Tumor presents as hard,irregular mass associated with desmoplastic stromal reaction.
Some of the tumors are gritty due to foci of calcifications and desmoplastic stroma
Rarely they present as circumscribed tumors
Larger tumors infiltrate deeper structure like pectoralis muscle or may ulcerate on surface
If the tumor is present in the central portion of breast then the retraction of nipple develop.
Peau d’orange develops in inflammatory carcinoma. It is caused by cutaneous lymphatic obstruction causing edema, which leads to swelling but the infiltrated skin is tethered by the ligament of Cooper such that it cannot swell, producing an orange skin like texture with dimpled appearance
Microscopy:
Tumor cells are arranged in glandular pattern, sheets, cords, cribriform pattern.
Tumor cells infiltrate into the fibro fatty stroma.
vascular, lymphatic invasion and perineural invasion may be present
Nuclear pleomorpism & atypical mitotic figures are seen.
Depending upon the tubule formation,nuclear pleomorpism & mitotic rate,tumors are graded according to Nottingham histologic score.
Histologic grade – Nottingham histologic grade depending upon nuclear grade, tubule formation and mitotic rate is an important prognostic factor. Depending upon these factors 3 histologic grades have been described. Grade 1 is well differentiated and grade 3 is poorly differentiated.
Tubule formation –
1 point – >75% of tumor
2 points- 10 – 75% of tumor
3 points – <10% of tumor
Mitotic figures
Nuclear pleomorphism
1 point – minimal nuclear variation in size and shape
2points – moderate nuclear variation in size and shape
