breast 1 Flashcards
What is the breast tissue comprised of?
epithelium (glands and ducts)
stroma (connective tissue and fibrofatty tissue)
Major ductal system originates in the nipple (6-10 lactiferous ducts)
What is in the mammary gland ?
10 lobes which contain lactiferous ducts and their branches and lobules aka glandular acini
Describe the TDLU in the mammary gland?
Terminal ductal lobular unit
consists of lobules, terminal branches of ducts , surrounding connective tissue
Where do most cancers arise from?
TDLU
Explain the histological aspect of the breast in regard to ducts and lobules
•Ducts and lobules- 2 cell layer thickness
–Superficial layer- epithelial cells
–Deep cell layer- myoepithelial cells
•Basement membrane separates the ducts, ductules and acini from the interlobular and intralobular connective tissue (stroma)
explain breast physiology
•At birth- Not fully formed
•Pre-pubertal
Branching ducts connected to nipple, no glandular component (=male breast)
•Post-pubertal
Terminal ducts give rise to lobules
Formation of interlobular connective tissue (fibrous and adipose tissue)
•Reproductive life- cyclic changes through menstrual cycle
Follicular phase- epithelial proliferation
Luteal phase- increases the number of acini, stroma- oedema
During menstruation- disappearance of stromal oedema, apoptosis and regression in the size of lobules
•Pregnancy and lactation
•Menopause- involution
define congenital abnormalities in breast
Supernumerary nipples/breasts
•Most common congenital anomaly
•Heterotropic glands along the milk line
•May be involved by a pathologic process (breast carcinoma occurring in the axilla)
how does breast disease present?
•Breast pain (mastalgia) •Palpable mass •Nipple discharge •Mammographic abnormality •Other presentations: –Skin-(peau d’orange)-oedema due to lymphatic obstruction –Nipple retraction
What are you looking for in a breast lump?
is it discrete or diffuse lumpiness? Solid vs cystic hard vs firm mobile vs fixed single vs multiple smooth vs irregular bilateral vs cyclical
When does one refer pt to further investigation ?
When lump remains after aspirate performed Family hx Lump a/w other symptoms new lump/new in pre-existing nodularity unresolving inflam persistent asymmetrical nodularity
Describe the clinical assessment of a breast lump
•History & examination
–Inspection and palpation
–Examination of the axilla
•Ultrasound
–Cysts, outlines mass lesions, young patients, guided bx
•Mammography
–Difficult in younger women (also with HRT) because breast tissue is more dense
•MRI (high sensitivity but low specificity)
–Image implants
–Staging of lobular ca if conservative surgery is indicated
–Evaluation of high risk patients
–Monitoring following neo adjuvant chemotherapy
•Pathology
What are the mammographic signs of malignancy?
•Densities •Calcifications –Small, irregular, clustered, linear or branching •Architectural distortion •Asymmetry
Classify diseases of the breast
Inflammatory condition (acute and chronic)
- acute mastitis
- mammary duct ectasia
- periductal mastitis
- fat necrosis
Benign tumours and fibrocystic changes
- Intraductal papilloma
- fibroadenoma
- phyllodes tumor
- fibrocystic change/disease
Malignant
carcinoma
What are examples of chronic inflammatory conditions of breast?
fat necrosis mammary duct ectasia periductal mastitis granulomatous mastitis lymphocytic mastitis
Define acute mastitis
typically associated w lactation
involves staph aureus and strep - staph more diffuse reaction than strep
essentially the nipple cracks during lactation providing leeway for these organisms to enter breast parenchyma
Presents as fever, erythema, pain
Treated w antibiotics (dicloxacillin) (Rarely perform surgical drainage)
Define Periductal mastitis
typically aw smoking .
Smoking causes Vit A deficiency and this causes squamous metaplasia of periductal cells. There is the secretion of keratin and this causes inflammation (chronic and granulomatous)
Presents with subareolar mass and nipple inversion
Tx with resection of involved duct
Define mammary duct ectasia
a/w 5th/6th decades of female life
Thick secretions in large ducts, which block these ducts and they spill into surrounding tissue/stroma- chronic inflam and granulomas
Seen as a periareolar mass and thick nipple discharge
can mimic carcinoma on mammogram
Define Fat necrosis
a/w trauma
seen typically in obese and post menopausal women
presents as necrotic parenchyma with fat laiden macrophages and foreign body giant cells
can mimic carcinoma on mammogram
Define lymphocytic and granulomatous mastitis
•Lymphocytic mastitis:
–Often associated with type I insulin dependent diabetes (diabetic mastopathy)
–palpable mass, usually subareolar, often bilateral
•Granulomatous mastitis
–Idiopathic or associated with systemic granulomatous disease (eg sarcoidosis)
Galactocoele definition
cystic dilatation of duct during LACTATION
can be come infected (seen in acute mastitis) w an abscess formation
Define fibrocystic changes
morphological elements that involve the glandular and stromal parts of the breast
cysts: dilatation of ducts - aprocrine metaplasia
fibrosis of stroma
adenosis also occurs -increase in no of acini per lobule
Above described the non prolierative changes
Proliferative changes include
- epitheliosis- epithelial hyperplasia (more than 2 layers in glands and duct) - shares some architectural and cytological features to CIS
- sclerosing lesions
- intraductal papilloma
Who does fibrocystic disease typically affect?
women 20-40
Cause of fibrocystic disease?
progestorone/oestrogen imbalance
Define sclerosing lesions
sclerosing adenosis- a/w increase in small ductules and acini and fibrosis of lobules radical scar/complex sclerosing lesion -hard and irregular -complex histology -larger -palpable mass
Can mimic carcinoma on radiology/histology
Define intraductal papilloma
benign papillary growth in the lactiferous duct
presents w bloody/serous nipple discharge
can recur if inadequately excised
Gynaecomastia
•Enlargement of the male breast
–Unilateral in 70%
–Oestrogen excess: cirrhosis, puberty, testicular tumours, treatment, idiopathic (older men)
–Drugs: Spironolactone, Chlorpromazine, Cimetidine, Androgens, alcohol, marijuana and heroin,
–Prolactin excess: pituitary-hypothalamus
Carcinoma of male breast a/w what gene?
BRCA 2 mutation - 10%
How does carcinoma of the male present?
presents as invasive carcinoma by the time of diagnosis
but this is a rare formation
usually occurs in OLDER men
