Breast

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Breast

  1. 1. Pathology of the breast • normal anatomy •developmental abnormalities •inflammations • fibrocystic changes • tumors • benign • malignant • pathology of the male breast
  2. 2. Normal anatomy •Epithelium: •Ducts •Lobules •Stroma: •Interlobular •Lobular
  3. 3. Ectopic breast • supernumerary breast along the milk lines Developmental abnormalities
  4. 4. Inflammatory and reactive conditions Fat necrosis • can form mass clinically • history of trauma or prior surgical intervention) • histiocytes with foamy cytoplasm
  5. 5. Inflammatory and reactive conditions Granulomatous Lobular Mastitis • etiology unknown Mammary duct ectasia • periductal inflammation, duct sclerosis • intermittent nipple discharge Tuberculosis •lactating breast, innoculation via the lactiferous ducts • slowly growing, solitary, painless mass
  6. 6. Benign proliferative lesions Fibrocystic changes: • Fibrosis, cysts, Apocrine change and papillae Hyperplasia: • ductal and lobular hyperplasia • atypical ductal and lobular hyperplasia
  7. 7. Benign tumors Fibroadenoma • proliferation of epithelial and stromal elements • most common breast tumor in adolescent and young adult women (peak age = third decade) •well-circumscribed, freely movable, nonpainful mass • ducts distorted into slit-like structures Tubular adenoma Lactating Adenoma
  8. 8. Cystosarcoma phyllodes (phyllodes tumor) •fleshy tumor, leaf-like pattern and cysts on cut surface •benign, malignant (low grade, high grade)
  9. 9. Breast carcinoma • most frequent malignant tumor in females •risk factors: genetic predisposition (breast ca in close/ 1st degree relatives), history of ca (breast, ovary, endometrium) • importance of preventive controls! – early diagnosis better prognosis
  10. 10. Breast carcinoma - classification Ductal carcinoma • Insitu • Invasive Lobular carcinoma • Insitu • Invasive
  11. 11. Carcinoma in situ • preinvasive - does not form a palpable tumor • not detected clinically (only X-ray – screening !!!) •no metastatic spread (basement membrane) • risk of invasion depending on grade
  12. 12. Invasive carcinoma Invasive ductal carcinoma • largest group (65 to 80 % of mammary carcinomas) • mid to late fifties Invasive lobular carcinoma • uniform cells, infiltrative growth (linear arrangement - indian file pattern)
  13. 13. • other types: tubular, mucinous, medullary, inflammatory – together about 10 % of breast ca • metastases: regional lymph nodes • treatment: surgery radiotherapy antihormonal therapy (Tamoxifen) chemotherapy Invasive carcinoma
  14. 14. Pathology of the male breast Gynecomastia • most common clinical and pathologic abnormality of the male breast • increase in subareolar tissue • associated with decreased androgens or increased estrogen: cirrhosis of the liver, chronic renal failure and hypogonadism Carcinoma of the male breast • uncommon < 1 % of all breast cancers
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