Date post: | 10-Jan-2017 |
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Non-neoplastic lesions of breast
Dr. Mangala G
LYMPHATIC DRAINAGE
AXILLARY (MOSTLY)
INTERNAL MAMMARY
SUPRACLAVICULAR
Anatomy of
Breast•Lobules•Acini•Lactiferous ducts •Lactiferous sinuses
Histology
• Lobe : (10 in whole breast)• Lobule : (many per lobe)• Acinus/I, Aka Alveolus/I : (Many Per
Lobule)• Duct(s) : INTRA- Or INTER- LOB(UL)AR,
leading to the lactiferous ducts in the nipple
L
O
B
E
LOBULE
One single ACINUS(alveolus)
Epithelial cells
MYO-epithelial cells
Three Normal Phases
• Active: about 50-50 Gland/Stroma ratio• Lactating: Mostly Glands (like thyroid!!!),
>>>50/50• Atrophic: mostly stroma, <<<50/50
At birth• Male and female breasts • Active secretion (transplacental
passage of maternal hormones) bilateral breast enlargement
• Colostrum-like secretion ("witch's milk")
• Recedes several months postpartum
Developmental abnormalitiesAplasia and hypoplasia
• Uncommon – associated with overdevelopment of the contralateral breast• Acquired (irradiation – chest wall tumors)• Unilateral or bilateral amastia (absence of a nipple, breast ducts, pectoralis major muscle) – Sex-linked recessive inheritance
Ectopic breast: Supernumerary breast (from ectopic breast tissue – along the milk lines (midaxillae – normal breasts – medial groin and vulva) • Unilateral axillary breast tissue
Polythelia• Areola and underlying mammary ducts
Aberrant Breast•Beyond the usual anatomic extent (no nipple or areola)
Clinical Presentation
Palpable lump Inflammatory mass Nipple discharge Non-palpable abnormality
Inflammation Acute Mastitis Most clinically important form of mastitis
Breast-feeding cracks/fissures in the nipples bacterial infection (esp. Staph. aureus)
Usually unilateral—acute inflammation in the breast can lead to abscess formation
Treatment = surgical drainage (often under general anesthesia) and antibiotics
Recurrent subareolar abscess. When squamous metaplasia extends deep into a duct, keratin becomes trapped and accumulates. If the duct ruptures, the ensuing intense inflammatory response to keratin results in an erythematous painful mass. A fistula tract may burrow beneath the smooth muscle of the nipple to open at the edge of the areola.
Mammary Duct Ectasia 5th and 6th decades Affects mainly large ducts Periductal chronic inflammation destruction and dilation of the ducts
with fibrosis The underlying cause is unknown
Ma Duct Ectasia Contd… Poorly defined periareolar mass; can be
confused clinically/radiologically with carcinoma
Can also present as a thick, cheesy nipple discharge +/- mass
Periductal fibrosis skin retraction
INFLAMMATION Fat Necrosis Uncommon lesion; may be a history of trauma, prior surgical intervention or
radiation therapy
Characterized by a central focus of necrotic fat cells with lipid-laden macrophages
and neutrophils
INFLAMMATION Chronic inflammation with lymphocytes and
multinucleated giant cells
Major clinical significance is its possible confusion with carcinoma (e.g. fibrosis clinically palpable mass / Ca2+ seen on mammography)
Fibrocystic Disease/Change
• Most common proliferative condition of the breast
• Non-neoplastic lesion• Important because it causes severe
periodic discomfort• One component –atypical
hyperplasia-high risk for cancer• Causes palpable lump-mimicking
cancer
Fibrosis + Cysts = Fibrocystic Disease
Terminology• Term fibrocystic change is preferred than
fibrocystic disease because some of the features are similar to physiological changes
• Terms fibroadenosis & epithelial hyperplasia – changes in 30-45years
• Cystic hyperplasia – changes from 40-45 years
Aetiopathogenesis
Hormonal imbalances
Excess estrogen
Responsiveness of breast tissue to
hormones(focal)
Clinical Features• Age group-30-55yrs
• Incidence-maximum just before menopause, decreases after menopause
• C/F vary with age & underlying pathology
• Gross Morphology:Younger age – Diffuse granularity in one /more segments of
breast - nodules upto 5mmTender,in premenstrual period Menopasual age - Ill defined rubbery mass discrete
swelling indicates cysts, if fibrosis +, lump is firm
Cyst, Gross
Cyst, Microscopic
FIBROCYSTIC CHANGE Contd…
• Histology:– Adenosis– Sclerosing adenosis– Epithelial hyperplasia– Papillomatosis– Cysts– Apocrine metaplasia– Fibrosis
Adenosis -• Increased number of acini/lobules (enlargement
of lobules)• Structurally normal• Lobular stroma increased
• Involves mainly epithelium,but myoepithelium may also be involved
• Correspond to grey-pink nodules on gross and fine nodules felt clinically
Epithelial hyperplasia• Proliferation of epithelial cells in
interlobular,intralobular ducts and acini -> solid mass obliterating lumen
Papillomatosis• Papillae lined by epithelial cells,projecting
into the lumens of dilated ducts/small cysts.• Have fibrovascular cores
Adenosis ↑ acini/lobule
Epithelial hyperplasia
Sclerosing Adenosis
Fibrocystic Changes- 1.Adenosis.2.Papilloma formation3.Epithelial hyperplasia.4.Small cysts
Sclerosing adenosisLobular proliferation
Epithelium involved, myoepithelium more involved
Increased collagen component in the tumour - mimic carcinomas clinically - calcification on mammogram
Cysts Dilatation of acini and terminal ducts Apocrine metaplasia Cysts lined by cells resembling
apocrine sweat glands-large columnar and deeply eosinophilic (pink cell metaplasia)
Fibrosis Related to hormonal imbalance changes in the loose connective tissue of
lobules,denser
Atypical hyperplasia Small ducts,may show abnormalities of
growth, disordered orientation,nuclear pleomorphism,mitotic figures