breast pathology presentation

Июль 30, 2022

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breast pathology presentation

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2. Pathology of the breast normal anatomy physiologic changes developmental abnormalities inflammations fibrocystic changes tumors benign malignant
3. Normal anatomy before puberty – breasts in both sexes – ducts variable degrees of branching, lack
4. Physiologic changes at birth male and female breasts active secretion (transplacental passage of maternal hormones) bilateral
5. Macromastia diffuse enlargement of both breasts adolescence or pregnancy exaggerated response to hormonal stimulation Pubertal (Virginal)
6. Developmental abnormalities Aplasia and hypoplasia uncommon – associated with overdevelopment of the contralateral breast acquired (irradiation
8. Ectopic breast supernumerary breast (from ectopic breast tissue – along the milk lines (midaxillae – normal
10. Inflammatory and reactive conditions Fat necrosis can simulate carcinoma clinically and mammographically history of antecedent trauma,
11. Inflammatory and reactive conditions Hemorrhagic necrosis with coagulopathy Warfarin treatment – shortly after initiation edema, hemorrhage,
12. Puerperal mastitis early stages (2nd and 3rd W) of lactation – 5% stasis of milk in
14. Benign proliferative lesions pathologic spectrum of seemingly related clinically benign breast abnormalities palpably irregular and painful
15. Benign proliferative lesions Adenosis elongation of the terminal ductules caricature of the lobule sclerosing adenosis apocrine
16. Benign tumors Fibroadenoma proliferation of epithelial and stromal elements most common breast tumor in adolescent and
17. Tubular adenoma far less common than fibroadenomas young women, discrete, freely movable masses uniform sized ducts
19. Cystosarcoma phyllodes (phyllodes tumor) initial description - over 150 years ago - fleshy tumor, leaf-like pattern
22. Proliferative changes ductal and lobular hyperplasia atypical ductal and lobular hyperplasia higher risk for the cancer
23. Breast carcinoma most frequent malignant tumor in females (followed by cervix and colon) highest incidence –
24. Breast carcinoma - classification IN SITU INVASIVE DUCTAL LOBULAR Ductal in situ (intraductal) Lobular in situ
25. Carcinoma in situ preinvasive - does not form a palpable tumor not detected clinically (only X-ray
26. Invasive carcinoma Invasive ductal carcinoma largest group (65 to 80 % of mammary carcinomas) mid to
27. other types: tubular, mucinous, medullary, inflammatory – together about 10 % of breast ca metastases: regional
28. Paget‘s disease of the nipple result of intraepithelial spread of intraductal carcinoma large pale-staining cells within
29. Paget’s disease
30. PAGET’S DISEASE OF NIPPLE Rare manifestation of breast CA. U/l erythematous eruption, Pruritus. Malignant cells/PAGET CELLS
31. Pathology of the male breast Gynecomastia most common clinical and pathologic abnormality of the male breast
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Pathology of the breast
normal anatomy
physiologic changes
developmental abnormalities

inflammations
fibrocystic changes
tumors
benign
malignant
pathology of the male breast

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Normal anatomy
before puberty – breasts in both sexes – ducts

variable degrees of branching, lack lobules
15 to 25 lactiferous ducts
start in the nipple – branch terminal ductal lobular unit (intralobular duct, multiple lobular ducts, ductules or acini + intralobular connective tissue)
hormonally responsive

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Physiologic changes
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
after menopause – gradual and progressive involution (lobular atrophy, increased fat, cystic dilatation of ducts)

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Macromastia
diffuse enlargement of both breasts
adolescence or pregnancy

exaggerated response to hormonal stimulation
Pubertal (Virginal) Macromastia
1669 - 23-year-old woman - breasts enlarged "overnight" to a combined weight of 104 pounds
Pregnancy
1 in 100,000 pregnancies - erythematous, edematous, painful

Physiologic changes

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Developmental abnormalities
Aplasia 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)
1 – 6 % of adult women, much less often in men
unilateral axillary breast tissue
Polythelia
areola and underlying mammary ducts
Aberrant Breast
beyond the usual anatomic extent (no nipple or areola)

Developmental abnormalities

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Inflammatory and reactive conditions
Fat necrosis
can simulate carcinoma clinically and

mammographically
history of antecedent trauma, prior surgical intervention)
histiocytes with foamy cytoplasm
lipid–filled cysts
fibrosis, calcifications, egg shell on mammography

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Inflammatory and reactive conditions
Hemorrhagic necrosis with coagulopathy
Warfarin treatment – shortly

after initiation
edema, hemorrhage, necrosis (thrombi in small blood vessels )
protein C deficiency
Breast augmentation
foreign materials (shellac, glazier's putty, spun glass, epoxy resin, beeswax, and shredded silk, silicone)
thin–walled silicone bag – capsule – disfiguration

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Puerperal mastitis
early stages (2nd and 3rd W) of lactation

– 5%
stasis of milk in distended ducts + staphylococci
abscess formation (ATB, incision and drainage)
Granulomatous Lobular Mastitis
etiology unknown, suggests carcinoma
Mammary duct ectasia
periductal inflammation, duct sclerosis
intermittent nipple discharge
Tuberculosis
less developed regions - serious condition
lactating breast, innoculation via the lactiferous ducts
slowly growing, solitary, painless mass

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Benign proliferative lesions
pathologic spectrum of seemingly related clinically benign breast

abnormalities
palpably irregular and painful breasts
discrete lumps, multiple nodules, cystically dilated ducts, apocrine metaplasia, interlobular and intralobular fibrosis
intraductal epithelial proliferation
fibrocystic disease, fibrocystic changes
extremely common (58% F)

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Benign proliferative lesions
Adenosis
elongation of the terminal ductules caricature of

the lobule
sclerosing adenosis
apocrine adenosis
tubular adenosis
nonpalpable lesion, recognized in mammograms
microcalcifications!

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Benign tumors
Fibroadenoma
proliferation of epithelial and stromal elements
most common breast

tumor in adolescent and young adult women (peak age = third decade)
higher incidence in black patients
well-circumscribed, freely movable, nonpainful mass
regress with age if left untreated
ducts distorted elongated slit-like structures - intracanalicular pattern, ducts not compressed
pericanalicular growth pattern (little practical value)

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Tubular adenoma
far less common than fibroadenomas
young women, discrete, freely

movable masses
uniform sized ducts
Lactating Adenoma
enlarging masses during lactation or pregnancy
prominent secretory change
Intraductal papilloma
in the mammary ducts, subareolar lactiferous ducts
periductal inflammation, duct sclerosis
serous or bloody nipple discharge
fibrosis, infarction, squamous metaplasia

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Cystosarcoma phyllodes (phyllodes tumor)
initial description - over 150 years ago -

fleshy tumor, leaf-like pattern and cysts on cut surface
circumscribed, connective tissue and epithelial elements (× fibroadenomas = greater connective tissue cellularity), 1-15 cm
less than 1 % of breast tumors
benign, malignant
metastases are hematogenous

low grade
high grade

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Proliferative changes
ductal and lobular hyperplasia
atypical ductal and lobular hyperplasia

higher risk for the cancer than "normal" population
associated w. microcalcifications (!mammography!)
incidental histological finding
atypical hyperplasia = precancerous lesion

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Breast carcinoma
most frequent malignant tumor in females (followed by cervix

and colon)
highest incidence – developed countries
(USA 84,8/100 000F/Y, Western Europe 64,7/100 000F/Y)
2nd killer among cancers (1st = lung ca)
risk factors: genetic predisposition (breast ca in close (1st degree) relatives), proliferative changes, early menarche, late menopause, history of ca (breast, ovary, endometrium)
importance of preventive controls! – early diagnosis better prognosis

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Breast carcinoma - classification
IN SITU
INVASIVE
DUCTAL
LOBULAR
Ductal in situ (intraductal)
Lobular

in situ

Ductal invasive

Lobular invasive

+ other types (12)

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Carcinoma in situ
preinvasive - does not form a palpable tumor

not detected clinically (only X-ray – screening !!!)
multicentricity and bilaterality (namely LCIS)
continuum: bland hyperplasia - increasing atypism - carcinoma in situ
no metastatic spread (basement membrane)
risk of invasion depending on grade

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Invasive carcinoma
Invasive ductal carcinoma
largest group (65 to 80 % of

mammary carcinomas)
mid to late fifties
stellate, white, firm (desmoplasia)
less often circumscribed, soft (medullary ca)
hormonally dependent (estrogen, progesterone)
Invasive lobular carcinoma
uniform cells, infiltrative growth (linear arrangement - indian file pattern)

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other types: tubular, mucinous, medullary, inflammatory – together about 10

% of breast ca
metastases: regional lymph nodes (axillary, parasternal), lungs, liver, bone marrow, brain
treatment: surgery (radical – mastectomy, breast conserving surgery – lumpectomy),
radiotherapy
antihormonal therapy (Tamoxifen)
chemotherapy

Invasive carcinoma

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Paget‘s disease of the nipple
result of intraepithelial spread of intraductal

carcinoma
large pale-staining cells within the epidermis of the nipple
limited to the nipple or extend to the areola
pain or itching, scaling and redness, mistaken for eczema
ulceration, crusting, and serous or bloody discharge

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Paget’s disease

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PAGET’S DISEASE OF NIPPLE
Rare manifestation of breast CA.
U/l erythematous eruption, Pruritus.
Malignant

cells/PAGET CELLS ? Extend from DCIS within ductal system – via lactiferous sinuses ? nipple skin without crossing the BM.
Tumour cells – disrupt tight squamous epithelial barrier – ECF seeps out onto nipple surface ? oozing scaly crust.
Paget’s cells – detected by nipple Bx/cytological preparation of the exudate.
Palpable mass ? 50 – 60 % of women => invasive CA.
No palpable mass => DCIS
Poorly differentiated, ER Negative, HER2/neu overexp.
Prognosis – depends on features of underlying Ca.

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Pathology of the male breast
Gynecomastia
most common clinical and pathologic abnormality

of the male breast
increase in subareolar tissue
in 30 to 40 percent of adult males, both breasts are affected in many cases
associated with hyperthyroidism, cirrhosis of the liver, chronic renal failure, chronic pulmonary disease, and hypogonadism, use of hormones - estrogens, androgens, and other drugs (digitalis, cimetidine, spironolactone, marihuana, and tricyclic antidepressants)
Carcinoma of the male breast
uncommon < 1 % of all breast cancers

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breast pathology presentation

Содержание

Pathology of the breast normal anatomy physiologic changes developmental abnormalities

Normal anatomy before puberty – breasts in both sexes – ducts

Physiologic changes at birth male and female breasts active secretion (transplacental

Macromastia diffuse enlargement of both breasts adolescence or pregnancy

Developmental abnormalities Aplasia and hypoplasia uncommon – associated with overdevelopment of

Ectopic breast supernumerary breast (from ectopic breast tissue – along the

Inflammatory and reactive conditions Fat necrosis can simulate carcinoma clinically and

Inflammatory and reactive conditionsHemorrhagic necrosis with coagulopathy Warfarin treatment – shortly

Puerperal mastitis early stages (2nd and 3rd W) of lactation

Benign proliferative lesions pathologic spectrum of seemingly related clinically benign breast

Benign proliferative lesions Adenosis elongation of the terminal ductules caricature of

Benign tumorsFibroadenoma proliferation of epithelial and stromal elements most common breast

Tubular adenoma far less common than fibroadenomas young women, discrete, freely

Cystosarcoma phyllodes (phyllodes tumor) initial description - over 150 years ago -

Proliferative changes ductal and lobular hyperplasia atypical ductal and lobular hyperplasia

Breast carcinoma most frequent malignant tumor in females (followed by cervix

Breast carcinoma - classification IN SITUINVASIVE DUCTALLOBULAR Ductal in situ (intraductal)Lobular

Carcinoma in situ preinvasive - does not form a palpable tumor

Invasive carcinomaInvasive ductal carcinoma largest group (65 to 80 % of