Non-neoplastic Breast Diseases Flashcards
Introduction anatomy of the breast
Consists of 15-25 lobes to secrete nutritive milk (in the inner luminal epithelial cells)
- each lobe is separated by dense CT and adipose tissues
- contain ducts that reach nipple to secrete the milk
Functional unit of the breast is the lobule which is supported by intralobular stroma
What are the most predominant breast specific symptoms/signs of disease
Pain , nipple discharge, “lumpiness”/palpable mass that can be painless
While still not highly correlated, nipple discharge is the most correlated symptom of breast cancer
Most common = lumpiness or masses
-95% are benign but all require a work up since some cancers can actually mimic benign lesions in growth pattern
Pain is second most common and disuse pain is usually due to cyclic edema and swelling or menses
- local pain is usually caused by ruptured cyst or trauma to the fat (fat necrosis)
- *most symptomatic breast lesions are benign (90%)**
- however 10% of breast cancer is symptomatic in women whereas in men 45% are
Acute mastitis
Bacterial infection of the breast usually occurring within first month of breastfeeding
- almost always staph aureus but rarely can be streptococcus mutans/sanguinis
Symptoms
- breast is red and painful to touch
- also systemic symptoms are often present
If not treated will spread to the entire breast and possible become hematogenous
- staph aureus = more likely to cause abscesses and hematologic spread
- strep mutans/sanguinis = more likely to cause
Treatment = appropriate antibiotics cellulitis
- oxacillin/clindamycin in staph aureus
- strep species = ampicillin
Squamous metaplasia of the lactiferous ducts
“recurrent subareolar abscesses or Zuska disease”
Keratinizing squamous metaplasia of the nipple ducts
Often sheds cells and plugs the nipple ducts and eventual rupture if not fixed
- if it spreads into peiductal tissue = granulomatous reactions
Is highly tied to smoking and vitamin A Deficiency
Clinical symptoms:
- painful erythematous subareolar mass
Duct ectasia
Palpable periaroelar mass that is often associated with thick white nipple secretions and occasionally skin retraction
Uncommonly shows pain or redness
Usually occurs in the 5th-6th decades of life
- more common in multiple pregnancies as well
Histology = dilated cuts are filed with inspissated secretion and numerous lipid-laden macrophages
- can sometimes produce cholesterol deposited granulomas
mimics invasive carcinoma of the breast (since it has irregular borders, looks like it on imaging and is palpable), so ALWAYS need to work this up
Fat necrosis
Painless palpable mass with skin thickening or retraction on the area
- may also so densities and calcifications on imaging (if represent = hemosiderin laden calcifications with giant cells and fibrous tissue surrounding)
usually is due to breast trauma or prior surgery and also mimics cancer in physical exam findings
Three groups of bengin epithelial changes/lesion of the breast
1) nonproliferative/ fibrocystic changes
- are NOT associated with cancer
- induces cysts, mild hyperplasia, apocrine changes, duct ectasia and fibroidadenoma
2) Proliferative disease without atypia
- slight increase risk for cancer
- includes papilloma, moderate hyperplasia, sclerosing lesions
3) Proliferative disease with atypica
- increase in breast cancer chances (13-17%)
- includes atypical ductal and lobular hyperplasia
Fibrocytsic breast changes
3 principle morphological changes
1) cystic change
2) fibrosis
3) adenosis
Cysts if present often appear “blue-domed” and semi-translucent
- are lined with atrophic epithelium or meta plastic apocrine cells w/ eosinophilic cytoplasm and round nuclei
- if the cysts rupture = fibrosis develops
often shows calcification of breast tissue also
Adenosis of breast = increased number of acini per lobule
Requires FNA biopsy for diagnosis
Epithelial hyperplasia
Is a type of Proliferative breast disease without atypia
Shows increased number of epithelial cells in luminal and myoepithelial layers
- often distended into the ducts and lobules of the breast
is usually incidental finding
Sclerosing adenosis and complex sclerosis lesions
Are subtypes of proliferating breast disease without atypia
There are increased acini that are cor pressed and distorted
Usually come to attention as palpable masses and/or calcifications
Complex sclerosing lesions have components of adenosine, papilloma and epithelial hyperplasia
- always shows a “radial scar” which is also seen in invasive caricnoma (mimics it)
- are not assocaited with prior trauma or surgery
Papillioma of the breast
Is a subtype of proliferative breast disease without atypia
Present with dilated breast ducts with multiple branching fibrovascular cores
- often shows apocrine metaplasia also
Large duct papilloma = sit in lactiferous sinuses of the nipple and are solitary
- 80% produce nipple discharge (usually serous)
- sometime bloody discharge is a torsion of the stalk si present
Small duct papilloma = usually multiply and are located deeper in the ductal system
Atypical ductal hyperplasia of the breast
Is a subtype of proliferative breats disease with atypia
Mimics ductal carcinoma in situ except that it does not fully fill the ducts involved
Atypical lobular hyperplasia of the breast
Is a subtype of Proliferative breast disease with atypia
Differs from lobular carcinoma in situ int hat cells do not fill or distention moire than 50% of the acini in the lobule
Gynecomastia
Enlargement of the male breast that presents as a button-like subareolar enlargement may be unilateral or bilateral
Histology = increase in dense collagen opus connective tissue associated with epithelial hyperplasia of the duct lining with characteristic micro papillae present
Results from an imbalance of estrogen vs testosterone
- hyper estrogenism
- liver cirrhosis (most common)
- overuse of marijuana, heroin or anabolic steroids
- antiretroviral therapies
is associated with a very slight increase risk fo breast cancer
