Breast

4,115 views

Published on

Published in: Health & Medicine
0 Comments
7 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
4,115
On SlideShare
0
From Embeds
0
Number of Embeds
9
Actions
Shares
0
Downloads
273
Comments
0
Likes
7
Embeds 0
No embeds

No notes for slide

Breast

  1. 1. Pathology of the breast <ul><li>normal anatomy </li></ul><ul><li>physiologic changes </li></ul><ul><li>developmental abnormalities </li></ul><ul><li>inflammations </li></ul><ul><li>fibrocystic changes </li></ul><ul><li>tumors </li></ul><ul><ul><li>benign </li></ul></ul><ul><ul><li>malignant </li></ul></ul><ul><li>pathology of the male breast </li></ul>
  2. 2. Normal anatomy <ul><li>before puberty – breasts in both sexes – ducts </li></ul><ul><li>variable degrees of branching, lack lobules </li></ul><ul><li>15 to 25 lactiferous ducts </li></ul><ul><li>start in the nipple – branch terminal ductal lobular unit (intralobular duct, multiple lobular ducts, ductules or acini + intralobular connective tissue) </li></ul><ul><li>hormonally responsive </li></ul>
  3. 3. Physiologic changes <ul><li>a t birth male and female breasts </li></ul><ul><li>active secretion ( transplacental passage of maternal hormones ) bilateral breast enlargement </li></ul><ul><li>colostrum - like secretion ( &quot;witch's milk&quot; ) </li></ul><ul><li>recedes several months postpartu m </li></ul><ul><li>after menopause – gradual and progressive involution (lobular atrophy, increased fat, cystic dilatation of ducts) </li></ul>
  4. 4. Physiologic changes <ul><li>Macromastia </li></ul><ul><li>diffuse enlargement of both breasts </li></ul><ul><li>adolescence or pregnancy </li></ul><ul><li>exaggerated response to hormonal stimulation </li></ul><ul><li>Pubertal (Virginal) Macromastia </li></ul><ul><li>1669 - 23-year-old woman - breasts enlarged &quot;overnight&quot; to a combined weight of 104 pounds </li></ul><ul><li>Pregnancy </li></ul><ul><li>1 in 100,000 pregnancies - erythematous, edematous, painful </li></ul>
  5. 5. Developmental abnormalities <ul><li>Aplasia and hypoplasia </li></ul><ul><li>uncommon – associated with overdevelopment of the contralateral breast </li></ul><ul><li>acquired ( irradiation – chest wall tumors ) </li></ul><ul><li>unilateral or bilateral amastia ( absence of a nipple , breast ducts, pectoralis major muscle) – sex-linked recessive inheritance </li></ul>
  6. 6. Developmental abnormalities <ul><li>Ectopic breast </li></ul><ul><li>s upernumerary b reast ( from ectopic breast tissue – along the milk lines ( midaxillae – normal breasts – medial groin and vulva ) </li></ul><ul><li>1 – 6 % of adult women , much less often in men </li></ul><ul><li>unilateral axillary breast tissue </li></ul><ul><li>Po lythelia </li></ul><ul><li>areola and underlying mammary ducts </li></ul><ul><li>Aberrant Breast </li></ul><ul><li>beyond the usual anatomic extent (no nipple or areola ) </li></ul>
  7. 7. Inflammatory and reactive conditions <ul><li>Fat necrosis </li></ul><ul><li>can simulate carcinoma clinically and mammographically </li></ul><ul><li>history of antecedent trauma, prior surgical intervention) </li></ul><ul><li>histiocytes with foamy cytoplasm </li></ul><ul><li>lipid–filled cysts </li></ul><ul><li>fibrosis, calcifications, egg shell on mammography </li></ul>
  8. 8. Inflammatory and reactive conditions <ul><li>Hemorrhagic necrosis with coagulopathy </li></ul><ul><li>Warfarin treatment – shortly after initiation </li></ul><ul><li>edema , hemorrhage , necrosis ( thrombi in small blood vessels ) </li></ul><ul><li>protein C deficiency </li></ul><ul><li>Breast augmentation </li></ul><ul><li>foreign materials ( shellac, glazier's putty, spun glass, epoxy resin, beeswax, and shredded silk , silicone ) </li></ul><ul><li>thin–walled silicone bag – capsule – disfigur ation </li></ul>
  9. 9. <ul><li>Puerperal mastitis </li></ul><ul><li>early stages (2 nd and 3 rd W) of lactation – 5% </li></ul><ul><li>stasis of milk in distended ducts + staphylococci </li></ul><ul><li>abscess formation (ATB, incision and drainage) </li></ul><ul><li>Granulomatous Lobular Mastitis </li></ul><ul><li>etiology unknown, suggests carcinoma </li></ul><ul><li>Mammary duct ectasia </li></ul><ul><li>periductal inflammation , duct sclerosis </li></ul><ul><li>intermittent nipple discharge </li></ul><ul><li>Tuberculosis </li></ul><ul><li>less developed regions - serious condition </li></ul><ul><li>lactating breast , innoculation via the lactiferous ducts </li></ul><ul><li>slowly growing, solitary, painless mass </li></ul>
  10. 10. Benign proliferative lesions <ul><li>pathologic spectrum of seemingly related clinically benign breast abnormalities </li></ul><ul><li>palpably irregular and painful breasts </li></ul><ul><li>discrete lumps, multiple nodules, cystically dilated ducts, apocrine metaplasia, interlobular and intralobular fibrosis </li></ul><ul><li>intraductal epithelial proliferation </li></ul><ul><li>fibrocystic disease , fibrocystic changes </li></ul><ul><li>extremely common (58% F) </li></ul>
  11. 11. Benign proliferative lesions <ul><li>Adenosis </li></ul><ul><li>elongation of the terminal ductules caricature of the lobule </li></ul><ul><li>sclerosing adenosis </li></ul><ul><li>apocrine adenosis </li></ul><ul><li>tubular adenosis </li></ul><ul><li>nonpalpable lesion, recognized in mammograms </li></ul><ul><li>microcalcifications ! </li></ul>
  12. 12. Benign tumors <ul><li>Fibroadenoma </li></ul><ul><li>proliferation of epithelial and stromal elements </li></ul><ul><li>most common breast tumor in adolescent and young adult women (peak age = third decade) </li></ul><ul><li>higher incidence in black patients </li></ul><ul><li>well-circumscribed, freely movable, nonpainful mass </li></ul><ul><li>regress with age if left untreated </li></ul><ul><li>ducts distorted elongated slit-like structures - intracanalicular pattern , ducts not compressed </li></ul><ul><li>pericanalicular growth pattern (little practical value) </li></ul>
  13. 13. <ul><li>Tubular adenoma </li></ul><ul><li>far less common than fibroadenomas </li></ul><ul><li>young women, discrete, freely movable masses </li></ul><ul><li>uniform sized ducts </li></ul><ul><li>Lactating Adenoma </li></ul><ul><li>enlarging masses during lactation or pregnancy </li></ul><ul><li>prominent secretory change </li></ul><ul><li>Intraductal papilloma </li></ul><ul><li>in the mammary ducts, subareolar lactiferous ducts </li></ul><ul><li>periductal inflammation , duct sclerosis </li></ul><ul><li>serous or bloody nipple discharge </li></ul><ul><li>fibrosis, infarction, squamous metaplasia </li></ul>
  14. 14. Cystosarcoma phyllodes ( phyllodes tumor) <ul><li>initial description - over 150 years ago - fleshy tumor, leaf-like pattern and cysts on cut surface </li></ul><ul><li>circumscribed, connective tissue and epithelial elements (× fibroadenomas = greater connective tissue cellularity), 1-15 cm </li></ul><ul><li>less than 1 % of breast tumors </li></ul><ul><li>benign, malignant </li></ul><ul><li>metastases are hematogenous </li></ul>low grade high grade
  15. 15. Proliferative changes <ul><li>ductal and lobular hyperplasia </li></ul><ul><li>atypical ductal and lobular hyperplasia </li></ul><ul><li>higher risk for the cancer than &quot;normal&quot; population </li></ul><ul><li>associated w. microcalcifications (!mammography!) </li></ul><ul><li>incidental histological finding </li></ul><ul><li>atypical hyperplasia = precancerous lesion </li></ul>
  16. 16. Breast carcinoma <ul><li>most frequent malignant tumor in females (followed by cervix and colon) </li></ul><ul><li>highest incidence – developed countries </li></ul><ul><li>(USA 84,8/100 000F/Y, Western Europe 64,7/100 000F/Y) </li></ul><ul><li>2 nd killer among cancers (1 st = lung ca) </li></ul><ul><li>risk factors: genetic predisposition (breast ca in close (1 st degree) relatives), proliferative changes, early menarche, late menopause, history of ca (breast, ovary, endometrium) </li></ul><ul><li>importance of preventive controls ! – early diagnosis better prognosis </li></ul>
  17. 17. Breast carcinoma - classification <ul><li>IN SITU </li></ul><ul><li>INVASIVE </li></ul><ul><li>DUCTAL </li></ul><ul><li>LOBULAR </li></ul>Ductal in situ (intraductal) Lobular in situ Ductal invasive Lobular invasive + other types (12)
  18. 18. Carcinoma in situ <ul><li>preinvasive - does not form a palpable tumor </li></ul><ul><li>not detected clinically (only X-ray – screening !!!) </li></ul><ul><li>multicentricity and bilaterality (namely LCIS) </li></ul><ul><li>continuum : bland hyperplasia - increasing atypism - carcinoma in situ </li></ul><ul><li>no metastatic spread (basement membrane) </li></ul><ul><li>risk of invasion depending on grade </li></ul>
  19. 19. Invasive carcinoma <ul><li>Invasive ductal carcinoma </li></ul><ul><li>largest group ( 65 to 80 % of mammary carcinomas ) </li></ul><ul><li>mid to late fifties </li></ul><ul><li>stellate , white, firm (desmoplasia) </li></ul><ul><li>less often circumscribed , soft (medullary ca) </li></ul><ul><li>hormonally dependent (estrogen, progesterone) </li></ul><ul><li>Invasive lobular carcinoma </li></ul><ul><li>uniform cells , infiltrative growth ( linear arrangement - indian file pattern) </li></ul>
  20. 20. Invasive carcinoma <ul><li>other types: tubular, mucinous, medullary, inflammatory – together about 10 % of breast ca </li></ul><ul><li>metastases: regional lymph nodes (axillary, parasternal), lungs, liver, bone marrow, brain </li></ul><ul><li>treatment: surgery (radical – mastectomy, breast conserving surgery – lumpectomy), </li></ul><ul><li>radiotherapy </li></ul><ul><li>antihormonal therapy (Tamoxifen) </li></ul><ul><li>chemotherapy </li></ul>
  21. 21. Paget‘s disease of the nipple <ul><li>result of intraepithelial spread of intraductal carcinoma </li></ul><ul><li>large pale-staining cells within the epidermis of the nipple </li></ul><ul><li>limited to the nipple or extend to the areola </li></ul><ul><li>pain or itching, scaling and redness , mistaken for eczema </li></ul><ul><li>ulceration, crusting, and serous or bloody discharge </li></ul>
  22. 22. Pathology of the male breast <ul><li>Gynecomastia </li></ul><ul><li>most common clinical and pathologic abnormality of the male breast </li></ul><ul><li>increase in subareolar tissue </li></ul><ul><li>in 30 to 40 percent of adult males , both breasts are affected in many cases </li></ul><ul><li>associated with hyperthyroidism, cirrhosis of the liver, chronic renal failure, chronic pulmonary disease, and hypogonadism, use of hormones - estrogens, androgens, and other drugs (digitalis, cimetidine, spironolactone, marihuana, and tricyclic antidepressants) </li></ul><ul><li>Carcinoma of the male breast </li></ul><ul><li>uncommon < 1 % of all breast cancers </li></ul>

×