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Classification of breast disease

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"Breast Diseases"[MeSH Terms]

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WHO Classification breast tumours fifth edition benign breast disease classification

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Classification of breast diseases

1. Developmental and physiological disorders

  • Congenital anomalies: amastia, athelia, polymastia, polythelia
  • Pubertal disorders: premature thelarche, virginal hypertrophy
  • Lactational changes
  • Involutional changes
  • Gynecomastia in males

2. Inflammatory and infective disorders

  • Acute lactational mastitis
  • Breast abscess
  • Periductal mastitis / duct ectasia
  • Granulomatous mastitis
  • Tuberculous mastitis
  • Fat necrosis
  • Inflammatory carcinoma, an important malignant mimic of mastitis

3. Benign breast disease

A. Nonproliferative breast changes

Often called fibrocystic changes, with no material increase in carcinoma risk:
  • Cysts, including apocrine cysts
  • Fibrosis
  • Adenosis
  • Apocrine metaplasia
  • Mild usual ductal hyperplasia

B. Proliferative breast disease without atypia

Slightly increased future carcinoma risk:
  • Usual ductal hyperplasia
  • Sclerosing adenosis
  • Intraductal papilloma
  • Radial scar / complex sclerosing lesion
  • Fibroadenoma, commonly considered separately as a benign fibroepithelial tumour

C. Proliferative breast disease with atypia

High-risk precursor lesions:
  • Atypical ductal hyperplasia (ADH)
  • Atypical lobular hyperplasia (ALH)
Robbins classifies benign epithelial lesions into nonproliferative change, proliferative disease without atypia, and proliferative disease with atypia according to subsequent breast-cancer risk. Robbins, Cotran & Kumar Pathologic Basis of Disease, p. 947.

4. Benign tumours

Epithelial
  • Intraductal papilloma
  • Adenoma of nipple
Fibroepithelial / stromal
  • Fibroadenoma
  • Phyllodes tumour: benign, borderline, or malignant
Other mesenchymal lesions
  • Lipoma
  • Hamartoma
  • Hemangioma
  • Pseudoangiomatous stromal hyperplasia

5. Carcinoma in situ

  • Ductal carcinoma in situ (DCIS)
  • Lobular carcinoma in situ (LCIS)
These are noninvasive epithelial neoplasms, but are major markers or precursors of invasive breast carcinoma. Robbins, Cotran & Kumar Pathologic Basis of Disease, pp. 951-953.

6. Invasive malignant tumours

A. Epithelial carcinomas

  • Invasive breast carcinoma of no special type (IBC-NST), previously invasive ductal carcinoma, NOS
  • Invasive lobular carcinoma
  • Special histological types:
    • Tubular
    • Mucinous
    • Papillary
    • Cribriform
    • Metaplastic carcinoma
    • Neuroendocrine neoplasms
    • Carcinoma with medullary pattern

B. Other malignant neoplasms

  • Malignant phyllodes tumour
  • Primary breast sarcoma
  • Primary breast lymphoma
  • Metastatic tumours to the breast

7. Paget disease of the nipple

  • Intraepidermal spread of malignant ductal cells in the nipple-areola complex
  • Usually associated with underlying DCIS or invasive carcinoma.

Practical clinical classification

Breast disease may also be grouped by presentation:
  • Breast pain (mastalgia)
  • Lump or mass
  • Nipple discharge
  • Inflammation
  • Diffuse nodularity
  • Screening-detected abnormality
Most breast lesions are benign, but a discrete mass, spontaneous unilateral bloody nipple discharge, or inflammatory change requires assessment to exclude cancer. Robbins & Kumar Basic Pathology, p. 705.
Origins of breast disorders: epithelial, stromal, benign, and malignant lesions
The current international tumour framework is the WHO breast-tumour classification, 5th edition.
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