BREAST PATHOLOGY

1. Alterations of enlarged lobular units
1.1 apocrine cyst versus columnar cell lesion without atypia
1.2 columnar cell lesion with atypia versus columnar cell lesion without atypia
1.3 secretory change versus columnar cell lesion with atypia
1.4 hypersecretory change versus ductal carcinoma in situ
1.5 papillary apocrine change versus apocrine ductal carcinoma in situ

2. Epithelial proliferative lesions
2.1 Usual hyperplasia versus atypical ductal hyperplasia
2.2 Gynecomastoid –type hyperplasia versus micropapillary atypical ductal hyperplasia or micropapillary ductal carcinoma in situ
2.3 Usual hyperplasia (solid pattern) versus atypical ductal hyperplasia
2.1 Prominent myoepithelial cells versus atypical ductal hyperplasia
2.2 Papilloma involved by florid hyperplasia versus atypical ductal hyperplasia
2.3 Atypical ductal hyperplasia versus low grade ductal carcinoma in situ
2.4 Cribriform atypical ductal hyperplasia versus collagenous spherulosis
2.5 Atypical ductal hyperplasia versus atypical lobular hyperplasia
2.6 Florid hyperplasia versus intermediate or high grade ductal carcinoma in situ
2.7 Mucocele-like lesion with atypical ductal hyperplasia versus mucocele-like lesion without atypia
2.8 Papillary apocrine change versus apocrine atypical ductal hyperplasia or apocrine ductal carcinoma in situ
3 Ductal carcinoma in situ
3.1 Ductal carcinoma in situ versus atypical lobular hyperplasia in a papilloma
3.2 Ductal carcinoma in situ versus microinvasive carcinoma
3.3 Entrapped epithelial elements post biopsy of ductal carcinoma in situ in papilloma versus invasion
3.4 Spindle cell pattern ductal carcinoma in situ versus florid hyperplasia
3.5 Encysted noninvasive papillary carcinoma versus atypical ductal hyperplasia in a papilloma
3.6 Paget’s disease versus toker cells
3.7 Ductal carcinoma in situ versus lobular carcinoma in situ
3.8 Secretory ductal carcinoma in situ versus usual hyperplasia with clear cells
3.9 Pagetoid pattern ductal carcinoma in situ versus ALH
3.10 Radiation change versus ductal carcinoma in situ
4 Lobular carcinoma in situ
4.1 Classic lobular carcinoma in situ versus variant lobular carcinoma in situ
4.2 Classic lobular carcinoma in situ versus atypical lobular hyperplasia
4.3 Usual hyperplasia with prominent myoepithelial cells versus lobular neoplasia
4.4 Ductal involvement by cells of atypical lobular hyperplasia versus low grade ductal carcinoma in situ
5 Sclerosing and adenotic lesions
5.1 Nodular sclerosing adenosis versus papilloma
5.2 Papilloma versus adenomyoepithelioma
5.3 Radial scar versus pure tubular carcinoma
5.4 Sclerosed adenotic papilloma versus tubular carcinoma
5.5 Sclerosing adenosis versus microglandular adenosis
5.6 Nonspecific perilobular or periductal chronic inflammation versus sclerosing lymphocytic lobulitis
6 Fibroepithelial lesions
6.1 Fibroadenoma versus cellular fibroadenoma
6.2 Fibroadenoma versus benign phyllodes tumor
6.3 Benign phyllodes tumor versus borderline phyllodes tumor
6.4 Borderline phyllodes tumor versus malignant phyllodes tumor
6.5 Malignant phyllodes tumor versus pure sarcoma
7 Stromal lesions
7.1 Myofibroblastoma versus fibromatosis
7.2 Epithelioid myofibroblastoma versus pure invasive lobular carcinoma
7.3 Myofibroblastoma versus low grade spindle cell metaplastic carcinoma
7.4 Spindle cell metaplastic carcinoma versus post biopsy spindle cell nodule
7.5 Fibromatosis versus scar
8 Special type carcinomas
8.1 Invasive pure lobular carcinoma versus lobular variant carcinomas versus no special type carcinoma with lobular features
8.2 Pure nvasive cribriform carcinoma versus cribriform ductal carcinoma in situ
8.3 Invasive pure tubular carcinoma versus no special type carcinoma with tubular features
8.4 Pure mucinous carcinoma versus mucocele-like lesion
8.5 Pure medullary carcinoma versus no special type carcinoma with medullary features
8.6 Secretory carcinoma versus no special type carcinoma
8.7 Adenoid cystic carcinoma versus no special type carcinoma with myoepithelial phenotype or ductal carcinoma in situ
8.8 Low grade spindle cell metaplastic carcinoma versus fibromatosis
8.9 Adenosquamous carcinoma versus squamous metaplasia
8.10 Histiocytes versus histiocytoid variant of invasive lobular carcinoma
8.11 Atypical lobular hyperplasia involving sclerosing adenosis versus invasive lobular carcinoma
9 Invasive carcinomas of no special type, special considerations
9.1 Lymphovascular invasion versus retraction artifact
9.2 Invasive micropapillary features versus retraction artifact
9.3 No special type tumors with immunohistochemical evidence of neuroendocrine differentiation versus small cell carcinoma
9.4 High grade carcinoma versus lymphoma
10 Sentinel lymph nodes
10.1 Benign transport versus isolated tumor cell clusters
10.2 Isolated tumor cells versus micrometastasis
10.3 Micrometastasis versus capsular lymphatic involvement
10.4 Micrometastasis versus benign glandular inclusion
11 Vascular lesions of the breast
11.1 Perilobular capillary hemangioma
11.2 Atypical vascular lesion
11.3 Low grade angiosarcoma
11.4 High grade angiosarcoma
11.5 Epithelioid angiosarcoma

Based on actual cases drawn from the extensive breast pathology consultation practice at Vanderbilt University Medical Center, Breast Pathology covers the full classification of breast tumors and focuses on especially challenging differential diagnoses or unusual and problematic morphologic presentations. Using a pattern-based approach, each case is presented as a difficult diagnostic choice with two or even three possible diagnoses for the pathologist. For each case there is a description illustrating an expert's diagnosis and analysis, along with commentary providing additional context on the evaluation of such specimens. The book places special emphasis on avoiding diagnostic pitfalls. Each case discussion is supported with several high quality color photomicrographs that facilitate an extensive visual history and learning experience. Brief references to the literature are also included.
The book presents a foreword by David L. Page, MD, Professor of Pathology, Vanderbilt University Medical Center.

Key Features of Breast Pathology:
• Provides a pattern-based approach to solving difficult diagnostic challenges
• Offers expert guidance to complex diagnoses of breast specimens
• Emphasizes difficult diagnoses and how to avoid diagnostic pitfalls
• Based on actual cases drawn from breast pathology consultation practice at Vanderbilt University Medical Center
• Includes over 400 high quality color photomicrographs

Authors
• Melinda E. Sanders, MDis Associate Professor of Pathology, Microbiology and Immunology Anatomic Pathology Division, Subspecialty Consultant in Breast Pathology, Vanderbilt University Medical Center.
• Jean F. Simpson, MDis President, Breast Pathology Consultants, Inc., Nashville, TN; and Adjunct Professor of Pathology, University of South Alabama, Mobile, Alabama.


Contents
1. Alterations of enlarged lobular units
2. Epithelial proliferative lesions
3 Ductal carcinoma in situ
4 Lobular carcinoma in situ
5 Sclerosing and adenotic lesions
6 Fibroepithelial lesions
7 Stromal lesions
8 Special type carcinomas
9 Invasive carcinomas of no special type, special considerations
10 Sentinel lymph nodes
11 Vascular lesions of the breast