Pathology of the breast

Dr. Ann saparamadu

Normal breast • Duct lobular unit

Duct lobular unit

• lobule

Classification of breast disease1. Inflammatory disorders

- acute pyogenic mastitis- mammary ductectasia- fat necrosis

2. Benign proliferate breast diseases- fibrocystic change- benign tumours - Fibroadenoma

- duct papilloma - nipple adenoma3. Breast carcinoma

- malignant tumours4. Stromal tumours - phylloides tumours

Clinical features of breast diseases

• Lump mobile - fibroadenoma *

lumpiness - fibrocystic disease *

ill-defined soft- fibrocystic change *ill-defined firm -carcinoma

• Nipple discharge clear/blood stained

ductectasia

duct papilloma

carcinoma

• Nipple eczema - Paget’s disease *

- nipple adenoma

Inflammatory diseases1. Acute pyogenic mastitis

• Acute inflammatory lesion

• Usually in post partum period

• Staphylococcus aureus commonest

• Usually confined to a segment

• Streptococcus pyogenes - wide spread inflammation and systemic symptoms

• Leads to breast abscess

Inflammatory diseases

1. Fat necrosis

• Localized area of inflammation following trauma

• Necrosis fat cells induce inflammation and repair Fat necrosis

• Fibrosis in repair gives rise to firm irregular lump

• Mimics malignancy

Fat necrosis

• microscopy

Inflammatory diseases

3 Ductectasia

• Abnormal progressive dilatation of large breast ducts

• Destruction of periductal elastic tissue

• Accumulate secretory products and shed epithelium in the lumen

• Induces chronic inflammation and fibrosis

• Clinically - perimenopausal age, nipple dischargefirm ill defined lump mimics malignancy

• No risk of malignancy

Classification of breast disease1. Inflammatory disorders

- acute pyogenic mastitis- mammary ductectasia- fat necrosis

2. Benign proliferate breast diseases- fibrocystic change- benign tumours - Fibroadenoma

- duct papilloma - nipple adenoma3. Breast carcinoma

- malignant tumours4. Stromal tumours - phylloides tumours

Proliferative diseases

Fibrocystic disease(fibroadenosis)

• Most frequent disorder of the female breast

• Starts in early middle age, peaks at perimenopausal period and reduce in post menopausal period

• Manifest clinically in 10% but asymptomatic in 40%

Synonyms - Fibroadenosis, cystic mastopathy

chronic mastitis

Aetiology - poorly understood

- imbalance of oestrogen and progesterone

Fibrocystic change

Characterized by hyperplastic overgrowth of components of the mammary units

• Epithelial overgrowth

- increase acini – adenosis

- epithelial proliferation

- papillomatosis

• Fibrous overgrowth ( specialized hormone responsive breast supporting stroma)

- fibrosis

Fibrocystic change

Depends on the underlying pathology

adenosis

epithelial hyperplasia

paillomatosis

apocrine metaplasia

sclerosing adenosis

cysts

fibrosis

Fibrocystic change

Fibrocystic change

• Clinical importance

many women have periodic discomfort

anxiety due to lump/ lumpiness

clinically mimics a carcinoma

One component, epithelial hyperplasia leads has a higher risk of malignancy

Epithelial hyperplasia

Gynaecomastia

• Normally male breast has only ducts

• Common proliferative disorder of the male breast

• Clinically firm mobile disc beneath the nipple

• Common in adolescents and old age

• De3pends on oestrogen

hyperthyroidism, pituitary disorders, tumours of the testis and adrenals, stilbestrol therapy, Klinfelter’s cirrhosis, drugs

Gynaecomastia

• micro

Benign tumours1 Fibroadenoma

• Commonest type of benign tumour

• Common in young

• Peak in the third decade

• Solitary / Multiple

• Arise from breast lobule

Fibroadenoma

• micro

Benign tumours

2. Duct papilloma

• Middle aged women

• Blood stained discharge

• Usually a solitary lesion

• Less common

Duct papilloma

• micro