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PATH 728Chapter 19

DISEASES OF THE BREAST

DISEASES OF THE BREASTSee Figure 19-23regarding breast lumps.Fibrocystic change: FC the most common cause of breast diseases. Found in 60-80% offemale breasts at autopsy. Contraceptives seem to decrease the risk of FC. Probably related toexaggerations is response to menstrual cycle. Small risk of malignant transformation. Sincethey occur as a palpable mass, the big concern is differentiating these from carcinoma.

There are 2 types:

1. Nonproliferative fibrocystic change:The most common form. There is increased fibrous stroma and dilation of gland ducts leadingto cyst formation. Contents of cysts may calcify and become visible on mammmograms.

2. Proliferative fibrocystic change:

Here, there is proliferation of ductal epithelium. These proliferative changes span the spectrumfrom nothing to worry about to those that carry a risk of malignancy. When no atypia to theproliferating epithelium is seen the increased risk of developing carcinoma is 1-2x normal.

With atypia the increased risk is 5x normal.

The only reliable way to differentiate fibrocystic change from carcinoma is via biopsy.

Tumors of the Breast: The most common breast neoplasms are of epithelial origin. Thereare benign and malignant vatieties.

Fibroadenoma: The most common benign tumor of the breast. Absolute or relativeestrogen increase thought to be a big factor. Occur in younger women (age 30 peak age).May regress after menopause. Malignant transformation uncommon. Detected as freelymovable, solitary nodules.

Intraductal papilloma: Solitary lesion dont usually undergo malignanttransformation.

Carcinoma: Second only to lung cancer as the leading cause of cancer death inwomen. Risk factorsinclude geography (North American > Asia), age (over age 50,a breast mass is most likely to be cancer), genes(BRCA-1 gene carries an 80% risk of

breast cancer by age 65 years), history(nulliparity, preexisting breast disease, andmaternal or sib history of breast cancer [ soft factors include smoking, obesity andalcohol abuse])

Morphology: Half of breast cancers occur in upper outer quadrantof the breast,20% in central area and the rest divided into the other segments. 90% breastcarcinomas are from duct epithelial origin.

Growth pattern: There are 2 groups-- noninvasive( mostly intraductal lesions)and invasive(infiltrating). Ductal carcinomas that have invaded account for 70% of allbreast Ca.

Clinical features: retraction or dimpling of the skin, lymphedema, peaudorange, and calcification on mammography (80%).

Prognosis: the 2 extremesInvasive lesions less than 2cm. and no positive nodes have an 87% 5 yr. survival.

When distant metastases have occurred, 5 yr. survival is 13%.

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MALE BREAST

Gynecomastia: may be from a variety of estrogen sources (tumors, digitalis, old age andobesity.

Carcinoma: while uncommon in males (1:125 ratio) they behave badly (50% havewidespread mets at the time of diagnosis).