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Breast disease

Breast disease. Dr. A. Basu MD. Topic. General concept. TDLU. D/D of a breast Lump. Solid Lump. Cystic Lump. Bilateral. Unilateral. Abscess ( tender) Galactocele ( History of Pregnancy) Cyst Breast. Fibrocystic disease ( Irregular lump). Fibro adenoma Cystosarcoma Phyllodes

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Breast disease

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  1. Breast disease Dr. A. Basu MD

  2. Topic • General concept

  3. TDLU

  4. D/D of a breast Lump Solid Lump Cystic Lump Bilateral Unilateral Abscess ( tender) Galactocele ( History of Pregnancy) Cyst Breast. Fibrocystic disease ( Irregular lump) Fibro adenoma Cystosarcoma Phyllodes Breast carcinoma Fat necrosis

  5. Diseases of Breast : lecture topic • Fibrocystic changes of breast: types • Inflammations • Tumors of the Breast

  6. Fibrocystic disease of breast

  7. Fibrocystic changes

  8. Fibrocystic disease (Non Proliferative change) • Gross: Blue dome cyst [ 1to 5 cm]

  9. Non Proliferative change: MICRO Cystic dilation of Glands an ducts Apocrine metaplasia of the lining epithelium of the duct and glands.

  10. Proliferative change • Epithelial Hyperplasia • Subtype: Atypical • Sclerosing adenosis

  11. (Atypical) Epithelial Hyperplasia : More chance of carcinoma. Normal

  12. Sclerosing adenosis • Excessive fibrosis of beast • Increased number of collapsed gland

  13. Sclerosing adenosis clinically mimic malignancy : because it is hard and rubbery on palpation.

  14. Clinical : Fibrocystic changes Lumpy Breast

  15. Inflammation of the breast • Acute mastitis ( produce breast abscess). • Mammary Duct ectasia • Traumatic fat necrosis.

  16. Acute mastitis ( produce breast abscess). • Etiology : Early week of Nursing and dermatitis.

  17. Acute mastitis

  18. Mammary Duct ectasia • Def : NON-inflammatory lesion. • Age : 40-50 years , who has children. • Cause : Accumulation of Breast secretion in Main Excretory Duct.

  19. Mammary Duct ectasia: Dilated Duct , Fibrosis around the dilated duct.Presence of PLASMA cells and lymphocytes

  20. Mammary Duct ectasia-C/F • Presents as a lump below the nipple. • Cause nipple Retraction : mimic carcinoma

  21. Traumatic fat necrosis • Early : Small Tender and localized lump. • Later : Fibrosis and calcification occur.

  22. Tumors of the Breast • Fibro adenoma • Phyllodes Tumors • Intraductal papilloma • Carcinoma of the breast

  23. Fibro adenoma : Breast Mouse • Disease involve TDLU • Most common benign tumor in female breast. • Its growth is related to estrogen. • Age : young women ( 3rd Decade) • They have both epithelial and connective tissue elements.

  24. Morphology • Size : 1 to 10 cm. • Tumor more than 10 cm : Giant fibro adenoma. Gross: Breast Mouse Micro: 2 features

  25. Gross: Well circumscribed , tan-white

  26. 1. Oval round duct space

  27. 2. Slit like , star shaped compressed duct

  28. Clinical • Solitary, discreet, moveable mass ( breast mouse). • Regress after menopause and calcify. • It will never become malignant.

  29. Phyllodes ( leaf –like) Tumors

  30. Phyllodes ( leaf –like) Tumors • Past name: Cystosarcoma Phylloid • It can become malignant • Usually a big tumor • Contain mainly stromal component. • Morphologically has a “ leaf like” appearance.

  31. Morphologically has a “ leaf like” appearance

  32. Phyllodes tumor • High-grade lesion behave aggressively and exhibit recurrence.

  33. Fibroadenoma Vs Phyllodes tumor

  34. Intraductal papilloma • An Intraductal papilloma may be associated with a serous or bloody nipple discharge . • Location : Subareolar • It’s a benign lesion.

  35. Intraductal papilloma arising in main lactiferous ducts

  36. Carcinoma Breast • Risk factors • Genetics and family History • Prolonged exposure to exogenous estrogen and obesity. • Alcohol consumption. • Environmental

  37. Risk factors • Proliferative breast diseases • Carcinoma of the contra lateral breast or endometrium. • Frequent in nulliparous women. • Obesity

  38. Age : Genetics and family History • Age : uncommon below 35 years Genetic disease associated with Breast cancer: • Li-Fraumeni syndrome ( multiple sarcoma and carcinoma). • Cowden disease ( multiple hamartoma syndrome).

  39. Gene and Breast carcinoma • Associate with BRCA 1 and BRCA 2 gene, • Over expression of c-erb –b2. HER2/neu

  40. Location of breast tumor Upper inner 10% Upper outer: 50% Central 20 Lower outer outer: 10% Lower inner: 10%

  41. Classification • Non Invasive • Ductal carcinoma in situ (DCIS) • Lobular carcinoma in situ (LCIS) • Invasive

  42. Invasive • Invasive ductal carcinoma ( not otherwise specified ; NOS) • Invasive lobular carcinoma • Medullar carcinoma • Colloid carcinoma • Tubular carcinoma

  43. DCIS Vs LCIS

  44. Duct Carcinoma In Situ : Features • Low grade DCIS : Good prognosis • DCIS with micro invasion • Variant : Comedo carcinoma • Paget disease of nipple: Extension of In situ duct carcinoma cell to the lactiferous duct and the skin of the nipple.

  45. Ductal carcinoma in situ (DCIS): with micro calcification

  46. Comedo subtype of DCIS : Central necrosis within the duct. Comedocarcinoma

  47. Paget disease of nipple • Extension of In situ duct carcinoma cell to the lactiferous duct and the skin of the nipple.

  48. Paget disease of nipple : Clinically resemble eczema.

  49. Paget cells: These cells have abundant clear cytoplasm and appear in the epidermis either singly or in clusters.

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