The document discusses inflammatory and proliferative disorders of the breast. It covers topics such as mastitis, fat necrosis, duct ectasia, fibrocystic changes/disease, and nipple discharge. Fibrocystic changes are described as one of the most common breast disorders, characterized by cyst formation, fibrosis, and adenosis. Histopathological features include cysts lined by apocrine epithelium and the presence of calcifications. While fibrocystic changes can mimic carcinoma, they are not associated with an increased risk of cancer when found in isolation.

1. Breast: Inflammatory and
proliferative disorders
Dr. Rupinder Kaur

2. Pathology
► Lesions preponderantly confined to females
► In males it is a rudimentary structure relatively insensitive
to endocrine influences and apparently resistant to
neoplastic growth
► More complex structure, the greater breast volume, &
extreme sensitivity to endocrine influences, all predispose
female breast to a number of pathologic conditions
► Most breast diseases present as palpable masses,
inflammatory lesions, nipple secretions or mammographic
abnormalities

3. Schematic representation of the breast, indicating the sites of origin of pathologic lesions.

4. Classification of breast lesions
► Inflammatory lesions:
- Acute and chronic inflammation ( mastitis)
► Lesions caused by trauma
- Fat necrosis
- Reaction to foreign bodies
- Lesions resulting from breast augmentation/ reduction
► Benign proliferative disease
- Cysts ( fibrocystic disease)
- Fibrous mastopathy/ other fibrous lesions
- Phyllodes tumour ( cystosarcoma phyllodes)

5. Classification of breast lesions
► Benign tumours
- Fibroadenoma
- Lactating adenoma
- Intraductal papilloma
- Granular cell tumour
► Malignant tumours
- Carcinoma of various types
- Sarcomas
► Rare tumour & tumour like conditions
► Metastatic tumours

6. Inflammatory lesions
► Uncommon, accounts for < 1% of breast lesions
► Erythematous , painful, swollen breast
► D/D: inflammatory carcinoma breast

7. Mastitis
► Benign lesions, c/o bimodal components of breast tissue
► Inflammatory cells; chronic/ acute
► Regenerative epithelial atypia
► Histiocytes, epithelioid cells, multinucleated giant cells and
plasma cells ( granulomatous)
► Microorganisms- infective

8. Myoepithelial cells
Ductal
epithelial
cells
Intra and periductal
inflammatory cells

9. Fat necrosis

10. Fat Necrosis
► Focal necrosis of the fat tissue in the breast followed by
inflammatory reaction
► Uncommon lesion
► Tends to occur as an isolated, sharply localized process in
one breast
► Many patients give H/O trauma, prior surgical intervention,
or radiation therapy

11. Fat necrosis
► Morphology-
Gross -hemorrhage in early stages
- central liquefactive necrosis of fat in
later stage
- grey white firm tissue containing
small foci of chalky white or
hemorrhagic debris

12. Classic cheesy appearance of fat in fat necrosis

13. Fat necrosis
Histology
- central focus of necrotic fat cells surrounded by lipid laden
macrophages
- Intense neutrophilic infiltration
- Progressive fibroblastic proliferation
- Increased vascularization
- Lymphocytic & histiocytic proliferation

14. Fat necrosis

16. Microphotograph showing neutrophilic infiltrate and
foamy histiocytes

17. Duct ectasia

18. Duct ectasia
► Occur in 5th or 6th decade of life
► Multiparous females
► Patients presents with poorly defined palpable periareolar
mass
► Associated with thick cheesy nipple secretion
► Morphology
- dilatation of ducts
- inspissations of breast secretions
- marked periductal & interstitial chronic
granulomatous inflammatory reaction
around cholesterol deposits

19. Duct ectasia
- dilated ducts filled by granular, necrotic acidophilic debris
containing lipid laden macrophages
- infiltrates of lymphocytes and histiocytes with
predominance of plasma cells

21. Duct Ectasia

22. Duct ectasia-duct lumen containing foamy macrophages

23. Duct filled with foamy histiocytes

24. Nipple discharge

25. Nipple discharge: causes
► Blood-stained:
. Duct papilloma
. Intraductal carcinoma (DCIS)
. Paget’s disease
. Invasive carcinoma (unusual)

26. Nipple discharge
► Serous - early pregnancy
► Yellowish, brown, green
- fibroadenosis /duct ectasia
► Milky
- galactorrhoea after lactation,also
hyperprolactinaemia (e.g. from pituitary
adenoma/drugs)
► Purulent - breast abscess

28. Benign proliferative
breast disease

29. Fibrocystic disease/changes

30. Fibrocystic disease/changes
► Represents single most common disorder of the breast
► Miscellaneous changes of breast involving ducts, lobules,
and stroma
► Clinical incidence approximately 40 to 50% of
patients, “lumps”
► Pathological incidence greater than 60 to 80%
► Terminology - fibrocystic change favoured over
disease

31. Fibrocystic disease/changes
► Accounts for more than half of all surgical operations
► Unusual before adolescence
► Common between the ages of 20-40 yrs with peak at or
just before the menopause
► Hormonal imbalance considered to be the basic to the
development of this multi-patterned disorder

32. Fibrocystic disease/changes
► Excess of estrogen or deficiency of progesterone as seen
in anovulatory women
► Oral contraceptive use decreases the risk as it supplies a
balance source of progesterone and estrogen

33. Fibrocystic dis/changes-
morphology
► Three principal patterns-
- Cyst formation, often with apocrine
metaplasia
- Fibrosis
- Adenosis
► Cysts - large grossly evident ,
- multifocal and bilateral
- cystic dilatation of ducts and lobules
- felt as ill defined discrete nodularities in
the breast

34. Fibrocystic dis/changes-
morphology
- secretory product within the ducts calcify which result in
micro-calcification
- termed as“Blue dome cysts” when unopened and contain
semi-translucent turbid fluid.
- Cysts are lined by polygonal cells with abundant granular
eosinophillic cytoplasm with small round hyperchromatic
nuclei resembling apocrine epithelium of sweat glands
( Apocrine Metaplasia)
- epithelial overgrowth and papillary projections are common
in cysts lined by apocrine metaplasia

35. Fibrocystic dis/changes-
morphology
► Fibrosis
- frequent rupture of cysts
- release of secretory material into adjacent
stroma
- this results in chronic inflammation and
scarring fibrosis
- which contributes to the palpable firmness
of the breast

36. Fibrocystic dis/changes-
morphology
► Adenosis
- increase in the number of acinar units/lobule
(normally seen during pregnancy)
- enlarged gland lumens (blunt duct adenosis)
- calcification present (occasionally)

37. Fibrocystic dis/changes-
morphology
► Cysts
► Fibrosis
► Apocrine Metaplasia
► Blunt duct Adenosis
► Papillomatosis (epithelial hyperplasia)

38. Fibrocystic dis/change- showing multiple
cysts

40. High power view showing dilated cysts

41. Fibrocystic change showing apocrine
metaplasia

42. High power view of apocrine metaplasia

43. Adenosis

44. Fibrocystic dis/change- clinical
significance
► In the absence of proliferative disease no risk of
developing cancer
► May mimic carcinoma by producing palpable lumps,
mammographic densities, calcification or nipple discharge

45. Thank you