Browsing by Author "Dabbs, David J."

Now showing 1 - 4 of 4
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    Breast cancer prognostic classification in the molecular era: the role of histological grade
    (BMC, 2010-07-30) Rakha, Emad A.; Reis-Filho, Jorge S.; Baehner, Frederick; Dabbs, David J.; Decker, Thomas; Eusebi, Vincenzo; Fox, Stephen B.; Ichihara, Shu; Jacquemier, Jocelyne; Lakhani, Sunil R.; Palacios, José; Richardson, Andrea L; Schnitt, Stuart J.; Schmitt, Fernando C.; Tan, Puay-Hoon; Tse, Gary M.; Badve, Sunil; Ellis, Ian O.; Pathology and Laboratory Medicine, School of Medicine
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    Breast lesions of uncertain malignant nature and limited metastatic potential: proposals to improve their recognition and clinical management
    (Wiley, 2016-08-16) Rakha, Emad A.; Badve, Sunil; Eusebi, Vincenzo; Reis-Filho, Jorge S.; Fox, Stephen B.; Dabbs, David J.; Decker, Thomas; Hodi, Zsolt; Ichihara, Shu; Lee, Andrew HS.; Palacios, José; Richardson, Andrea L.; Vincent-Salomon, Anne; Schmitt, Fernando C.; Tan, Puay-Hoon; Tse, Gary M.; Ellis, Ian O.; Department of Pathology and Laboratory Medicine, IU School of Medicine
    Breast lesions comprise a family of heterogeneous entities with variable patterns of presentation, morphology and clinical behaviour. The majority of breast lesions are classified traditionally into benign and malignant conditions and their behaviour can, in the vast majority of cases, be predicted with a reasonable degree of accuracy. However, there remain lesions which show borderline features and lie in a grey zone between benign and malignant, as their behaviour cannot be predicted reliably. Defined pathological categorization of such lesions is challenging, and for some entities is recognized to be subjective and include a range of diagnoses, and forms of terminology, which may trigger over- or undertreatment. The rarity of these lesions makes the acquisition of clinical evidence problematic and limits the development of a sufficient evidence base to support informed decision-making by clinicians and patients. Emerging molecular evidence is providing a greater understanding of the biology of these lesions, but this may or may not be reflected in their clinical behaviour. Herein we discuss some breast lesions that are associated with uncertainty regarding classification and behaviour, and hence management. These include biologically invasive malignant lesions associated with uncertain metastatic potential, such as low-grade adenosquamous carcinoma, low-grade fibromatosis-like spindle cell carcinoma and encapsulated papillary carcinoma. Other lesions of uncertain malignant nature remain, such as mammary cylindroma, atypical microglandular adenosis, mammary pleomorphic adenoma and infiltrating epitheliosis. The concept of categories of (1) breast lesions of uncertain malignant nature and (2) breast lesions of limited metastatic potential are proposed with details of which histological entities could be included in each category, and their management implications are discussed.
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    Invasion in breast lesions: the role of the epithelial-stroma barrier
    (Wiley, 2018) Rakha, Emad A.; Miligy, Islam; Gorringe, Kylie L.; Toss, Michael S.; Green, Andrew R.; Fox, Stephen B.; Schmitt, Fernando C.; Tan, Puay-Hoon; Tse, Gary M.; Badve, Sunil; Decker, Thomas; Vincent-Salomon, Anne; Dabbs, David J.; Foschini, Maria P.; Moreno, Filipa; Wentao, Yang; Geyer, Felipe C.; Reis-Filho, Jorge S.; Pinder, Sarah E.; Lakhani, Sunil R.; Ellis, Ian O.; Pathology and Laboratory Medicine, School of Medicine
    Despite the significant biological, behavioural and management differences between ductal carcinoma in situ (DCIS) and invasive carcinoma of the breast, they share many morphological and molecular similarities. Differentiation of these two different lesions in breast pathological diagnosis is typically based on the presence of an intact barrier between the malignant epithelial cells and stroma, namely the myoepithelial cell (MEC) layer and surrounding basement membrane (BM). Despite being robust diagnostic criteria, the identification of MECs and BM to differentiate in situ from invasive carcinoma is not always straightforward. The MEC layer around DCIS may be interrupted and/or show an altered immunoprofile. MECs may be absent in some benign locally infiltrative lesions such as microglandular adenosis and infiltrating epitheliosis, and occasionally in non-infiltrative conditions such as apocrine lesions, and in these contexts this does not denote malignancy or invasive disease with metastatic potential. MECs may be also absent around some malignant lesions such as some forms of papillary carcinoma yet these behave in an indolent fashion akin to some DCIS. In Paget's disease, malignant mammary epithelial cells extend anteriorly from the ducts to infiltrate the epidermis of the nipple but do not typically infiltrate through the BM into the dermis. Conversely, BM-like material can be seen around invasive carcinoma cells and around metastatic tumour cell deposits. Here, we review the role of MECs and BM in breast pathology and highlight potential clinical implications. We advise caution in interpretation of MEC features in breast pathology and mindfulness of the substantive evidence base in the literature associated with behaviour and clinical outcome of lesions classified as benign on conventional morphological examination before changing classification to an invasive lesion on the sole basis of MEC characteristics.
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    Phyllodes tumours of the breast: a consensus review
    (Wiley, 2016-01) Tan, Benjamin Y.; Acs, Geza; Apple, Sophia K.; Badve, Sunil S.; Bleiweiss, Ira J.; Brogi, Edi; Calvo, José P.; Dabbs, David J.; Ellis, Ian O.; Eusebi, Vincenzo; Farshid, Gelareh; Fox, Stephen B.; Ichihara, Shu; Lakhani, Sunil R.; Rakha, Emad A.; Reis-Filho, Jorge S.; Richardson, Andrea L.; Sahin, Aysegul; Schmitt, Fernando C.; Schnitt, Stuart J.; Siziopikou, Kalliopi P.; Soares, Fernando A.; Tse, Gary M.; Vincent-Salomon, Anne; Tan, Puay Hoon; Pathology and Laboratory Medicine, School of Medicine
    Phyllodes tumours constitute an uncommon but complex group of mammary fibroepithelial lesions. Accurate and reproducible grading of these tumours has long been challenging, owing to the need to assess multiple stratified histological parameters, which may be weighted differently by individual pathologists. Distinction of benign phyllodes tumours from cellular fibroadenomas is fraught with difficulty, due to overlapping microscopic features. Similarly, separation of the malignant phyllodes tumour from spindle cell metaplastic carcinoma and primary breast sarcoma can be problematic. Phyllodes tumours are treated by surgical excision. However, there is no consensus on the definition of an appropriate surgical margin to ensure completeness of excision and reduction of recurrence risk. Interpretive subjectivity, overlapping histological diagnostic criteria, suboptimal correlation between histological classification and clinical behaviour and the lack of robust molecular predictors of outcome make further investigation of the pathogenesis of these fascinating tumours a matter of active research. This review consolidates the current understanding of their pathobiology and clinical behaviour, and includes proposals for a rational approach to the classification and management of phyllodes tumours.