The document discusses several benign breast lesions and conditions: - Mammary duct ectasia, which involves ectasia and thickening of large ducts with accumulation of debris, calcification, and chronic inflammation. - Fibrocystic changes and sclerosing lesions, which present as multiple nodules involving glandular proliferation and compression. - Columnar cell lesions, including simple columnar cell change, columnar cell hyperplasia, and lesions with atypia, the earliest neoplastic changes. - Inflammatory conditions such as fat necrosis, mastitis, and granulomatous lobulitis. These can mimic carcinoma clinically and mammographically.

2.  An increased number or enlargement of
glandular components.
 Physiological/simple
 Sclerosing adenosis
 Radial scar and complex sclerosing lesion
 Tubular adenosis
 Microglandular adenosis
 Blunt duct adenosis/ ccc/cch

12.  Multiple nodules-rounded and well defined
 Retention of lobular architecture
 Numeric increase in the glandular elements
 Stromal proliferation
 Glandular compression and distortion-more
towards centre of lesion
 Tubules retain the two cell layers
 Microcalcification+/-

13.  Fibrous stroma dense ,hyalinized with elastic
tissue
 Lacks atypical features
 Apocrine metaplasia+/_

14.  Sclerosing adenosis lesion with superimposed
apocrine metaplasia
 Atypia may be moderately severe -
distinction from apocrine DCIS (with lobular
cancerisation) may be difficult
 Immunostaining will demonstrate an intact
myoepithelial layer and basement membrane
 Follow up of patients showed no greater
cancer risk than other atypical lesions

26.  Glands lined by a monolayer of bland epithelial
cells –no outer myoepithelial mantle.
 Tubules –haphazard, small, regular, rounded
without angulation.
 Lumens contain PAS positive,diastase resistant
secretory material .
 Myoepithelial layer absent but dense basement
membrane present
 Epithelial cells cuboidal or flattened without
apical snouts, cytologically benign.
 Cells- vacoulated and contain PAS positive
material.
 BM- PAS neg. reticulin –complete ring
 Type IV Collagen

27.  The cells show positive immuno staining with
S100, CK 8/18 & EGFR and negative staining
for ER, PGR & Her-2
 Immuno stains for Collagen IV or laminin are
usually positive indicating an intact bounding
basement membrane
 There is an association with atypical
proliferations and malignancy in up to 50% of
cases

40.  Histologically complex with adenosis
epithelial hyperplasia and frequent cyst
formation.
 Usually not palpable
 Often multiple
 Frequently bilateral
 Incidental findings in specimens and
mammography

41.  Usually detected as stellate shadows on
mammograms
 Therefore common in screening
 Radiologically very similar to cancers
 Note: both low grade cancers (especially tubular
cancers) and radial scars may remain unchanged
between screening rounds so a lack of growth is
no guarantee that the lesion is a radial scar
 > 10mm called "Complex sclerosing lesions

42. Gross:
 firm chalky white lesions with irregular outline
 like head of a flower
Microscopy :
 Lobular architecture is distorted
 Centre of lesion –sclerosis and elastosis
 Entrapped epithelial structure mimics carcinoma
 Surrounded by epithelial sructures showing
dilation ,adenosis, and epithelial hyperplasia.

43.  Haphazard arrangement of irregular small
tubules
 Two cell layers
 Apocrine metaplasia+/_
 Calcification+/-
 Associated sclerosing adenosis+/-

44.  Benign lesion.
 But associated with ADH,DCIS.-thus increased
risk of breast ca.

45.  pattern

66. BLUNT DUCT ADENOSIS,PRETUBULAR
HYPERPLASIA/COLUMNAR
ALTERATION OF
LOBULES/CAPSS/ELUCA
ATYPICAL CYSTIC LOBULES/ATYPICAL
CYSTIC DUCT/SMALL ECTATIC DUCTS LINED
BY ATYPICAL DUCTAL CELLS WITH
APOCRINE SNOUTS
DUCTAL INTRAEPITHELIAL NEOPLASIA 1 –
FLAT TYPE/ CLINGING
CARCINOMA,MONOMORPHIC TYPE/
CLINGING INSITU DUCT CARCINOMA FLAT
TYPE.

67. Schnitt and
vincent
salomon
Columnar cell
change
No atypia
With atypia
Columnar cell
hyperplasia
No atypia
With atypia

70. Simpson
CCC
CCH
CCH with
architectural
atypia
CCH with
cytological atypia
CCH with
cytological and
achitectural atypia
CCC with
cytological atypia

72.  ‘presumably neoplastic intraductal
alteration, characterised by the replacement
of native epithelial cells by a single layer or
three to five layers of mildly atypical cells’.
 By Simpson’s classification, FEA would
pertain to categories 4 and 6
 Only low grade cytological atypia
 No architectural atypia
 No high grade atypia.

73. Simpson
CCC
CCH
CCH with
architectural
atypia
CCH with
cytological atypia
CCH with
cytological and
achitectural atypia
CCC with
cytological atypia

88. .
• CCLs with atypia are the early precursor
lesions in the low grade neoplasia pathway
• CCL WITH ATYPIA
• ADH/LOW GRADE DCIS
• LOW GRADE
CARCINOMAS[TUBULAR/CRIBRIFORM/LOBUL
AR/TUBULILOBULAR/]

89.  44-51 yrs
 Non palpable in 86%
 Intraluminal calcifications detected
mammogaraphically -74% cases of CCL

90.  TDLU
 Enlarged
 Epithelial proliferation and cystic dilatation
 Variably dilated acini at low power
 First terminal ductules are affected later acini
 Interlobular stroma diminished

91.  Simple columnar cell change
 1-2 layers of uniformly distibuted cuboidal to tall
columnar cells
 Apical snout
 Nucleus
 Large
 Crowded
 Perpendicular to BM
 No atypia
 calcification

92.  More than 2 layers of uniformly distibuted
cuboidal to tall columnar cells
 Tufts/ mounds can be seen
 No true papillae or cribriforn structures
 Apical snout+/- hobnailing
 Nucleus
 Large
 Crowded/ nucleus overlaps
 Perpendicular to BM
 No atypia
 calcification

93.  The earliest morphologically identifiable
neoplastic alteration among CCLs.
 Luminae-rigidly round [unlike irregular
outline in CCC and CCH without atypia.]
 Cells-atypical- larger, taller, uniform, high
N:C ratio, hyperchroamtic

94.  CCL s with low grade nuclear atypia= FLAT
EPITHELIAL ATYPIA
 CCLs with high grade nuclear atypia= high
grade DCIS
 CCLs with architectural atypia=ADH/ low
grade DCIS.

97.  Acute inflammation with abcess.
 Chronic granulomatous mastitis and its
differential diagnosis
 Periductal mastitis /duct ectasia
 Diabetic mastopathy and lymphocytic
mastopathy

98.  Usually occurs in the lactating breast
 Localised swelling/redness/tenderness
 Pus drained on aspiration
 Antibiotics effective

104.  Perilobular mastitis
 c/f:
 Breast mass in women of childbearing age
 Usually parous women
 Oten related to recent pregnancy
 Mimics carcinoma
 May be b/l
 Strong tendency for persistence or recurrence
in more than half the cases
The cause remains unknown (obstruction and
hypersensitivity reaction have been suggested).

105. Oral contraceptive use
Systemic lupus erythematosus
Hyperprolactinemia
Erythema nodosum

106.  Destructive granulomas.
 Lobulocentric disease pattern.
 Relative sparing of interlobular stroma

107.  Granulomatous infections
 Sarcoidosis
 Mammary duct ectasia
 Peurperal mastitis
 Vasculitis
 Foreign body reaction to polyvinyl plastic or silicone used for
mammaplasty can result in tumor-like masses, granulomas, and sinus
tracts
 Granulomatous angiopanniculitis
 Bacteria
 Bartonella henselae (cat scratch disease)
 Corynebacteria
 Fungi
 Actinomycosis
 Blastomycosis
 Cryptococcosis
 Histoplasmosis
 Mycobacterium tuberculosis

109. Granulomatous angiopanniculitis
This lesion contains multiple non-
necrotic,noncaseous granulomas with a
giant cell component and lymphocytic
angiitis, which involves predominantly
the subcutis but can extend into the
breast tissue without affecting lobules or
ducts.

110. “Infection should always be ruled
out”

115.  Often seen following conservation surgery for
breast cancer
 May occur at any time after about 6 months
following treatment
 Commonly presents as breast thickeneing
 Less commonly as a lump
 Changes include:
 Hyalinisation of collagen and necrosis
 Vascular changes
 Characteristic radiation fibroblasts

116.  30 year old female - 2 month history of firm
non-tender lump in breast deep to areola

122.  Inflammatory breast lesion
 Mimic carcinoma.
 It likely has an autoimmune cause.
 Association with diabetes, especially type 1
and less commonly type 2 (i.e., diabetic
mastopathy).
 Identical lesions occur in nondiabetic
patients, often with other evidence of
autoimmune disease (e.g., Hashimoto’s
thyroiditis) or circulating autoantibodies.

123.  Hard, painless, irregularly contoured,
movable masses.
 Occur in men and women
 Present as a solitary mass or bilateral
disease, and recur in either breast.
 Recognition of the potential for recurrence
is important because it can spare patients
with documented diabetic mastopathy from
repeated breast biopsies.
 Mammography reveals dense tissue
suggestive of malignant change.

124.  Lymphocytic lobulitis
 lymphocytic vasculitis
 Dense keloid-like fibrosis
 Peculiar epithelioid cells embedded in dense
fibrous tissue.

125.  Predominance of B lymphocytes
 Expression of HLA-DR antigen in involved
lobular epithelium.
 Frequent presence of circulating
autoantibodies associated with HLA DR3,
DR4, DR5.
 Resemble benign lymphoepithelial lesions of
the salivary gland and in Hashimoto’s
thyroiditis.

126.  The epithelioid stromal cells in sclerosing
lymphocytic lobulitis can sometimes be so
prominent and abundant that the possibility of
an infiltrating carcinoma or granular cell tumor
is seriously considered.
 Ashton and colleagues reported that the stromal
cells have features of Myofibroblasts, reacting
with antiactin.
 These cells were negative for antibodies to
keratin (AE1/3), S-100 protein, desmin, MAC-
387, factor XIIIa, CD20 (L26), and CD45RO, but
they reacted with anti-CD68, suggesting some
lysosome formation.

129.  Often involves the superficial subcutaneous
tissue rather than the breast parenchyma
itself.
 A history of trauma can be elicited in about
half the cases, usually 1 to 2 weeks before
diagnosis.
 Cases of mammary fat necrosis have also
been reported after radiation therapy and
as a local manifestation of Weber-Christian
disease

130.  The disease can simulate carcinoma because
of skin retraction and the scirrhous (stellate
scarlike) nature of the reparative response.
 Traumatic fat necrosis shows variable and
irregular stellate fibrosis around areas of
necrotic, variably vacuolated fat, with
abundant admixed foamy macrophages.

142.  varicocele tumor, comedomastitis, periductal
mastitis, plasma cell mastitis, stale milk
mastitis, chemical mastitis, granulomatous
mastitis, and mastitis obliterans.

143.  The earliest lesions are characterised by the
accumulation of foamy macrophages
between the basement membrane and the
epithelium and also within duct lumens.
Later lesions show periductal chronic
inflammation whilst the most advanced
lesions show marked periductal scarring.
Superimposed (dystrophic) calcification may
be seen.

144.  Most cases occur in premenopausal parous
women, possibly caused by duct obstruction
or triggered by different components of
stagnant colostrum.
 It may produce retraction or inversion of the
nipple, and nipple discharge is present in
about 20% of cases

145.  There is ectasia of the large ducts, with
accumulation of detritus in the lumen and
fibrous thickening of the wall, which contains an
increased amount of elastic fibers.
 Calcification is common, producing tubular,
annular, and linear shadows on the mammogram.
 There is no epithelial hyperplasia or apocrine
metaplasia.
 If there is epithelial denudation, the luminal
material may escape from the duct, resulting in
a florid inflammatory reaction that is rich in
macrophages and plasma cells

146.  In advanced stages, fibrous obliteration of
the ducts can occur.
 Mammary duct ectasia is probably unrelated
to fibrocystic disease, but duct ectasia may
be related to breast abscess, which usually
results from the rupture of mammary ducts.
 Abscesses occur most often during lactation
but can also occur independently of it.
 Abscesses may be located deep within the
parenchyma or periareolar region.

147.  Microscopic examination shows a central
cavity filled with neutrophils and secretion
surrounded by inflamed and eventually
fibrotic breast parenchyma, with obliteration
of the lobular pattern.
 Clinically, a localized abscess may simulate
carcinoma.
 Periareolar abscess associated with squamous
metaplasia of lactiferous ducts is referred to
as Zuska’s disease.
 Squamous metaplasia of lactiferous ducts
requires surgical excision for cure

153.  Very uncommon in the breast
 May be identified incidentally in a patient
with systemic amyloidosis
 May very rarely present as a mass lesion -
amyloid tumour

154.  THANKS……