Breast

• Clinical Presentations of Breast Disease

• Inflammatory Disorders
• Benign Epithelial Lesions
• Carcinoma of the Breast
Normal breast anatomy and anatomical location of common
.
breast lesions
Clinical Presentations of Breast Disease
 Inflammatory Disorders
• Uncommon
• Erythematous swollen painful breast
• A. Acute Mastitis-Staphylococcus aureus ,
• First month of breast feeding
B.Mammary Duct Ectasia-

• Fifth or sixth decade of life,

• Palpable periareolar mass
• Thick, white nipple secretions
• Dilation of ducts,
• Inspissation of breast secretions,
• Periductal and interstitial chronic
granulomatous inflammatory
reaction
 C.Periductal Mastitis-Recurrent subareolar abscess ,Zuska
disease
• A/W Cigarette smoking
• Painful erythematous
subareolar mass
• Keratinizing squamous
metaplasia of the nipple ducts
• Keratin plugs the ductal system,
dilation and rupture of the
duct.
• Chronic and granulomatous
inflammatory response
• Secondary bacterial infection.
 D.FAT NECROSIS
• Painless mass
• Skin thickening
• Breast trauma or prior surgery.
• Firm, gray-white nodules - small
chalky-white foci of calcification
Mammographic density
• Necrotic fat cells ,giant cells,
calcifications, and hemosiderin.
E.GRANULOMATOUS MASTITIS
• 1% of all breast biopsy
specimens
• Systemic granulomatous
diseases -Wegener
granulomatosis or sarcoidosis
• Mycobacteria or fungal
Infections in
immunocompromised patients
• Adjacent to foreign objects
such as breast prostheses or
nipple piercings
 Benign Epithelial Lesions

• (1) Non proliferative breast changes,

• (2) Proliferative breast disease
A. Without atypia
B. With atypia
 1.Nonproliferative breast changes -fibrocystic
changes
• Lumpy bumpy” breasts on palpation
• 20 to 40 years
• No increase in the risk of cancer
• There are three principal morphologic changes:
(1) Cystic change
(2) Fibrosis and
(3) Adenosis- increase in the number of acini per
lobule
Fibrocystic disease
 Nonproliferative breast changes -Fibrocystic
changes
• Small cysts form by the dilation lobules
• They coalesce to form larger cysts.
• Blue dome cysts- brown or blue color cysts
containing turbid, semi-translucent fluid
• Apocrine cells with round nuclei and abundant
granular eosinophilic cytoplasm line the walls
• Secretory debris with calcifications
• Surgery
Nonproliferative breast changes -fibrocystic changes
Proliferative breast disease without atypia

• 1.Epithelial Hyperplasia
• 2.Sclerosing Adenosis
• 3.Complex Sclerosing Lesion
• 4.Papillomas.
• Mild increase in risk of cancer
1.Epithelial hyperplasia

• Presence of more than two

cell layers
2.Sclerosing Adenosis
• Enlarged terminal duct
lobular unit
• Acini are compressed and
distorted by dense stroma.
• Calcifications are present
within some of the lumens.
• Acini are arranged in a
swirling pattern,
 3.Complex sclerosing lesions
• Combination of sclerosing adenosis,
papillomas , and epithelial hyerplasia.
• Radial sclerosing lesion -“radial scar”
• Commonly occurring benign lesion
• Irregular masses
• D/D invasive carcinoma
mamographically , grossly, and
histologically
• HPE-Central nidus of entrapped
glands in a hyalinized stroma with
long radiating projections into stroma
4.Papillomas.

• Growth within a dilated duct .

• Multiple branching fibrovascular
cores
• Large duct papillomas - solitary
and situated in the lactiferous
sinuses of the nipple.
• Small duct papillomas - multiple
and located deeper within the
ductal system.
 Proliferative breast disease with atypia
• Atypical ductal hyperplasia
histologic resemblance to
ductal carcinoma in situ (DCIS).
• It consists of a monomorphic
proliferation of regularly spaced
cells
• Limited in extent and only
partially filling ducts
• Moderate increase in risk of
cancer
• Atypical lobular hyperplasia
involves contiguous ducts
through pagetoid spread
• Proliferation of cells identical to
those of lobular carcinoma in
situ
• Involve <50% of the acini within
a lobule
• Moderate increase in risk of
cancer
Proliferative breast disease with atypia
ADH ALH
Pathologic Lesion Relative Risk Absolute Lifetime Risk
NONPROLIFERATIVE BREAST CHANGES 1.0 (3%)
Duct ectasia
Cysts
Apocrine change
Mild hyperplasia
Adenosis
Fibroadenoma w/o complex features
PROLIFERATIVE DISEASE WITHOUT ATYPIA 1.5 to 2.0 (5% to 7%)
Moderate or florid hyperplasia
Sclerosing adenosis
Papilloma
Complex sclerosing lesion (radial scar)
Fibroadenoma with complex features
PROLIFERATIVE DISEASE WITH ATYPIA 4.0 to 5.0 ( 13% to 17%)
Atypical ductal hyperplasia (ADH)
Atypical lobular hyperplasia (ALH)
CARCINOMA IN SITU 8.0 to 10.0 (25% to 30%)
Lobular carcinoma in situ (LCIS)
Ductal carcinoma in situ (DCIS)