PathoPhysiology Chapter 33

1. CHAPTER 33
ALTERATIONS IN FEMALE
GENITAL AND REPRODUCTIVE
FUNCTION

2. MENSTRUAL DISORDERS
Amenorrhea
• Absence or suppression of menstruation
• Causes
• Hormonal disturbances
• Stress
• Neoplasms (ovarian, adrenal, or pituitary tumors)

3. Amenorrhea
• Treatment
• Aimed at the underlying cause
• Hormonal supplementation
• Surgery (tumor removal)
Menstrual Disorders (Cont.)Menstrual Disorders (Cont.)

4. MENSTRUAL DISORDERS (CONT.)
• Causes of primary amenorrhea
• Hypothalamus
• Anorexia nervosa
• Strenuous exercise
• GnRH deficiency
• Congenital defects
• Tumor

5. MENSTRUAL DISORDERS (CONT.)
• Causes of primary amenorrhea
• Pituitary
• Prolactinoma, hyperprolactinemia, hypopituitarism
• Thyroid
• Hypothyroidism

6. MENSTRUAL DISORDERS (CONT.)
• Causes of primary amenorrhea
• Adrenal
• Congenital adrenal hyperplasia, adenomas/carcinoma
• Ovarian
• Ovarian failure, polycystic ovary disease, 17-
hydroxylase deficiency
• Vaginal
• Vaginal agenesis, transverse vaginal septum,
imperforate hymen, testicular feminization

7. MENSTRUAL DISORDERS (CONT.)

8. MENSTRUAL DISORDERS (CONT.)
• Causes of secondary amenorrhea
• Hypothalamus
• Anorexia nervosa, weight loss
• Strenuous exercise
• Pseudocyesis, systemic disease, tumor
• Post-pill amenorrhea
• Pituitary
• Prolactinoma
• Hyperprolactinemia

9. • Causes of secondary amenorrhea
• Thyroid
• Hypothyroidism
• Hyperthyroidism
• Adrenal
• Congenital adrenal hyperplasia
• Cushing’s disease
• Adenomas/carcinoma
• Ectopic ACTH
Menstrual Disorders (Cont.)Menstrual Disorders (Cont.)

10. MENSTRUAL DISORDERS
(CONT.)
• Causes of secondary amenorrhea
• Ovarian
• Ovarian failure
• Resistant ovary syndrome
• Tumors
• Uterine
• Intrauterine pregnancy
• Trophoblastic disease, uterine synechia
• Extrauterine
• Ectopic pregnancy

11. Abnormal Uterine Bleeding Patterns
• Metrorrhagia
• Bleeding between menstrual periods
• Causes
• Slight bleeding from endometrium during ovulation
• Uterine malignancy
• Cervical erosions
• Endometrial polyps
• Estrogen therapy
Menstrual Disorders (Cont.)Menstrual Disorders (Cont.)

12. Abnormal Uterine Bleeding Patterns
• Hypomenorrhea
• Deficient amount of menstrual flow
• Causes
• Endocrine or systemic disorders interfering with
hormones
• Partial obstruction of menstrual flow
Menstrual Disorders (Cont.)Menstrual Disorders (Cont.)

13. Abnormal Uterine Bleeding Patterns
• Oligomenorrhea
• Infrequent menstruation
• Cause
• Endocrine/systemic disorder causing failure to ovulate
• Menorrhagia
• Increase in amount or duration of bleeding
• Cause
• Lesions of reproductive organs
Menstrual Disorders (Cont.)Menstrual Disorders (Cont.)

14. Abnormal Uterine Bleeding Patterns
• Dysfunctional uterine bleeding
• Abnormal endometrial bleeding not associated with
tumor, inflammation, pregnancy, trauma, or
hormonal effects
• Most common around time of menarche and
menopause
• Not common between 20 and 25 years of age
Menstrual Disorders (Cont.)Menstrual Disorders (Cont.)

15. MENSTRUAL DISORDERS
(CONT.)
Abnormal Uterine Bleeding Patterns
• Dysfunctional uterine bleeding
• Adolescents
• Immaturity in functioning of the pituitary and ovary
• Perimenopause
• Progressive function and failure of the ovary to produce
estrogen
• Treatment
• Surgery, oral contraceptives, and/or
antiprostaglandins

16. MENSTRUAL DISORDERS
(CONT.)
• Dysmenorrhea
• Painful menstruation
• Primary
• Develops 1-2 years after menarche
• Results from increase prostaglandin that promotes
uterine contractions and ischemia of endometrial
capillaries
• Sharp, suprapubic cramping severe enough to limit
activity, nausea, vomiting, diarrhea

17. • Dysmenorrhea
• Secondary
• Associated with pelvic disorders such as endometriosis
or pelvic adhesions
• Dull quality and may increase with age
• Treatment
• Prostaglandin inhibitors
• Oral contraceptives
• Laparoscopy, medical/surgical therapy
Menstrual Disorders (Cont.)Menstrual Disorders (Cont.)

18. Uterine Prolapse
• Prolapse (sinking) of the uterus from its normal
position into the vagina
• Results from the relaxation of pelvic structures
and the cervix
• Can occur at any age
Alterations in Uterine Position andAlterations in Uterine Position and
Pelvic SupportPelvic Support

19. ALTERATIONS IN UTERINE
POSITION AND PELVIC
SUPPORT (CONT.)
Uterine Prolapse
• Causes
• Congenital defects
• Pregnancy
• Childbirth

20. ALTERATIONS IN UTERINE
POSITION AND PELVIC
SUPPORT (CONT.)

21. Uterine Prolapse
• First degree
• Uterus halfway between vaginal introitus and level
of ischial spines
• Second degree
• End of cervix begins to protrude through the introitus
• Third degree (complete prolapse)
• Body of uterus is outside the vaginal introitus
Alterations in Uterine Position andAlterations in Uterine Position and
Pelvic Support (Cont.)Pelvic Support (Cont.)

22. Alterations in Uterine Position andAlterations in Uterine Position and
Pelvic Support (Cont.)Pelvic Support (Cont.)

23. Uterine Prolapse: Signs and Symptoms
• Depend on severity of prolapse
• Sensation of fullness, vaginal discomfort
• Discomfort in walking/sitting
• Difficulty urinating
• Bleeding, ulceration of cervix from friction,
ulceration
• Treatment
• Hysterectomy
• Pessary (for nonsurgical candidates)
Alterations in Uterine Position andAlterations in Uterine Position and
Pelvic Support (Cont.)Pelvic Support (Cont.)

24. Retrodisplacement of the Uterus
• Body of uterus is displaced from usual
location overlying bladder to posterior of the
pelvis
• Very common (20%-30%)
• Can be detected in 20%-30% of women
• May be present throughout woman’s life or
develop after childbirth
Alterations in Uterine Position andAlterations in Uterine Position and
Pelvic Support (Cont.)Pelvic Support (Cont.)

25. Retrodisplacement of the Uterus
• Causes
• Congenital
• Pregnancy
• Childbirth
• Five positions
• Anteverted, midposition, anteflexed, retroflexed, or
retroverted
Alterations in Uterine Position andAlterations in Uterine Position and
Pelvic Support (Cont.)Pelvic Support (Cont.)

26. Retrodisplacement of the Uterus
• Signs and symptoms
• In many women, no symptoms occur
• Pelvic pain or pressure
• Dysmenorrhea
• Dyspareunia
• Treatment
• No treatment if no symptoms
• Pessary or surgical correction (severe symptoms)
Alterations in Uterine Position andAlterations in Uterine Position and
Pelvic Support (Cont.)Pelvic Support (Cont.)

27. Alterations in Uterine Position andAlterations in Uterine Position and
Pelvic Support (Cont.)Pelvic Support (Cont.)

28. Cystocele
• Protrusion of a portion of the urinary bladder
into a weakened part of the anterior vagina
• Causes
• Injury during childbirth or surgery
• Aging, obesity
• Obesity
• Heavy lifting
Alterations in Uterine Position andAlterations in Uterine Position and
Pelvic Support (Cont.)Pelvic Support (Cont.)

29. Cystocele
• Symptoms
• Depends on severity
• Vaginal pressure and fullness
• Dysuria
• Back pain
• Treatment
• Surgical repair of vagina to restore bladder to normal
position
Alterations in Uterine Position andAlterations in Uterine Position and
Pelvic Support (Cont.)Pelvic Support (Cont.)

30. Alterations in Uterine Position andAlterations in Uterine Position and
Pelvic Support (Cont.)Pelvic Support (Cont.)

31. Rectocele (Proctocele)
• Protrusion of anterior rectal wall into a
weakened area of posterior vagina
• Causes
• Injury during childbirth or surgery
• Weakness with aging
• Multiparity
• Obesity
• Postmenopausal status
Alterations in Uterine Position andAlterations in Uterine Position and
Pelvic Support (Cont.)Pelvic Support (Cont.)

32. Rectocele
• Symptoms
• Depends on severity
• Constipation
• Painful bowel evacuation
• Painful intercourse
• Treatment
• Surgical repair of vagina to restore rectum to proper
position
Alterations in Uterine Position andAlterations in Uterine Position and
Pelvic Support (Cont.)Pelvic Support (Cont.)

33. Alterations in Uterine Position andAlterations in Uterine Position and
Pelvic Support (Cont.)Pelvic Support (Cont.)

34. INFLAMMATION AND
INFECTION
Pelvic Inflammatory Disease (PID)
• Any acute, subacute, recurrent, or chronic
infection of the oviducts, ovaries, and
adjacent reproductive organs
• Cervicitis (cervix)
• Endometritis (uterus)
• Salpingitis (oviducts)
• Oophoritis (ovaries)
• Parametritis (when connective tissue underlying
these structures is involved)

35. Pelvic Inflammatory Disease
• Common organisms
• Neisseria gonorrhoeae
• Chlamydia trachomatis
• Causes
• Alteration of cervical mucus that prevents bacterial
agents from ascending into the uterus
• Pelvic surgery, insertion of intrauterine device,
abortion procedures, infection during/after
pregnancy
Inflammation and Infection (Cont.)Inflammation and Infection (Cont.)

36. INFLAMMATION AND
INFECTION (CONT.)
Pelvic Inflammatory Disease
• Signs and symptoms
• Abdominal tenderness
• Cervical/adnexa pain or tenderness on palpation
• Fever
• Elevated WBC count

37. INFLAMMATION AND
INFECTION (CONT.)
Pelvic Inflammatory Disease
• Treatment
• Early and aggressive antibiotic therapy
• If indicated, hospitalization and surgery to remove
infected area

38. Inflammation and Infection (Cont.)Inflammation and Infection (Cont.)

39. INFLAMMATION AND
INFECTION (CONT.)
Vulvovaginitis
• Inflammation of the vulva and vagina
• Common organisms
• Candida albicans (most common)
• Trichomonas vaginalis
• Haemophilus vaginalis
• Neisseria gonorrhoeae
• Human papillomavirus (HPV)
• Herpesvirus type 2

40. INFLAMMATION AND
INFECTION (CONT.)
Vulvovaginitis
• Other predisposing factors
• Chemical irritation from feminine hygiene products
• Trauma
• Allergic reactions
• Antibiotic therapy

41. INFLAMMATION AND
INFECTION (CONT.)
Vulvovaginitis
• Symptoms
• Thick, white vaginal discharge
• Red, edematous mucous membranes
• Intense itching
• Malodorous, purulent discharge
• Treatment
• Local and systemic antibiotic, antifungal, or antiviral
medications
• Avoidance of factors that promote irritation

42. INFLAMMATION AND
INFECTION (CONT.)
Bartholinitis
• Inflammation of the Bartholin glands
• Located on sides of vaginal orifice that lubricate
vaginal introitus
• Signs and symptoms
• Abscess causing tenderness, swelling, and pus
• Fever, malaise
• Treatment
• Appropriate antibiotic therapy
• Surgical incision and drainage

43. BENIGN GROWTHS AND
ABERRANT TISSUE
Uterine Leiomyomas
• Myomas or fibroids
• Most common uterine tumor
• Affects approximately 20% women >35 years
• Blacks 3 times more than whites
• Make appearance and grow during
reproductive years
• Growth enhanced by high estrogen and GH
levels

44. Benign Growths and AberrantBenign Growths and Aberrant
Tissue (Cont.)Tissue (Cont.)

45. Uterine Leiomyomas
• Signs and symptoms
• Abnormal vaginal bleeding and discharge
• If large mass:
• Abdominal pain and pressure
• Backache
• Constipation
• Urinary frequency/urgency
Benign Growths and AberrantBenign Growths and Aberrant
Tissue (Cont.)Tissue (Cont.)

46. BENIGN GROWTHS AND
ABERRANT TISSUE (CONT.)
Uterine Leiomyomas
• Treatment
• Depends on size, symptoms, location, patient age
• Small
• Monitor carefully for growth patterns
• Large or multiple
• Surgical removal
• Hysterectomy (if indicated)

47. BENIGN GROWTHS AND
ABERRANT TISSUE (CONT.)
Ovarian Cysts
• Sacs on an ovary that contain fluid or
semisolid material
• Follicular
• Maturing ovarian follicle fails to release an ovum;
instead follicle continues to enlarge and produce
estrogen

48. BENIGN GROWTHS AND
ABERRANT TISSUE (CONT.)
Ovarian Cysts
• Corpus luteum
• Corpus luteum fails to degenerate normally.
• Cyst grows and produces progesterone
• Theca-lutein
• Commonly bilateral and filled with clear straw-
colored fluid
• Associated with hydatidiform mole, hormone
therapy, or choriocarcinoma

49. BENIGN GROWTHS AND
ABERRANT TISSUE (CONT.)
Ovarian Cysts
• Sign and symptoms
• Normally produce no symptoms
• When ruptures causes intraperitoneal hemorrhage
and abdominal pain
• Treatment
• Immediate surgical intervention to control the
hemorrhage and repair site of rupture

50. BENIGN GROWTHS AND
ABERRANT TISSUE (CONT.)
Endometriosis
• Increased risk in nulliparous women >30-40
years of age
• Benign disease but tends to infiltrate and
spread to adjacent tissues
• Presence of endometrial tissue outside the
lining of the uterine cavity. Abnormal tissue
implant is called endometrioma.

51. BENIGN GROWTHS AND
ABERRANT TISSUE (CONT.)
Endometriosis
• Once implanted, ectopic tissues periodically
rupture and bleed in response to
reproductive hormones
• Spilling of irritative discharge into peritoneum
causes irritation
• Repeated irritation causes the formation of
dense tissue adhesions

52. BENIGN GROWTHS AND
ABERRANT TISSUE (CONT.)
Endometriosis
• Etiology theories
• Transportation
• Endometrial tissue flows backward through oviducts
during normal menstrual cycle implanting on ovary,
peritoneal surfaces, and other areas

53. BENIGN GROWTHS AND
ABERRANT TISSUE (CONT.)
Endometriosis
• Etiology theories
• Metaplasia
• Inflammation or a hormonal change triggers conversion
of one tissue to another form that is not normal

54. BENIGN GROWTHS AND
ABERRANT TISSUE (CONT.)
Endometriosis
• Etiology theories
• Induction
• Combination of transportation and metaplasia;
regurgitated epithelium induces mesenchyma to form
endometrial epithelium

55. BENIGN GROWTHS AND
ABERRANT TISSUE (CONT.)
Endometriosis
• Sites of occurrence
• Pelvis (in order of frequency)
• Ovary
• Peritoneum of cul-de-sac or pouch of Douglas
• Uterosacral ligaments
• Round ligament
• Oviduct
• Peritoneal surface of the uterus
• Bladder or intestine (less common)

56. BENIGN GROWTHS AND
ABERRANT TISSUE (CONT.)
Endometriosis
• Signs and symptoms
• Dysmenorrhea
• Pain in lower abdomen, vagina, posterior pelvis,
back
• Pain begins 5-7 days before menses and lasts for 2-3
days
• Dyspareunia
• Pain with defecation
• Excessive menstrual bleeding

57. BENIGN GROWTHS AND
ABERRANT TISSUE (CONT.)
Endometriosis
• Treatment
• Varies according to extent of disease
• Induction of menopause-like state with hormonal
agents (progestational steroids, antigonadotropic
agents)
• Surgical excision of affected structures

58. CANCER
Cervical Cancer
• Causes
• Human papillomavirus (HPV) (certain types)
• Intercourse at a young age
• Multiple sexual partners
• Multiple pregnancies
• Herpesvirus type 2
• Other venereal infections

59. Cervical Cancer
• Detected by evaluating cervical cells (Pap
test)
• Screening after 3 negative, yearly Pap tests
• >30 years every 2 years if not at high risk
• Sexually active women younger than 21 years
should be tested within 3 years of first coitus
• No screening for women with hysterectomy
unrelated to cervical neoplasia
• Low-risk women with regular screening may stop at
age 70
Cancer (Cont.)Cancer (Cont.)

60. Cervical Cancer
• Signs and symptoms
• Preinvasive
• Asymptomatic
• Changes in cells in cervical epithelium in Pap
Cancer (Cont.)Cancer (Cont.)

61. Cervical Cancer
• Signs and symptoms
• Early invasive
• Abnormal vaginal bleeding
• Persistent vaginal discharge
• Pain and bleeding after intercourse
• Progression usually beyond early stages when
symptoms appear
Cancer (Cont.)Cancer (Cont.)

62. Cervical Cancer
• May spread to vaginal wall, pelvis, bladder,
rectum, and pelvic lymph nodes
• Treatment
• Pre-cancer
• Cryotherapy, excision, laser surgery
• Invasive carcinoma
• Hysterectomy, chemotherapy, radiation therapy
• Cure rate for stage I is 85%-90%
• Cure rate for stage II is 5%-10%
Cancer (Cont.)Cancer (Cont.)

63. Endometrial Cancer
• Involves endometrial lining of the uterus
• Risks
• Infertility
• Late menopause (older than 55 years)
• Obesity
• Diabetes
• Hypertension
• Unopposed estrogen therapy
Cancer (Cont.)Cancer (Cont.)

64. Endometrial Cancer
• Signs and symptoms
• Bleeding between menstrual periods
• Postmenopausal bleeding
• Diagnosis
• No screening tests
• Histologic tissue examination
Cancer (Cont.)Cancer (Cont.)

65. CANCER (CONT.)
Endometrial Cancer
• Treatment
• Radiation therapy
• Total hysterectomy with removal of the ovaries and
oviducts
• 5-year survival rate with early diagnosis: 85%
• Cure rate drops 50% if cancer metastasized before
diagnosis

66. Ovarian Cancer
• Leading cause of death from genital cancer
• Peak incidence 60-80 years of age
• High mortality rate
• 45% long-term survival rate
Cancer (Cont.)Cancer (Cont.)

67. CANCER (CONT.)
Ovarian Cancer
• Signs and symptoms
• None until late in disease
• When occur include:
• Increased abdominal girth
• Weight loss
• Abdominal pain
• Dysuria or urinary frequency
• Constipation

68. CANCER (CONT.)
Ovarian Cancer
• Treatment
• Removal of uterus, ovaries, and oviducts
• Radiation therapy
• Chemotherapy
• Prophylactic oophorectomy or salpingo-
oophorectomy
• Recommended in high-risk women

69. CANCER (CONT.)
Vaginal Cancer
• Early to mid-50s
• Young women whose mothers took
diethylstilbestrol during pregnancy
• Possible metastasis to bladder, rectum, vulva,
pubic bone, and other surrounding structures

70. Vaginal Cancer
• Signs and symptoms
• Vaginal spotting and discharge
• Pain
• Groin masses
• Changes in urinary pattern
Cancer (Cont.)Cancer (Cont.)

71. Vaginal Cancer
• Treatment
• Early stage
• Treat malignant area while preserving normal parts of
vagina
• Radiation therapy
• Surgery varies on size, depth, and location of tumor
Cancer (Cont.)Cancer (Cont.)

72. CANCER (CONT.)
Vaginal Cancer
• Treatment
• Preservation of a functional vagina is possible only in
early stage.
• Grafting may be done to avoid vaginal stenosis in
younger women

73. Cancer of the Vulva
• 5% of all gynecologic malignancies
• Occurs at any age with peak in mid-60s
• Predisposing factors
• STDs
• Chronic pruritus of vulva with swelling and dryness
• Obesity
• Hypertension
• Diabetes
• Never being pregnant
Cancer (Cont.)Cancer (Cont.)

74. CANCER (CONT.)
Cancer of the Vulva
• Signs and symptoms
• Leukoplakic changes (whitish plaque-like or
ulcerated lesions) in vulva
• Once cancer develops, masses may be present
• Abnormal urination and defecation

75. Cancer of the Vulva
• Treatment
• Partial excision to remove lesion
• Advanced disease
• Total vulvar excision
• Local relapse is common whether
conservative or radical procedure is
undertaken
Cancer (Cont.)Cancer (Cont.)

76. PREGNANCY DISORDERS
Pregnancy-Induced Hypertension
• 0.5%-10% pregnancies
• Leading cause of pregnancy-related deaths
• Causes
• Poor nutrition
• Genetic
• Immunologic factors

77. PREGNANCY DISORDERS
(CONT.)
Pregnancy-Induced Hypertension
• Signs and symptoms
• Weight gain and edema
• Arterial spasm in kidneys, brain, and liver
• Decreased renal flow and GFR
• Severe
• Clonic convulsions followed by coma
• Renal failure
• Liver malfunction
• Extreme hypertension

78. Pregnancy-Induced Hypertension
• Treatment
• High mortality rate if untreated
• Vasodilating drugs
• Seizure prophylaxis
• Rapid delivery of fetus
Pregnancy Disorders (Cont.)Pregnancy Disorders (Cont.)

79. PREGNANCY DISORDERS
(CONT.)
Hyperemesis Gravidarum
• Excessive vomiting throughout entire
pregnancy
• 1:1000 pregnancies
• Treatment
• IV therapy to correct metabolic and nutritional
abnormalities
• Antiemetic agents
• Supportive care in hospital

80. Placenta Previa
• When placenta is implanted abnormally over
the internal cervical os
• More common with multiple pregnancies
• 1:200 deliveries
• Causes
• Unknown
Pregnancy Disorders (Cont.)Pregnancy Disorders (Cont.)

81. PREGNANCY DISORDERS
(CONT.)
Abruptio Placentae
• Premature separation of the placenta before
delivery
• Occurs after 20 weeks’ gestation
• 1% of deliveries
• Causes
• Trauma
• Short umbilical cord
• Occlusion of the inferior vena cava
• PIH
• Abnormal uterine anatomy

82. PREGNANCY DISORDERS
(CONT.)
Abruptio Placentae
• Treatments
• Cesarean section for fetal distress or
hemorrhage control
• Medication to control preterm labor

83. Spontaneous Abortion
• Expulsion of the products of conception from
the uterus before the period of fetal viability
• Miscarriage
• 10%-15% of pregnancies
• Causes
• Chromosomal abnormalities
• Faulty implantation
• Maternal factors (systemic and localized)
• Infections (cytomegalovirus, herpesvirus, rubella)
Pregnancy Disorders (Cont.)Pregnancy Disorders (Cont.)

84. PREGNANCY DISORDERS
(CONT.)
Spontaneous Abortion
• Signs and symptoms
• Vaginal bleeding
• Abdominal cramps
• Treatment
• If incomplete abortion, surgical intervention to
control bleeding and remove remaining uterine
contents

85. REACTIVE-INFLAMMATORY
BREAST DISORDERS
Mammary Duct Ectasia
• Chronic inflammatory process in and around
the terminal subareolar ducts
• More prevalent in postmenopausal women
• Etiology
• Ducts become distended with cellular debris
• Inflammation with zone of granulation tissue
created around a small cavity filled with thick,
yellow/brown material
• Grows into palpable mass

86. REACTIVE-INFLAMMATORY
BREAST DISORDERS (CONT.)
Mammary Duct Ectasia
• Signs and symptoms
• Palpable mass
• Dimpling or distortion of the breast or areola
• Persistent nipple discharge
• Diagnosis
• Biopsy to r/o malignancy
• Treatment
• Surgical excision of dilated subareolar ducts

87. REACTIVE-INFLAMMATORY
BREAST DISORDERS (CONT.)

88. REACTIVE-INFLAMMATORY
BREAST DISORDERS (CONT.)
Breast Abscess
• Etiology
• Congenital inverted nipple predisposes for abscess
• Syndrome of mammary duct ectasia
• Staphylococcus aureus is most common causative
organism

89. Breast Abscess
• Signs and symptoms
• Area of tenderness
• Redness
• Induration under the periareolar skin
• Treatment
• Excise major duct system beneath the areola
• Poor response to antibiotic therapy
Reactive-Inflammatory BreastReactive-Inflammatory Breast
Disorders (Cont.)Disorders (Cont.)

90. REACTIVE-INFLAMMATORY
BREAST DISORDERS (CONT.)
Fat Necrosis
• Death of a portion of tissue after trauma or
injury to the breast
• Signs and symptoms
• Painless, ill-defined, firm, poorly mobile mass
• Skin thickening
• Retraction

91. REACTIVE-INFLAMMATORY
BREAST DISORDERS (CONT.)
Fat Necrosis
• Diagnosis
• Clinical observation
• Mammography
• Treatment
• Excisional biopsy

92. BENIGN BREAST DISORDERS
Fibrocystic Breast Disease
• Presence of palpable breast mass that
fluctuates with menstrual cycle
• 30-50 years
• Microscopic and macroscopic cysts with
fibrosis or overgrowth of stromal fibrous tissue

93. BENIGN BREAST DISORDERS
(CONT.)
Fibrocystic Breast Disease
• Signs and symptoms
• Tenderness or pain in one or both breasts
immediately before onset of menstrual cycle
• Firm, regular in shape, mobile on palpation
• Located in upper outer quadrant of breasts
• Size fluctuates throughout menstrual cycle

94. BENIGN BREAST DISORDERS
(CONT.)
Fibrocystic Breast Disease
• Diagnosis
• Ultrasound
• Needle aspiration
• Treatment
• Danazol (a weak androgen)
• Oral contraceptives
• Local heat, supportive bra
• Avoidance of coffee, tea, cola, and chocolate
• Low-fat, high-carbohydrate diet

95. BENIGN BREAST DISORDERS
(CONT.)

96. MALIGNANT DISORDERS OF
THE BREAST
• Most common form of cancer in women ages
25-75 years
• Leading cause of death in U.S. women 40-44
years old
• Males
• 100 times less common
• More common in white women

97. Etiology
• Risk factors
• Hormonal influences
• Early onset of menses and late menopause (increases)
• Postmenopausal hormone replacement therapy
(increases)
• Reproductive factors
• Giving birth < 18 years (decreases)
• Giving birth > 35 years (increases)
• Low parity (increases) risk while high parity (lowers)
• Breast-feeding (decreases)
Malignant Disorders of the BreastMalignant Disorders of the Breast
(Cont.)(Cont.)

98. Etiology
• Risk factors
• Dietary
• Low fat (decreases)
• Family history of breast cancer
• Mother or sister (increases)
• Age
• Begins to increase by 25-30 years
• Continues to increase with age
• Radiation exposure
• History of cancer
Malignant Disorders of the BreastMalignant Disorders of the Breast
(Cont.)(Cont.)

99. Pathogenesis
• Arise in epithelium of the glandular ducts of
breast
• Lesions have infiltrating edges that begin to
invade normal tissue
• Malignant cells begin to disseminate into
lymph system of axilla
Malignant Disorders of the BreastMalignant Disorders of the Breast
(Cont.)(Cont.)

100. Pathogenesis
• Metastases to other body sites
• Liver, lung, bone
• 5-year survival rate is 98% with no lymph involvement
• Rate drops to 26% with metastasis
• More positive lymph nodes, less favorable the
prognosis
Malignant Disorders of the BreastMalignant Disorders of the Breast
(Cont.)(Cont.)

101. Clinical Manifestations
• Dimpling of the skin
• Nipple retraction
• Changes in breast contour
• Bloody discharge for nipple
Malignant Disorders of the BreastMalignant Disorders of the Breast
(Cont.)(Cont.)

102. Malignant Disorders of the BreastMalignant Disorders of the Breast
(Cont.)(Cont.)

103. MALIGNANT DISORDERS OF
THE BREAST (CONT.)
Diagnosis
• Most discovered with self-exam
• Mammography
• Guidelines recommend yearly >40 years

104. MALIGNANT DISORDERS OF
THE BREAST (CONT.)

105. MALIGNANT DISORDERS OF
THE BREAST (CONT.)

106. MALIGNANT DISORDERS OF
THE BREAST (CONT.)
Treatment
• Surgery
• Lumpectomy
• Removal of lesion only
• Mastectomy
• Removal of only the breast
• Modified radical mastectomy
• Removal of breast with portion of axillary lymphatic
system dissected

107. MALIGNANT DISORDERS OF
THE BREAST (CONT.)
Treatment
• Surgery
• Radical mastectomy
• Removal of breast, lymphatic drainage, and underlying
pectoral muscles
• Chemotherapy
• Radiation therapy
• Supportive measures

108. MALIGNANT DISORDERS OF
THE BREAST (CONT.)