The Breast, Pt 1

The Breast, Pt 1

Disorders of Development
1. Milk Line Remnants
  1. supernumerary nipples or breasts
2. Accessory Axillary Breast Tissue
  1. ductal system extends into subcutaneous tissue of the chest wall
  2. outside normal breast area
3. Congenital Nipple Inversion
  1. failure to evert
  2. congenital: not a problem
  3. Acquired: possible invasive cancer or inflammatory nipple disease
Clinical Presentations of Breast Disease
1. Pain
  1. Cyclic
  2. Noncyclic
2. Palpable Masses
3. Nipple Discharge
Inflammatory Disorders
1. Acute Mastitis
  1. first month of breastfeeding
  2. due to cracks and fissures
  3. red, painful, fever
2. Squamous Metaplasia of Lactiferous Ducts
  1. painful, erythematous subareolar mass
  2. inverted nipple
  3. smoking is a risk factor (vitamin A deficiency)
  4. drain the avscess cavity
3. Duct Ectasia
  1. thick, white nipple secretions
  2. irregular palpable mass mimics the clinical and rediographic appearance of carcinoma
4. Fat Necrosis
  1. painless palpable mass, skin thickening
5. Lymphocytic Mastopathy
  1. AKA: Sclerosing Lymphocytic Lobulitis
  2. hard palpable masses
  3. Atrophic ducts and lobules
  4. diabetes, autoimmune thyroid disease
6. Granulomatous Mastitis
  1. systemic granulomatous diseases or localized ones
  2. hypersensitivity to lactation antigens
  3. similar to Corynebacteria infection
Benign Epithelial Lesions
1. Nonproliferative Breast Changes
  1. Fibrocystic Changes
    1. "lumpy bumpy" breasts
    2. Nonproliferative
    3. Cysts
      1. small cysts
      2. blue or brown fluid
      3. atrophic epithelium
      4. calcifications
    4. Fibrosis
      1. inflammation and fibrosis from cyst rupture
    5. Adenosis
      1. increased number of acini per lobule
      2. possible calcifications
      3. columnar cells with nuclear atypia
    6. Lactational Adenomas
      1. Normally present in lactating women
      2. palpable masses
2. Proliferative Breast Disease without Atypia
  1. small increase risk of breast cancer
  2. Epithelial Hyperplasia
    1. normal breast ducts and lobules
    2. double layer of myoepithelial cells and luminal cells
  3. Sclerosing Adenosis
    1. increased number of acini
    2. stromal fibrosis will compress lumens
  4. Complex Sclerosing Lesion
    1. adenosis, papillomas, epithelial hyperplasia
    2. irregular shape
  5. Papilloma
    1. epithelial hyperplasia and apocrine metaplasia
    2. nipple discharge
  6. Gynecomastia
    1. enlargement of male breast
    2. increase in dense collagenous connective tissue associated with epithelial hyperplasia
    3. imblance between estrogens and androgens
    4. drugs and alcohol
    5. Klinefelter
3. Proliferative Breast Disease with Atypia
  1. Atypical Ductal Hyperplasia
    1. resembles DCIS
    2. only partially filled ducts
  2. Atypical lobular hyperplasia
    1. cells identical to LCIS
    2. do not fill the acini
    3. cells are between ductal basement membrane and overlying normal luminal cells

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	Created by Jeff Amos about 10 years ago