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Non neoplastic breast diseases - Handout
- 1. NON-NEOPLASTIC BREAST DISEASES (Dr. Usman Shams) ACUTE MASTITIS • Description Bacterial infection of the breast, usually due to staph AUREUS. • Etiology Breast-feeding…fissures develop in the nipple, which provides a route of entry. • Presentation Warm erythematous breast with purulent nipple discharge…may progress to abscess. • Treatment Continued drainage (keep feeding the infant) and antibiotics. PERIDUCTAL MASTITIS • Description Inflammation of the SUBAREOLAR DUCTS. • Association Usually seen in smokers. • Presentation SUBAREOLAR mass with nipple retraction…from fibrosis and myofibroblast action. • Etiology Vitamin A deficiency…epithelium of the duct becomes squamous…keratin plug… infection…inflammation. DUCT ECTASIA • Description Inflammation with dilation (ECTASIA) of the SUBAREOLAR ducts. • Epidemiology RARE, classically arises in multiparous postmenopausal women. • Presentation PARIAREOLAR mass with GREEN-BROWN NIPPLE DISCHARGE (inflammatory debris). • Microscopy Chronic inflammation with PLASMA CELLS. FAT NECROSIS • Description Necrosis of breast fat. • Etiology Trauma • Presentation Presents as a mass on examination or an abnormal calcification on mammogram (due to saponification). • Microscopy Necrotic fat with associated calcifications and giant cells. FIBROCYSTIC CHANGE OF THE BREAST • Description Development of fibrosis and cysts in the breast. • Epidemiology Most common change in the premenopausal breast, thought to be hormone mediated. • Presentation Vague irregularity of the breast tissue (“lumpy breast”), usually in the upper outer quadrant. • Gross Cysts have a blue dome appearance on gross. • Association a. Fibrosis, cysts, and apocrine metaplasia…no increased risk. b. Ductal hyperplasia and sclerosing adenosis (fibrosis and increase in the number of glands in the lobule and often calcified)…2x increased risk for invasive carcinoma bilaterally. c. Atypical hyperplasia…5x increased risk for invasive carcinoma bilaterally. INTRADUCTAL PAPILLOMA • Description Papillary growth, usually into a large duct. • Microscopy Characterized by FIBROVASCULAR projections lined by epithelial (luminal) and MYOEPITHELIAL cells. • Presentation Classically presents as bloody nipple discharge in a premenopausal woman. • Distinguish Must be distinguished from papillary carcinoma, which also presents as bloody nipple discharge.