First monthFirst month Second MonthSecond Month

• Milk line remnantMilk line remnant• Accessory axillary breast tissueAccessory axillary breast tissue• Congenital nipple inversionCongenital nipple inversion

Life long breast changesLife long breast changes

Cyclic hormonal effectCyclic hormonal effect

Breast abscessBreast abscess

Granulomatous mastitisGranulomatous mastitis

Periductal Periductal (recurrent )mastitis(recurrent )mastitis

Mammary ductectasiaMammary ductectasia

Fat necrosisFat necrosis

ProlactinomaProlactinoma

FibroademomaFibroademoma

Phyllodes TumorPhyllodes Tumor

SarcomaSarcomaRadiation induced angiosarcomaRadiation induced angiosarcoma

Fibrocystic changesFibrocystic changes

Cribriform and solid Cribriform and solid in situ carcinomain situ carcinoma

Comedo carcinomaComedo carcinoma

Paget’s diseasePaget’s disease

Infiltrating ductal Infiltrating ductal carcinomacarcinoma

Invasive ductal carcinomaInvasive ductal carcinoma

GradingGrading

Modified Bloom Richardson Grading SystemModified Bloom Richardson Grading System

ER PR HER2 P53ER PR HER2 P53

MetastasisMetastasis

Breast CarcinomaBreast CarcinomaMetastasisMetastasis

Risk FactorsRisk Factors• AgeAge• Genetics: BRCA1,BRCA2(first degree relatives)Genetics: BRCA1,BRCA2(first degree relatives)• Carcinoma of contralateral breastCarcinoma of contralateral breast• Endometrial carcinomaEndometrial carcinoma• Reproductive life( early menarche, late Reproductive life( early menarche, late

menopause)menopause)• Parity( nulliparous > multiparous)Parity( nulliparous > multiparous)• First live birthFirst live birth• Race (Northern Europe)Race (Northern Europe)• Geographic Influence (immigration)Geographic Influence (immigration)• Radiation Exposure (therapeutic or environmental)Radiation Exposure (therapeutic or environmental)

Risk Factors Cont’edRisk Factors Cont’ed

• Estrogen exposureEstrogen exposure

• Obesity( specially in postmenopausal Obesity( specially in postmenopausal state)state)

• DietDiet

• ExerciseExercise

• Breast feedingBreast feeding

• Environmental toxinsEnvironmental toxins

• TobaccoTobacco

Prognostic and predictive Prognostic and predictive factorsfactors

Major:Major:

• Invasive vs In situInvasive vs In situ

• Distant Metastasis Distant Metastasis

• Lymph node metastasisLymph node metastasis

• Locally advanced diseaseLocally advanced disease

• Inflammatory carcinomaInflammatory carcinoma

Prognostic Factors cont’edPrognostic Factors cont’ed

Minor:Minor:

• Histological typeHistological type

• Tumor gradeTumor grade

• Estrogen and progesterone receptorsEstrogen and progesterone receptors

• Lymphovascular invasionLymphovascular invasion

• Proliferative rateProliferative rate

• DNA contentDNA content

StagingStagingStage 0:Stage 0: DCIS or LCIS ( 5 year survival 92%)DCIS or LCIS ( 5 year survival 92%)Stage I : Invasive <2 cm, including in situ and Stage I : Invasive <2 cm, including in situ and microinvasivemicroinvasiveStage II: Invasive <5cm or >5cm without nodal Stage II: Invasive <5cm or >5cm without nodal involvementinvolvementStage III: Invasive>5 cm+ nodal involvement or Stage III: Invasive>5 cm+ nodal involvement or any breast ca+ fixed L.N, orany breast ca+ fixed L.N, or inflammatory breast cancerinflammatory breast cancerStage IV: Any form of breast Ca+ distant breast Stage IV: Any form of breast Ca+ distant breast metastasismetastasis

Treatment option based on LN Treatment option based on LN involvementinvolvement

0: 0: NoNo systemic therapy depends on the mainsystemic therapy depends on the main

tumortumor

1-31-3: some form of standard systemic : some form of standard systemic treatmenttreatment

indicated ( hormonal or chemotherapy)indicated ( hormonal or chemotherapy)

4-94-9: high dose chemotherapy: high dose chemotherapy

10 or more10 or more: autologous bone marrow : autologous bone marrow

transplantationtransplantation

Lobular CarcinomaLobular Carcinoma

Lobular CarcinomaLobular Carcinoma

Colloid CarcinomaColloid Carcinoma

Tubular CarcinomaTubular Carcinoma

Medullary CarcinomaMedullary Carcinoma

Breast B. cell LymphomaBreast B. cell Lymphoma

Metastasis to the breastMetastasis to the breast

GynecomastiaGynecomastia

Male breast CarcinomaMale breast Carcinoma