>FINAL GRADE</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFF99 WIDTH="115"><div> Score</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="432"><div>  </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 22 ><NOBR><div> <I><B>Grade I, Well differentiated</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="115"><div> 3-5 points</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="432"><div>  </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 43 WIDTH="265"><div> <I><B>Grade II, Moderately differentiated</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="115"><div> 6-7 points</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="432"><div>  </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 22 ><NOBR><div> <I><B>Grade III, Poorly differentiated</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="115"><div> 8-9 points</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="432"><div>  </div> </tD> </tR> </TABLE></div> <bR> <bR> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="660" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#800000 HEIGHT= 19 WIDTH="567"><div> <I><B>Feature</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="78"><div> <I><B>Score</B></I></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="567"><div> <I><B>Tubule formation (extent within tumor)</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="78"><div>  </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="567"><div> <I><B>>75%</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="78"><div> 1</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="567"><div> <I><B>10-75%</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="78"><div> 2</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="567"><div> <I><B><10%</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="78"><div> 3</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="567"><div> <I><B>Nuclear pleomorphism</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="78"><div>  </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="567"><div> <I><B>Small regular uniform</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="78"><div> 1</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="567"><div> <I><B>Moderate variation</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="78"><div> 2</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="567"><div> <I><B>Marked variation</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="78"><div> 3</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="567"><div> <I><B>Mitotic Count per 10 high power fields (hpf)</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="78"><div>  </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="567"><div> <I><B>0-9</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="78"><div> 1</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="567"><div> <I><B>10-19</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="78"><div> 2</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 WIDTH="567"><div> <I><B>>20</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="78"><div> 3</div> </tD> </tR> </TABLE></div> <bR> <div> <I> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="778" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 24 ><NOBR><div> <I>Characteristic</I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF WIDTH="272"><div> BRCA1</div> </tD> <tD VALIGN=CENTER BGCOLOR=#BFBFBF WIDTH="325"><div> BRCA2</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 20 WIDTH="161"><div> <B>Chromosome</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF WIDTH="272"><div> <B>17q21</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#BFBFBF WIDTH="325"><div> <B>13q12</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 20 WIDTH="161"><div> <B>Gene</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF WIDTH="272"><div> <B>100 kb</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#BFBFBF WIDTH="325"><div> <B>70 kb</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 20 WIDTH="161"><div> <B>Protein</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF WIDTH="272"><div> <B>1863 amino acids</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#BFBFBF WIDTH="325"><div> <B>3418 amino acids</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 57 WIDTH="161"><div> <B>Function</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF><NOBR><div> <B>Tumor suppressor</B></div> <div> <B>Interacts with nuclear protein</B></div> <div> <B>Possible role in DNA repair</B></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#BFBFBF WIDTH="325"><div> <B>Tumor suppressor</B></div> <div> <B>Interacts with nuclear protein</B></div> <div> <B>Possible role in DNA repair</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 20 WIDTH="161"><div> <B>Mutations</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF WIDTH="272"><div> <B>>500 identified</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#BFBFBF WIDTH="325"><div> <B>>200 identified</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 20 ><NOBR><div> <B>Risk of breast CA</B></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF WIDTH="272"><div> <B>>70% by age 80 yrs</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#BFBFBF WIDTH="325"><div> <B>>60% by age 70 yrs</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 20 WIDTH="161"><div> <B>Age at onset</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF WIDTH="272"><div> <B>40-50 yrs</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#BFBFBF WIDTH="325"><div> <B>50 yrs and older</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 39 ><NOBR><div> <B>Risk of other tumors</B></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF><NOBR><div> <B>30-60% of ovarian cancer by 70 yrs</B></div> <div> <B>Prostate and colon cancer</B></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#BFBFBF WIDTH="325"><div> <B>Male breast cancer, ovary, bladder, prostate, pancreas</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 58 WIDTH="161"><div> <B>Mutations in nonfamilial breast cancer</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF WIDTH="272"><div> <B><5%</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#BFBFBF WIDTH="325"><div> <B><5%</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 39 WIDTH="161"><div> <B>Epidemiology</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF WIDTH="272"><div> <B>Specific mutations more common in some ethnic groups</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#BFBFBF WIDTH="325"><div> <B>Specific mutations more common in some ethnic groups</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#BFBFBF HEIGHT= 58 WIDTH="161"><div> <B>Pathology of breast CA</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFBF WIDTH="272"><div> <B>Higher incidence of medullary CA (13%) and higher grade tumors</B></div> <div> <B>DCIS less frequent</B></div> </tD> <tD VALIGN=CENTER BGCOLOR=#BFBFBF><NOBR><div> <B>Variable, may be mutation specific</B></div> </NOBR></tD> </tR> </TABLE></I></div> <bR> </td> </tr></table></body>