This document discusses several non-neoplastic breast conditions including inflammations like acute mastitis, granulomatous mastitis, mammary duct ectasia, fat necrosis, and galactocele. It also covers fibrocystic changes including proliferative conditions like epithelial hyperplasia and sclerosing adenosis. Gynecomastia in males is also mentioned. Histopathology images are provided to illustrate duct ectasia, epithelial hyperplasia, apocrine cysts, and intraductal papilloma.

1. BREAST - 1
DR. ROOPAM JAIN
PROFESSOR & HEAD, PATHOLOGY

3. B, Normal terminal
duct-lobular unit
(TDLU).
C, SMA-100
immunostain for
myoepithelium

6. NON-
NEOPLASTIC
CONDITIONS

7. NON-NEOPLASTIC CONDITIONS
INFLAMMATIONS
ACUTE MASTITIS AND BREAST ABSCESS
• Acute pyogenic infection of the breast occurs chiefly during the
first few weeks of lactation.
• Bacteria such as staphylococci and streptococci.
• Initially a localised area of acute inflammation
• may cause single or multiple breast abscesses.
• Extensive necrosis and replacement by fibrous scarring

8. NON-NEOPLASTIC CONDITIONS
INFLAMMATIONS
GRANULOMATOUS MASTITIS
• 1. Systemic non-infectious granulomatous
• 2. Infections e.g. tuberculosis
• 3. Silicone breast implants
• 4. Idiopathic granulomatous mastitis

9. Squamous Metaplasia of
Lactiferous Ducts
• Squamous metaplasia of lactiferous ducts is known by a variety of
names, including recurrent subareolar abscess, periductal mastitis, and
Zuska disease.
• Women, and sometimes men, present with a painful erythematous
subareolar mass that clinically appears to be a bacterial abscess.
• In recurrent cases, a characteristic fistula tract often tunnels under the
smooth muscle of the nipple and opens onto the areola.
• The key feature is keratinizing squamous metaplasia of the nipple ducts

11. INFLAMMATIONS
MAMMARY DUCT ECTASIA
(PLASMA CELL MASTITIS)
• Duct ectasia presents as a palpable periareolar mass
• often associated with thick, white nipple secretions and occasionally
with skin retraction.
• Pain and erythema are uncommon.
• This disorder tends to occur in the fifth or sixth decade of life,
• usually in multiparous women.

12. • Patients present with a poorly defined palpable
periareolar mass, sometimes with skin retraction, often
accompanied by thick, white nipple secretions.
• This lesion is characterized chiefly by dilation of ducts,
inspissation of breast secretions, and a marked
periductal and interstitial chronic granulomatous
inflammatory reaction

13. Duct ectasia
Chronic inflammation and fibrosis surround an ectatic duct filled
with inspissated debris.
The fibrotic response can produce a firm irregular mass that mimics
invasive carcinoma on palpation or mammogram.

14. FAT NECROSIS
• generally initiated by trauma.
• The condition presents as a well-defined mass with indurated
appearance.

15. GALACTOCELE
• A galactocele is cystic dilatation of one or more ducts occurring during
lactation.
• ]
• The mammary duct is obstructed and dilated to form a thin-walled cyst
filled with milky fluid.
• Rarely, the wall of galactocele may get secondarily infected.

16. FIBROCYSTIC CHANGE
• Fibrocystic change is the most common benign breast condition
• Its incidence has been reported to range from 10-20% in adult women,
• most often between 3rd and 5th decades of life,
• dramatic decline in its incidence after menopause suggesting the role of
oestrogen in its pathogenesis.
• fibrocystic change of the female breast is characterised by :
• i) Cystic dilatation of terminal ducts.
• ii) Relative increase in inter- and intralobular fibrous tissue.
• iii) Variable degree of epithelial proliferation in the terminal ducts

17. FIBROCYSTIC CHANGE
A. NONPROLIFERATIVE FIBROCYSTIC CHANGES:
SIMPLE FIBROCYSTIC CHANGE
• Simple fibrocystic change most commonly includes 2 features—
formation of cysts of varying size, and increase in fibrous stroma.
• Cysts are formed by dilatation of obstructed collecting ducts,
• obstruction being caused by periductal fibrosis following inflammation
or fibrous overgrowth from oestrogen stimulation.

18. Simple fibrocystic change.
A, Diagrammatic view. It shows cystic dilatation of ducts and increase
in fibrous stroma. There is mild epithelial hyperplasia in terminal
ducts.
B, Non-proliferative fibrocystic changes—fibrosis, cyst formation,

19. FIBROCYSTIC CHANGE
B. PROLIFERATIVE FIBROCYSTIC CHANGES: EPITHELIAL
HYPERPLASIA AND SCLEROSING ADENOSIS
• Proliferative fibrocystic change in the breasts includes 2 entities:
• epithelial hyperplasia
• sclerosing adenosis.

20. FIBROCYSTIC CHANGE
B. PROLIFERATIVE FIBROCYSTIC CHANGES: EPITHELIAL
HYPERPLASIA AND SCLEROSING ADENOSIS
Epithelial hyperplasia
• epitheliosis is defined as increase in the layers of epithelial cells over
the basement membrane to three or more layers in the ducts
(ductal hyperplasia) or lobules (lobular hyperplasia).

21. FIBROCYSTIC CHANGE
B. PROLIFERATIVE FIBROCYSTIC CHANGES: EPITHELIAL
HYPERPLASIA AND SCLEROSING ADENOSIS
sclerosing adenosis
• Sclerosing adenosis is benign proliferation of small ductules or acini
and intralobular fibrosis.

22. C, Proliferative
fibrocystic changes
showing moderate
epithelial hyperplasia.

23. A, A normal duct or acinus with a single basally located
myoepithelial cell layer (cells with dark, compact nuclei and scant
cytoplasm) and a single luminal cell layer (cells with larger open
nuclei, small nucleoli, and more abundant cytoplasm).
B, Epithelial hyperplasia. The lumen is filled by a heterogeneous,
mixed population of luminal and myoepithelial cell types. Irregular
slitlike fenestrations are prominent at the periphery

24. GYNAECOMASTIA
(HYPERTROPHY OF MALE BREAST)
• Unilateral or bilateral enlargement of the male breast is known as
gynaecomastia.
• Since the male breast does not contain secretory lobules, the
enlargement is mainly due to proliferation of ducts and increased
periductal stroma.
• Gynaecomastia occurs in response to hormonal stimulation, mainly
oestrogen.

27. Apocrine cysts
A, Clustered, rounded
calcifications are seen in a
specimen radiograph.
B, Gross appearance of
typical cysts filled with dark,
turbid fluid contents.
C, Cysts are lined by
apocrine cells with round
nuclei and abundant
granular cytoplasm. Note the
luminal calcifications.

28. Intraductal
papilloma
A central fibrovascular core extends from the wall of a duct.
The papillae arborize within the lumen and are lined by myoepithelial
& luminal cells.