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Breast Path
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Transcript of Breast Path
Pathology of the breast
Dr. Ann saparamadu
Normal breast • Duct lobular unit
Duct lobular unit
• lobule
Classification of breast disease1. Inflammatory disorders
- acute pyogenic mastitis- mammary ductectasia- fat necrosis
2. Benign proliferate breast diseases- fibrocystic change- benign tumours - Fibroadenoma
- duct papilloma - nipple adenoma3. Breast carcinoma
- malignant tumours4. Stromal tumours - phylloides tumours
Clinical features of breast diseases
• Lump mobile - fibroadenoma *
lumpiness - fibrocystic disease *
ill-defined soft- fibrocystic change *ill-defined firm -carcinoma
• Nipple discharge clear/blood stained
ductectasia
duct papilloma
carcinoma
• Nipple eczema - Paget’s disease *
- nipple adenoma
Inflammatory diseases1. Acute pyogenic mastitis
• Acute inflammatory lesion
• Usually in post partum period
• Staphylococcus aureus commonest
• Usually confined to a segment
• Streptococcus pyogenes - wide spread inflammation and systemic symptoms
• Leads to breast abscess
Inflammatory diseases
1. Fat necrosis
• Localized area of inflammation following trauma
• Necrosis fat cells induce inflammation and repair Fat necrosis
• Fibrosis in repair gives rise to firm irregular lump
• Mimics malignancy
Fat necrosis
• microscopy
Inflammatory diseases
3 Ductectasia
• Abnormal progressive dilatation of large breast ducts
• Destruction of periductal elastic tissue
• Accumulate secretory products and shed epithelium in the lumen
• Induces chronic inflammation and fibrosis
• Clinically - perimenopausal age, nipple dischargefirm ill defined lump mimics malignancy
• No risk of malignancy
Classification of breast disease1. Inflammatory disorders
- acute pyogenic mastitis- mammary ductectasia- fat necrosis
2. Benign proliferate breast diseases- fibrocystic change- benign tumours - Fibroadenoma
- duct papilloma - nipple adenoma3. Breast carcinoma
- malignant tumours4. Stromal tumours - phylloides tumours
Proliferative diseases
Fibrocystic disease(fibroadenosis)
• Most frequent disorder of the female breast
• Starts in early middle age, peaks at perimenopausal period and reduce in post menopausal period
• Manifest clinically in 10% but asymptomatic in 40%
Synonyms - Fibroadenosis, cystic mastopathy
chronic mastitis
Aetiology - poorly understood
- imbalance of oestrogen and progesterone
Fibrocystic change
Characterized by hyperplastic overgrowth of components of the mammary units
• Epithelial overgrowth
- increase acini – adenosis
- epithelial proliferation
- papillomatosis
• Fibrous overgrowth ( specialized hormone responsive breast supporting stroma)
- fibrosis
Fibrocystic change
Depends on the underlying pathology
adenosis
epithelial hyperplasia
paillomatosis
apocrine metaplasia
sclerosing adenosis
cysts
fibrosis
Fibrocystic change
Fibrocystic change
• Clinical importance
many women have periodic discomfort
anxiety due to lump/ lumpiness
clinically mimics a carcinoma
One component, epithelial hyperplasia leads has a higher risk of malignancy
Epithelial hyperplasia
Gynaecomastia
• Normally male breast has only ducts
• Common proliferative disorder of the male breast
• Clinically firm mobile disc beneath the nipple
• Common in adolescents and old age
• De3pends on oestrogen
hyperthyroidism, pituitary disorders, tumours of the testis and adrenals, stilbestrol therapy, Klinfelter’s cirrhosis, drugs
Gynaecomastia
• micro
Benign tumours1 Fibroadenoma
• Commonest type of benign tumour
• Common in young
• Peak in the third decade
• Solitary / Multiple
• Arise from breast lobule
Fibroadenoma
• micro
Benign tumours
2. Duct papilloma
• Middle aged women
• Blood stained discharge
• Usually a solitary lesion
• Less common
Duct papilloma
• micro