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
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
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)
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