Rosen's Breast Pathology, 4e

Pre face

Not long after I retired from clinical practice in 2010 ­Jonathan W. Pine, Jr, Senior Executive Editor, contacted me about preparing a fourth edition of Breast Pathology . This came as a shock as I had only recently recovered from the ef- fort that produced the third edition and was adjusting to the freedom conferred by retirement. Mr. Pine and I had a very good working relationship in producing the third edition, and being curious to learn what he had in mind, I walked the short distance from my home to the offices of Wolters Kluwer/Lippincott Williams & Wilkins in Philadelphia. As a result of this and subsequent conversations, we arrived at the plan that has given birth to this fourth edition. After writing the initial edition and revising it twice single-handedly, I am honored that my three colleagues and their associates consented to do the heavy lifting that has been necessary to bring this much-improved Fourth ­Edition to completion. The book has benefitted greatly from their many decades of experience in the diagnosis of mam- mary pathology at three of the most prestigious American academic medical centers that are international leaders in the treatment of breast diseases: New York Presbyterian ­Hospital/Weill Cornell Medical College, ­Memorial Hospital for Cancer and Allied Diseases/Memorial Sloan-­Kettering Cancer Center, and Massachusetts General Hospital/­ Harvard Medical School. I have known Syed A. Hoda, MD, for 20 years and worked closely with him for nearly a decade in the Breast Pathology Consultation practice I established at New York Presbyterian Hospital, with the support and encourage- ment of Daniel M. Knowles, Chairman of Pathology and ­Laboratory Medicine. I was very pleased that Syed agreed to serve as Editor, taking responsibility for overseeing the proj- ect and looking after the innumerable details involved in the creation of a book of this scope. Not the least of these tasks was the final stage of uploading the chapter manuscripts and images as required by the publisher. Drs. Hoda, Brogi, and Koerner each undertook the revision of approximately one-third of the book, in some instances with the assistance of their associates. While ad- hering to the basic outline established in prior editions, each chapter has been thoroughly updated to include the most recent information available when the manuscript was com- pleted, as reflected in the substantial number of 2010 to 2013 references cited. In addition to thorough and extensively illustrated descriptions of the surgical pathology and cytol- ogy of the breast, the reader will find comprehensive, de- tailed overviews of the many clinical facets of breast disease, including epidemiology, clinical presentation, diagnostic imaging, molecular/genetic analysis, clinical management, and prognosis. Many new pictures have been added, others have been replaced, and all have been carefully adjusted to

enhance image quality. Chapter 40, titled “Lymphoid and Hematopoietic Neoplasms of the Breast,” was completely rewritten using contemporary diagnostic terminology by Judith A. Ferry, MD, from Massachusetts General Hospital/ Harvard University. In the Introduction to the third edition to this book, I drew attention to the growing recognition that “altered gene expression is fundamental to neoplastic processes” and noted that “the devil is in the details” of how the exceedingly complex system of gene actions becomes disrupted, resulting in the phenotypic changes in cells and tissues employed by pathologists for diagnosis and estimating prognosis. It has become apparent that the situation is even more complex. Some genotypic alterations are linked to specific neoplasms with similar phenotypic appearances, such as the genetic alterations that underlie the diminished or absent expression of adhesion molecules like E-cadherin in lobular carcinoma or the ETV6 – NTRK3 fusion gene that characterizes secretory carcinoma. On the other hand, an increasing number of ge- netic alterations of significance for prognosis and treatment, not readily apparent in the histologic phenotype of neo- plasms, are being discovered by gene expression profiling, and this is leading to an appreciation of unique characteris- tics of individual tumors that may render them susceptible to personalized therapies aimed at these targets. Of particular interest is the discovery that some of the genomic alterations found in mammary carcinomas also occur in carcinomas that arise in other organs such as the uterus and ovaries. In view of the rapid advances being made in the study of the molecular biology of breast carcinoma and the grow- ing intersection of the resultant knowledge with diagnostic pathology, it was deemed important to expand this book by adding Chapter 45, titled “Molecular ­Classification and Test- ing of Breast Carcinoma,” by Drs. Yun Wu and Aysegul A. Sahin from the M. D. Anderson Cancer Center/University of Texas. This chapter provides an introduction to molecular classifications under investigation and predictive molecular tests that are currently used in clinical practice. Data from molecular studies relevant to specific entities can be found in individual chapters. Additional comments about provoca- tive concepts relating to the molecular classification of breast carcinoma that have emerged as a result of gene expression profiling are addressed in a section titled “Molecular versus Morphology for the Classification of Breast Carcinoma: Must It Be Either/Or” in the Introduction. Histopathologic examination will continue to be the primary basis for the diagnostic classification of mammary lesions in the foreseeable future. Molecular advances used in the past two decades to generate alternative classifica- tions have contributed to defining selected prognostic and therapeutic subgroups within the context of the standard

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