Non neoplastic lesions of breast dr. mangala 14-9-2016
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Transcript of Non neoplastic lesions of breast dr. mangala 14-9-2016
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Non-neoplastic lesions of breast
Dr. Mangala G
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LYMPHATIC DRAINAGE
AXILLARY (MOSTLY)
INTERNAL MAMMARY
SUPRACLAVICULAR
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Anatomy of
Breast•Lobules•Acini•Lactiferous ducts •Lactiferous sinuses
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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
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L
O
B
E
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LOBULE
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One single ACINUS(alveolus)
Epithelial cells
MYO-epithelial cells
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Three Normal Phases
• Active: about 50-50 Gland/Stroma ratio• Lactating: Mostly Glands (like thyroid!!!),
>>>50/50• Atrophic: mostly stroma, <<<50/50
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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
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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
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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)
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Clinical Presentation
Palpable lump Inflammatory mass Nipple discharge Non-palpable abnormality
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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
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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.
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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
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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
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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
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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)
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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
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Fibrosis + Cysts = Fibrocystic Disease
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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
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Aetiopathogenesis
Hormonal imbalances
Excess estrogen
Responsiveness of breast tissue to
hormones(focal)
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Clinical Features• Age group-30-55yrs
• Incidence-maximum just before menopause, decreases after menopause
• C/F vary with age & underlying pathology
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• 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
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Cyst, Gross
Cyst, Microscopic
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FIBROCYSTIC CHANGE Contd…
• Histology:– Adenosis– Sclerosing adenosis– Epithelial hyperplasia– Papillomatosis– Cysts– Apocrine metaplasia– Fibrosis
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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
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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
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Adenosis ↑ acini/lobule
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Epithelial hyperplasia
Sclerosing Adenosis
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Fibrocystic Changes- 1.Adenosis.2.Papilloma formation3.Epithelial hyperplasia.4.Small cysts
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Sclerosing adenosisLobular proliferation
Epithelium involved, myoepithelium more involved
Increased collagen component in the tumour - mimic carcinomas clinically - calcification on mammogram
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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)
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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