Jemds.

com Original Research Article

Histopathological Spectrum of Breast Lesions

- A Study Done in a Tertiary Care Hospital
Letha Padmom1, Kiran Sapru2, Devi Beena3

1Department of Pathology, Azeezia Institute of Medical Sciences and Research, Kollam, Kerala, India.
2Department of Pathology, Azeezia Institute of Medical Sciences and Research, Kollam, Kerala, India.
3Department of Pathology, Azeezia Institute of Medical Sciences and Research, Kollam, Kerala, India.

ABSTRACT

BACKGROUND
Breast cancer accounts for about one-third of female cancers and nearly about one- Corresponding Author:
fourth of all malignancies. Breast carcinoma, in India, is the second most common Kiran Sapru,
Assistant Professor,
malignancy after carcinoma cervix. Well timed and precise detection of a lump in the
Department of Pathology,
breast and prompt intervention can reduce not only the concern but is also lifesaving Azeezia Institute of Medical Sciences and
in many. We wanted to study the histopathological spectrum and prevalence of breast Research, Kollam, Kerala, India.
lesions. E-mail: [email protected]

METHODS DOI: 10.14260/jemds/2020/308

This is a retrospective study done among 867 cases of breast lesions. The
histopathological features were studied, and the various entities were diagnosed Financial or Other Competing Interests:
None.
based on the WHO classification of tumours of the Breast.
How to Cite This Article:
RESULTS Padmom L, Sapru K, Beena D.
Unilateral lesions (91.7%) were much more common than bilateral lesions. Most of Histopathological spectrum of breast
the cases were benign (88.3%) of which the most common was fibroadenoma lesions- a study done in a tertiary care
accounting for 496 (57%) of all cases followed by fibroadenosis (16.26%). Among the hospital. J. Evolution Med. Dent. Sci.
malignant cases the most common was invasive ductal carcinoma NOS accounting for 2020;9(17):1412-1415, DOI:
92 cases (10.6%). 10.14260/jemds/2020/308

Submission 18-10-2019,
CONCLUSIONS Peer Review 03-02-2020,
The pattern of breast lesions provides beneficial information concerning Acceptance 11-02-2020,
clinicopathological spectrum of breast lesions. For the correct and adequate Published 27-03-2020.
treatment, clinical diagnosis, correlation and confirmation with the histopathological
diagnosis of a breast lump is a must. Proper breast cancer awareness study and
screening programs should be conducted across women of all status so that basic
training and motivation can be given to women to report to the doctors as early as
possible once a lump is noticed. This can reduce the morbidity and mortality
associated with breast tumours.

KEY WORDS
Fibro Adenoma, DCIS, Ductal Carcinoma

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Jemds.com Original Research Article

BACKGROUND who had been treated for malignancy earlier were excluded
from the study.
Among the 867 specimens, majority of the specimens were
In India, the second most common malignancy after cervical those of lumpectomy specimens and a few specimens were
carcinoma is carcinoma breast1 and is seen in 20/1,00,000 mastectomy specimens. The clinical details and examination
women.2 Lesions of the breast are diverse including several findings, magnetic resonance imaging (MRI), fine-needle
entities with remarkably diverse characteristic features3 aspiration cytology (FNAC), mammography findings, and
extending from inflammatory non-neoplastic and benign other relevant information were acquired from the
lesions to life threatening invasive carcinomas.4 World-wide histopathology registration form. All the specimens of breast
breast lesions have become a major cause of mortality among which were received in Pathology department in different
women.5 Most of the breast lesions usually present as a lump forms such as excisional biopsy, lumpectomy and mastectomy
or swelling in the breast which is a very sensitive matter for were processed by standard protocol and formalin fixed
female patients because of which timely reporting to the paraffin embedded tissue sections stained with haematoxylin
doctor for an examination won’t happen.6 Neoplasms of the and eosin were studied and assessed. The histopathological
features were noted, and the tumours were diagnosed on the
breast are diversified. Malignant breast lesions are less
basis of WHO classification.6
common than benign tumours. Benign lesions of the breast
usually present in the second decade of life.7 Common benign
lesions of the breast include fibroadenoma, phyllodes tumour,
Statistical Analysis
lactating adenoma and tubular adenoma. Benign proliferative
Chi-square test was used to find association between
lesions include fibrocystic disease, inflammatory lesions such
spectrums of lesions. SPSS software was used for statistical
as breast abscess, and granulomatous mastitis. Malignant
analysis.
lesions are ductal carcinoma, lobular carcinoma, colloid
carcinoma, mucinous carcinoma and medullary carcinoma.8
Numerous studies have been conducted with regard to
breast lesions. Risk of breast cancer will increase in RESULTS
association with proliferative and atypical lesions. For early
diagnosis, diagnostic methods such as mammography, The ages of the cases ranged between 16 years to 60 years. The
ultrasonography, and fine-needle aspiration cytology are peak occurrence of the non-neoplastic lesions was found to be
being progressively used nowadays. Evolution of more in the second and third decades, of which benign proliferative
advances in imaging modalities and increased use of fine lesions were found to be in the age group 31-40 years.
needle aspiration cytology have immensely helped in the Unilateral lesions (91.7%) were much more common than
preoperative assessment of lesions in the breast. Even though, bilateral lesions in our study. Out of the 867 cases we received
in a majority of percentage of cases distinction between benign during the study period 766 were benign (88.3%) of which the
and malignant lesions still depends on histological assessment. most common was fibro adenoma accounting for 496 (57%) of
Benign lesions are equally important as it has the potential to all cases followed by fibroadenosis (16.26%). Among the
imitate cancers and not all the benign lesions are totally free of malignant cases the most common was invasive ductal
risks. Preservation of breast tissue is the treatment for most of carcinoma NOS accounting for 92 cases (10.6%).
the benign breast disease as far as possible in contrast to Fibro adenoma accounted for 496 (57%) cases of all the
traumatizing disfiguring surgeries in breast carcinomas. benign breast lesions. Most of the cases were seen in 21-30
Treatment for mass lesions in the breast depends on the root years succeeded by 11-20 years. Most of cases presented with
cause which may vary from simple pain medication to surgical unilateral breast lump. Grossly tumour masses ranged from
removal of lump or mastectomy. For the diagnosis and 0.5 cms to 6.5 cms and in most of them, they showed slit like
categorization of breast lesions histopathology still plays an spaces on cut surface. Intracanalicular and pericanalicular
important role.9 pattern were seen histologically and, in some cases, both the
The main purpose of the study is to analyse, highlight and patterns were identified in the same lesion.
to identify the histopathological spectrum and prevalence of We got 4 cases of giant fibro adenomas which additionally
breast lesions. showed histological changes such as adenosis, cyst formation
and apocrine change. Out of 766 benign breast lesions,
fibrocystic disease were seen in 88 cases (10%). Majority of
the patients belonged in the age group of 41-50 years.
METHODS
Microscopically, they were characterized by overgrowth of
both fibrous stroma and of epithelial elements which
A retrospective study was conducted in the department of comprised of lobules and ducts, in varying proportions. In our
Pathology, Azeezia Medical College, Kollam on 867 cases from study 4 cases were lactating adenoma. All the cases of lactating
2018 to 2019. The sample size was taken based on the adenomas were seen around the age group of 21-30 years. One
convenience of the study. All mastectomy specimens and wide case of tubular adenoma was also there in our study.
local excision specimens which were received for Macroscopically, the tumour measured around 3 x 2 cm and on
histopathological examination suspected for neoplastic and microscopy, the lesion was lined by benign epithelial cells and
non-neoplastic lesions of the breast during the study period
numerous closely packed uniform small tubules, with very less
were included in the study. The study was approved by Ethical
stroma.
Committee and informed consent was obtained. Women those

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Of all benign lesions, benign Phyllodes tumour was seen in frequency of fibro adenoma in England is about 7.7% and in
5 cases in our study. Most of which were seen in the age range the USA it is about 8.5%.4 In the study, it is seen that benign
of 41-50 years. Grossly, the size of the tumour was around 5- lesions of the breast were more common which was about
15 cm in diameter and cut surface was showing many irregular 83.4% in ≤40 years age group, whereas malignant lesions of
nodules. Microscopically, these tumours showed stromal the breast were more common which was about 85.1% in >40
proliferation along with mitotic figures that were less than 2- years age group, which correlates to the findings in the studies
3 per 10 high power fields. Among the 101 malignant lesions, by Kumar7 and Reddy et al.4 In our study, the most common
92 cases were of invasive ductal carcinoma NOS (10.6%), 7 benign lesion is fibro adenoma 496 cases (57%), followed by
cases were of intraductal carcinoma (9%), and one case each fibrocystic change 16% and carcinoma 11.7%. Our findings
in medullary carcinoma and mucinous carcinoma, was seen. were correlating with the findings of cases reported by
Sangma et al,15 Hatim et al14 ,Rasheed et al 15 and Dayanand et
Among the malignant lesions of the breast, invasive ductal
al.16
carcinoma NOS was the most common.
In our study the peak occurrence of fibro adenoma was
seen in 21-30 years followed by 11-20 years. We had three
Benign Number of Cases
Fibro adenoma 496 (57%) cases (2.8%) of complex fibro adenoma in our study along with
Fibroadenosis 141 (16.26%) which showed various morphological patterns like adenosis,
Fibrocystic disease 88 (10%)
Inflammatory lesion 26 (2.9%) cyst formation and apocrine change which was correlating
Benign phyllodes 5 (0.5%) with study done by Vilasini Patil et al.17 Geethamala K et al18
Ductal papilloma 5 (0.5%)
Galactocele 5 (0.5%)
and Dupont et al19 also reported 1.5% and 22% of complex
Table 1. Benign Breast Lesions fibro adenomas respectively and opined in the general
population there is 3.1 times increased risk of developing
Malignant Number of Cases invasive breast carcinoma from complex fibro adenoma when
Invasive ductal carcinoma, NOS 92 (10.6%) in comparison to women with fibro adenoma. Uncoordinated
Intraductal carcinoma 7 (9%)
Mucinous carcinoma 1 (0.1%) proliferation of the epithelial and stromal component leads to
Medullary carcinoma 1 (0.1%) the development of fibro adenoma which mostly arise from the
Table 2. Malignant Breast Lesions terminal duct lobular unit and due to the expansive growth of
the lesion10 it creates a pseudo capsule and might involve a
part of the surrounding tissues. The stromal element of fibro
D I SC U S SI O N adenoma undergoes myxoid degeneration such as sclerosis,
hyalinization, or calcification. The epithelial element of the
fibro adenoma may present as proliferative or non-
The breast tissue is comprised of peculiar epithelium and proliferative aspects of breast parenchyma which constitutes
stroma which has the capability of changing into benign or of apocrine metaplasia, ductal hyperplasia, sclerosing
malignant lesions. There are about six to ten major duct adenosis, and florid adenosis which is considered as
systems in the human breast. Keratinizing squamous complex.20,21
epithelium lines, the overlying skin of the breast which steeps In the present study lactating adenoma accounted for
into the nipple orifices which then promptly turns and 1.87% of cases which was comparable to that of studies by
continues to line the ducts as a double-layered cuboidal Pudale et al22. In our study the mean age of presentation of
epithelium. The larger ducts then branch which finally lead to lactating adenoma was found to be 27 years. Only one case of
the formation of the terminal duct lobular unit. The ducts and tubular adenoma was seen in a 23-year-old female. Pudale et
the lobules are lined by two cell types and they are the luminal al and Vilasini et al also reported an incidence of lactating
epithelial cells that overlay the epithelial cells10. Majority of adenoma which was seen in patients belonging to the age
the benign spectrum of lesions in the breast includes fibro group of 11-30 years.22,17 In our study inflammatory breast
adenomas, phyllodes tumour, mastitis, and breast abscess changes were seen in 26 specimens and these usually develop
whereas the malignant spectrum of breast lesions includes as a result of systemic or target organ-specific diseases and
ductal carcinoma, lobular carcinoma, tubular carcinoma, usually the secondary location site is breast. Of all benign
mucinous carcinoma, medullary carcinoma, papillary inflammatory benign lesions, granulomatous mastitis
carcinoma, and metaplastic carcinoma. Breast lesions always accounted for 2 cases in the present study. Hatim et al13 and
Vilasini et al17 found an incidence of mastitis with most of the
show a female preponderance when compared to incidence in
cases in between 31-40 years. In this study 4 cases were that
males, and the histopathological spectrum of breast lesions
of duct ectasia (2.5%) which was found to be correlating with
varies among different countries and ethnic group11. The
incidence of 2.77% cases reported by Rasheed et al.14 Duct
common predisposing conditions for breast lesions include
ectasia is a condition in which there is an obstruction and
multiparty, low parity, low age at first childbirth, and late
associated inflammation of the lactiferous duct. Mammary
menopause, all these to only highlight the fact toward
duct ectasia usually presents with pain, swelling, nipple
excessive circulating oestrogen.2,10 retraction, and bloody nipple discharge and due to this
Occurrence of benign lesions of breast in our present study presentation, this can mimic as breast cancer and this lesion is
was 88.3% of all the breast lesions. These findings were usually considered as a premalignant lesion or as a precursor
comparable with the studies done by Hatim et al 13 who had for malignancy.17
80% of the cases and Rasheed et al14 who had 80.7% cases. The In our study the other benign lesions were phyllodes
mean age in our study which is 33.63 years is found to be much tumour and duct papilloma with an incidence of less than 1%
lesser when compared to the study in the western literature each. Of all fibroepithelial breast diseases phyllodes tumour
where the mean age is found to be 54 years. Reported

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Jemds.com Original Research Article
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secretion.10 In the current study, invasive ductal carcinoma seven year retrospective review. Indian Journal of
NOS 92 cases (10.6%) is the most common malignant breast
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