Breast is a glandular organ influenced by hormones in females with various structures giving rise to different types of lesions and lumps. Inflammatory lesions are common in lactating females. Benign tumors are frequent in young adults and malignant tumors are common in older females. Breast diseases are mostly confined to females not only for the hormonal influence but also of their more complex structure and greater volume, whereas male breasts are rudimentary non-functional organs, relatively insensitive to endocrine stimuli and apparently resistant to neoplastic growth.¹

Advances in imaging techniques and increased use of fine needle aspiration cytology have greatly assisted the preoperative evaluation of breast lesions. However, in a large proportion of cases differentiation between malignant and benign lesions still rests on histopathological examination. Cancer of breast is one of the commonest malignant tumors in the world and is one of leading causes of death in women.²

Most of the breast diseases produces palpable lumps, both neoplastic and non-neoplastic lesions are seen.³ Benign neoplasm of the breast are more common than the malignant neoplasm and are completely curable. The spectrum of benign breast lesions show considerable variation from one geographical region to another.⁴

India is experiencing an unprecedented rise in number of the breast cancer cases across all the sections of the society. There is no way we can prevent the breast cancer, but we can detect it early and treat it adequately. Achieving this will lead to a society with better long-term survival as well as a better quality of life. According to Indian council of medical research statistics, 10,000 breast cancers are being diagnosed every year in India and more than 70% of them diagnosed in advanced stage.⁵

FNAC is important part of triple assessment (clinical exam, imaging, FNAC) of palpable breast lump. Although histopathological diagnosis is universal accepted mode of diagnosis and follow up.⁶  Hence, in this study we will be dealing with histopathological study of breast lesions. The maximum breast lesions can be diagnosed accurately and correct typing can be done. The present study was conducted to study the histopathological patterns of neoplastic breast lesions.

The present Prospective observational study was carried out in the department of pathology in a tertiary care hospital during the period Jan. 2023 to Dec.2024. The aim was to analysis histomorphological spectrum of breast neoplasm with their prevalence, age distribution and characteristics.

Inclusion criteria: Age: Patients of all ages were included in the study. Gender: Patients of both genders were included.

Exclusion criteria: The patients with lesion other than the breast lesion were excluded from study. Those who didn’t gave consent. Those with prior history of breast carcinoma and or on treatment for carcinoma.

 Study population: The present study consists of total 220 cases which were operated or biopsy was done and tissue sent for histopathological examination. These patients were examined and given probable clinical diagnosis based on detailed clinical history and other radiological and laboratory investigation, and then histological correlation was done.

 Histopathological study: The specimens were received in the form of biopsies, lumpectomy, quadrantectomy, simple mastectomy, modified radical mastectomy and radical mastectomy. Surgical specimen was obtained in fixative (10% formalin). Detailed clinical history, investigation, radiologic findings were noted in each patient. Specimens were identified; specimen number were given to each specimen. Note whether the specimen is biopsy or local excision for palpable mass and different types of mastectomy.

Gross examination was done which included size, shape, color, consistency and cut surface. The most representative areas of each specimen were found and sections were taken of size 1.5x 1 cm. Minute specimen received in the form of biopsy were wrapped in the lens paper for fixation. Tissue processing was done. Section was dehydrated in alcohol, cleared in xylol, and embedded in paraffin wax. The corresponding blocks were prepared and 3-to-5-micron thick section were cut from each paraffin block and stained with hematoxylin and eosin stain.

This study is prospective study of histopathology of 220 patients with breast lesion. It was done in department of pathology of our institution, during the period of Jan. 2024 to Dec.2024.

Table No.1: Frequency of occurrence of breast lesions on the histopathology.

Out of total 5500 specimen received in histopathology section during the study period of Jan. 2024 to Dec.2024, breast specimens were 220(4 %).

Table No 2: Showing age wise distribution of the total cases.

In this study, age of the patients was ranged from (14-80 years). Maximum patients were from the age group 21-30 years i.e.79(35.9 %), followed by 59(26.81 %) patients in 31-40 years age groups, 43(19.54 %) patients in 41-50 years age groups, 29(13.18 %) patients in 51-60 years age groups, 7(3.18%) patients in 61-70 years age groups, 2(0.98%) patients in 71-80 years age groups, no cases were present below 10 years of the age and above 80 years of age.

Table No 3 : Showing proportion of male and female cases.

In our study, out of 220 cases of breast lesions, 214 were females and 6 were males cases. This shows that breast lesions are more common in female as compared to male.

Table No.  4 :Showing laterality of the breast lesions.

In our study out of 220 patients, involvement of left breast 112 (50.9%) was more than right breast 105 (47.72%) and 3(1.36%) cases were having bilateral breast lesions.

Table No. 5: Showing frequency of occurrence of breast lesions in different quadrants of breast.

Note- Multiple quadrant =more than 2 quadrant, Diffuse= involving all quadrants/whole breast.

Out of 220 cases, maximum number of breast lesions were located in the upper outer quadrant 115 (52.27%), followed by upper inner quadrant 30 (13.63%), lower outer 23 (10.45%), central 21 (9.54%), lower inner 13 (5.9%), multiple quadrant involvement was seen in 11(5%) and diffuse involvement seen in 7 (3.18%) cases.

Table No. 6: Typing and frequency of occurrence of different benign lesions on histopathology.

Among the total 150 benign lesions, fibroadenoma was most common lesion on histopathology present in 105 (47.72%) cases, of all lesions on histopathology. Followed by Fibroadenosis of breast 12(5.45%), Phyllodes 10(4.54%), 6 cases of fibrocystic disease.

Table No.7: Typing and frequency of occurrence of malignant lesions on histopathology

Out of 70(100%) cases of malignancy, Infiltrating duct carcinoma - no special type (NST) was present in 60 cases, 85.71% of malignant lesions. There were 2 cases of medullary carcinoma of the breast i.e.2.85% of all the malignant tumor of breast. 1 case each of ductal carcinoma in situ, invasive lobular carcinoma in situ, invasive papillary carcinoma, mucinous carcinoma, invasive lobular carcinoma, oncocytic carcinoma, metaplastic carcinoma, and low grade fibromyxo sarcoma.

PHOTOGRAPHS

Figure 1: Fibroadenoma: Gross photograph shows well circumscribed mass with cut surface having numerous slits.

Figure 2: Phyllodes tumor: Gross photograph showing grayish white tumor mass with cut surface having cleft –like spaces.

Figure 3: Fibroadenoma: Microphotograph showing predominant intracanalicular pattern. Ducts lined by inner cuboidal and outer myoepithelial lining in fibromyxoid stroma. [ H&E:10X]

Figure 4: Lactating adenoma: Microphotograph shows closely packed glands with actively secreting cells having abundant eosinophilic cytoplasm. [H&E:10X].

Figure 5: Infiltrating duct carcinoma (NST): Microphotographs shows solid sheet of tumor cells with stromal invasion. [H&E:40X]

Figure 6: Invasive Lobular carcinoma Microphotographs showing small, discohesive tumor cells having Indian file arrangement. [H&E:40X]

In the present study, out of 5500 specimens received in histopathology section, breast lesions specimens were 220 (4%). Mudholkar et al (2012)⁷ studied 366 specimens over a period of 5 years which was 4% of all 9086 histopathology specimens.

In our study maximum patients were from the age group 21-30 years i.e.79(35.9 %), followed by 59(26.81 %) patients in 31-40 years age groups. Kanchana et al (2015)⁸ also reported maximum 30.33% of cases from this age group. Ibrahim et al (2015)⁹ reported 30.97% cases from this age group. Next common age group was in 31-40 years. we reported 26.78% cases from this age group. Kanchana et al (2015)⁸, Ibrahim et al (2015)⁹ reported nearly close i.e. 30.33%, 30.97% cases respectively. All study discussed here nearly correlate well with our study.

In the present study 214 were females and 6 were male cases. Which is compared to study done by Aslam et al (2013)¹⁰ and Vijayabharathi et al (2015)⁶ reported 3.9% and 4.09% male cases respectively. High proportion of the female cases shows that breast diseases are more common in female than male.

In our study left breast involvement present in 112 (50.9%) of the cases, right breast involvement in 105(47.72%) of the cases and bilateral involvement in 3(1.36%) of the cases. In all the study by Sandhu et al (2010)¹¹ 47.4% right breast involved, 51.6% left and bilateral 1% while in a study by Rathi et al (2015)¹² 44.26% right breast involved, 49.18% left and bilateral 6.55% similar to our study.

In our study out of 220 cases, maximum number of breast lesions were in the upper outer quadrant 115 (52.27%). In all studies, the upper outer quadrant is main quadrant involved. Mudholkar et al (2012)⁷, Rathi et al (2015)¹² reported 45%,63.11% cases respectively.

In all studies on histopathology, infiltrating duct carcinoma of no special type (NST) was most common lesion. In our study we reported it in 60 (85.71%) cases of malignant lesions. Mudholkar et al (2012)⁷, Ibrahim et al (2015)⁹ and Sulhyan etal(2017)¹³ reported it in  88%, 59.5% and 81.33% of malignant lesions respectively.

In our study, mucinous carcinoma was reported in 1.42% of the cases, nearly similar frequency was reported by Mudholkar et al (2012)⁷ in 1.5% of malignant lesions. We reported medullary carcinoma in 2.85% cases, whereas Ibrahim et al(2015)⁹ reported it in comparatively higher 11.5% of cases.

Our study showed that among all malignant lesions, there were 60(85.71%) cases with infiltrating duct carcinoma of no special type (NST) and majority cases (43.33% and 36.66%) were present in 6^th and 5^th decades each. While Ibrahim etal(2015)⁹ study showed (59.55%) cases were diagnosed as infiltrating duct carcinoma of no special type (NST) and majority cases (23.4% and 21.8%) were present in 5^th and 6^th decades respectively.

Medullary carcinoma was the second most common histological type in this study. It accounting for 2.85% of cases. Ibrahim etal(2015)⁹ study shows, medullary carcinoma seen in 2.8% of all malignant cases of which majority (46.6%) were present in 51-60 age group.

Breast sample made 4 % of the total histopathology sample received during study period.

• In our study, maximum benign lesions were most common lesions and were most common in 3^rd decade of life. Among the benign lesion, fibroadenoma was most common lesion. Majority of it presented in 3^rd
• In our study, maximum malignancy cases were reported in the 6^thand 5^th Among the malignancy cases infiltrating duct carcinoma of no special type (NST) was the most common tumor diagnosed on histopathology next to the fibroadenoma. Majority of it presented in the 6^th and 5^th decade.
• Left side and upper outer quadrant were most affected breast sites.
• Every patient is first examined clinically with help of detailed history and supportive required investigation, and finally a most probable clinical diagnosis is given. Thus, histopathological study plays an important role in diagnosis of breast lesions and hence in treatment and prognosis.

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