Benign conditions of the breast Flashcards
Describe the layers of the glandular tissue and ducts
- 2 layers
- Inner luminal layer (that secretes milk)
- Outer myoepithelial layer (that is contractile under oxytocin and allows for the mobilisation of milk)
State the developmental abnormalities of the breast
- Ectopic breast tissue
- Breast hypoplasia
- Stromal overgrowth (juvenile hypertrophy and gestational hypertrophy)
- Breast assymetry
- Nipple inversion
What is stromal overgrowth
- Leads to excessive breast size
- Can be uncomfortable and cause body image issues
- Can occur during puberty (juvenile hypertrophy) or during pregnancy (gestational hypertrophy)
Why can stromal overgrowth be difficult to manage?
Because if you do a breast reduction the process may continue so the breast grows in size again
Nipple inversion
- Common and most likely normal if not new
* If it is new and/or unilateral then it is more likely to be associated with a benign or malignant condition
What is acute mastitis?
A cellulitis associated with breast feeding
How does acute mastitis occur?
- Skin fissuring from breast feeding
- May let bacteria in
- Milk stasis favours the growth of the bacteria
- Infection of the breast tissue
- May be abscess
How is acute mastitis treated?
If there is an abscess then incision and drainage, and antibiotics
When can granulomatous inflammation of the breast tissue occur?
In systemic diseases
•Sarcoidosis
•Tuberculosis (rare)
What is idiopathic granulomatous mastitis?
Lobule centred non-necrotising granulomatous inflammatory process with a tendency to reoccur after incision (it may respond to steroids but need to be sure it isn’t an infection)
Foreign body reactions in the breast
- Foreign body reactions can arise to breast implants
- Can lead to capsular contractures causing discomfort and distortion of the breast
- Reactions can occur to silicone leakage after implant rupture
what is recurrent subareolar abscess associated with?
- Mamillary fistula
- Squamous metaplasia of lactiferous ducts
- Smoking
What is periductal mastitis?
- Dilation of the central lactiferous ducts
- Periductal chronic inflammation
- Scarring
What are the signs of periductal mastitis?
- Often asymptomatic
- A mass
- Nipple retraction or inversion
- Discomfort
- Calcified luminal secretions on a mammogram
when is periductal mastitis most common?
In middle age
What is periductal mastitis associated with?
Smoking
What is fat necrosis?
Follows trauma, is benign but a core biopsy may be required to rule out cancer
What is fibrocystic change?
- Spectrum of change
- Small/ large cysts, increased amounts of glandular tissue
- increased fibrous stroma
- epithelial hyperplasia of usual type or with atypia
- solitary papillomas, papillomatosis and radial scars are also part of the wider spectrum of fibrocystic change
Describe the risk of cancer with fibrocystic change
- non proliferative = no excess risk of subsequent breast cancer
- proliferative without atypia = 2-fold excess risk of breast cancer
- Proliferative with atypia = 5 fold risk, or more if positive family history
What is adenosis in the breast?
Increase in the glandular breast cancer
What is sclerosis adenosis?
Benign proliferation of the distorted glandular tissue and stroma
How is apocrine metaplasia recognised?
- Large, rounded epithelial cells
- Copious, granular eosinophilic cytoplasm
- Characteristic apical projections
How is apocrine metaplasia recognised?
- Large, rounded epithelial cells
- Copious, granular eosinophilic cytoplasm
- Characteristic apical projections
What is apocrine metaplasia associated with?
Fibrocystic change
What are the differences between atypical lobular hyperplasia and lobular carcinoma?
The extent and the amount of cellular proliferation
What are radial scars?
Benign lesions characterised by a fibrotic core with elastic fibres, trapped glands and a pseudo-infiltrative appearance
What is an intraduct papilloma?
Benign tumour of the epithelium lining in the mammary ducts
What are the different patterns of epithelial hyperplasia?
- Ductal
* Lobular
What is atypical ductal hyperplasia?
- Features in common with low grade ductal carcinoma in situ
- Associated with micro calcifications
When are columnar cell lesions detected?
- Mammography
* Associated with microcalcifications
Describe diabetic fibrous mastopathy
- Stromal fibrosis with infiltrating lymphocytes, may present with a hard mass
- Associated with type 1 diabetes
What is pseudo-angiomatous stromal hyperplasia?
Proliferation of myofibroblasts may cause a mass
Phyllodes tumour
- Epithelium and mesenchyme
- Cellular stroma with mitotic activity, cytological atypia and an infiltrative border
- Requires surgical excision with a margin of normal breast tissue
What benign condition can mimic paget’s disease?
Nipple adenoma
