Modified sweety gland

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Only mature acini Filled with milk
Enlarged
 DISEASES OF BREAST

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1-Inflammatory Diseases: 2- Fibrocystic Changes: 3- Breast Tumors

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a) Mastitis A. Non-proliferative a. Benign
=(acute&chronic).
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a. Malignant.
a) Fat necrosis. A. Proliferative changes.
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 Inflammatory Disorders
1- Acute Suppurative Mastitis And Breast Abscess:

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v Etiology:
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§ It usually occurs during lactation.

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§ It is due to staphylococcal infection through cracks in nipple, particularly with bad hygiene.
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v Gross picture: " ulitis

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§ Initially inflammation is diffuse and breast appears swollen, edematous, red and tender.
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§ When localized leading to Þ acute abscess.
§ If untreated, it may change into Þ chronic abscess
[which may be clinically mistaken for a neoplasm.]
v Microscopic picture:
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Chorus
Diffuse stage Infiltration by neutrophils.
-

§ Central:
cavity filled with neutrophils and secretion, 0 %
localized
Abscess § surrounded by:
-
inflamed & eventually fibrotic breast parenchyma
-

causing chronic abscess.

-

2- Chronic Mastitis: Silicon body mastitis

- Chronic abscess. - Tuberculosis. - Syphilis. - Actinomycosis. - Idiopathic granulomatous mastitis.

- Foreign-body granulomatous reaction to leaked silicone from breast. - implants.

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 3- Plasma Cell Mastitis (Duct Ectasia, Periductal Mastitis)
- - -
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v Definition:
it is marked dilatation of mammary ducts containing inspissated

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secretions and surrounded by chronic inflammation rich in plasma cells.

Etiology:
v
it usually occurs above the age of 40 years, but of unknown etiology.
v Gross picture:
§ breast mass: firm tender greyish white breast mass @

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§ ducts: large, dilated , containing thick, tan-yellow secretion.
v Microscopic picture:
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§ dilated ducts containing:

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fatty debris and foamy macrophages
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§ surrounded by:
extensive lympho-plasmacytic infiltrate and granulomatous inflammation

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and later fibrosis.

4- Traumatic Fat Necrosis:

v Grossly:
§ It is hard; sometimes- chalky white mass.
§ It may be clinically mistaken for a tumor

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v Etiology:
-
Fibrocystic Disease
(Fibroadenosis, Mammary Cystic Hyperplasia)
-

§ It is the most common condition involving the female breast.

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§ It is thought to represent exaggerated response to hormonal (estrogen) stimuli.

§ These changes mostly occur at the age of 35-50 years.

-

v Clinical picture:

§ Irregular firm mass (often mistaken for malignancy).

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§ Pain.

§ Commonly multiple & bilateral.

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§ Nipple discharge.
-

v Gross picture:

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§ Unilateral or bilateral.
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§ Irregular rubbery greyish non-capsulated mass
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§ or masses with scattered variable-sized cysts ranging between microscopic size and few centimeters
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containing clear or turbid fluid

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v Microscopy:
[There is a variable mixture of the following changes]:
A) Adenosis This is increased number of acini leading to increased size of the lobules.

B) Lobular
hyperplasia The cells lining the acini are hyperplastic forming many layers

§ The ducts are lined by many layers of cells.

§ Heterogenous mixture of cells (epithelial, myoepithelial cells)

Cells Þ are small normochromic, with scant mitotic activity.

C) Usual ductal Ducts Þ show irregular fenestrations
hyperplasia Intraductal Þ epithelial proliferation may form papillae projecting into Ductal lumen
(epitheliosis) (papillary hyperplasia).
papillae Þ are irregular in shape and distribution.
§ Atypical ductal hyperplasia (ADH).
§ Diagnosis of ADH is made, when some but not all critera of DCIS (see later) are present

§ These are dilated ducts containing secretions.

D) Cysts § Frequently these cysts rupture and elicit a stromal chronic inflammatory response

E) Apocrine The linings of cysts frequently undergo apocrine metaplasia

metaplasia (large cells with abundant eosinophilic cytoplasm).

F) Stromal
fibrosis
§ It is adenosis & extensive stromal fibrosis that compresses and distorts the lobules giving a
G) Sclerosing false impression of invasive cancer. Invasive cancer
adenosis § Identification of myoepithelial cells within the compressed lobules differentiates this benign
condition from breast carcinoma.

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v Prognosis:
§ Changes not associated with increased risk of carcinoma:

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a. Fibrosis.

b. Cyst formation.

c. Inflammation.
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d. Mild ductal/lobular hyperplasia,
-

e. Apocrine metaplasia.

§ Changes associated with increased risk of carcinoma:

severe
a. Moderate or florid hyperplasia: 1.5-2 times the risk.
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b. ADH: 5 times the risk.

-

Characters of malignancy