Clinical Presentations of Breast Disease
Pain is the most common breast symptom and may be cyclical or noncyclical Diffuse cyclical pain with menses has no pathologic correlate, and most effective treatments target hormone levels. Noncyclical pain is usually associated with a focal site in the breast. the great majority of painful masses are benign, about 10% of breast cancers present with pain,
Discrete palpable masses are the second most common breast symptom and must be distinguished from the normal nodularity of the breast. A breast mass usually does not become palpable until it is about 2 cm in diameter.
the likelihood that a palpable mass is malignant increases with the age of the patient. For example, only 10% of breast masses in women under age 40 proved to be malignant compared to 60% of masses in women over age 50
Pain is the most common breast symptom and may be cyclical or noncyclical Diffuse cyclical pain with menses has no pathologic correlate, and most effective treatments target hormone levels. Noncyclical pain is usually associated with a focal site in the breast. the great majority of painful masses are benign, about 10% of breast cancers present with pain, Discrete palpable masses are the second most common breast symptom and must be distinguished from the normal nodularity of the breast. A breast mass usually does not become palpable until it is about 2 cm in diameter.the likelihood that a palpable mass is malignant increases with the age of the patient. For example, only 10% of breast masses in women under age 40 proved to be malignant compared to 60% of masses in women over age 50
MAMMARY DUCT ECTASIA
This disorder tends to occur in the fifth or sixth decade of life, usually in multiparous women, and,. Patients present with a poorly defined palpable periareolar mass
This lesion is characterized chiefly by dilation of ducts, inspissation of breast secretions, and a marked periductal and interstitial chronic granulomatous inflammatory reaction . The dilated ducts are filled by granular debris that contains principally lipid-laden macrophages. The periductal and interductal inflammation
FAT NECROSIS
Fat necrosis can present as a painless palpable mass, skin thickening or retraction,
The majority of women will give a history of trauma or prior surgery Grossly, the lesion may consist of hemorrhage in the early stages and, later, central liquefactive necrosis of fat.
The central focus of necrotic fat cells is initially surrounded by macrophages and an intense neutrophilic infiltration. Then, during the next few days, progressive fibroblastic proliferation, increased vascularization, and lymphocytic and histiocytic infiltration wall off the focus.
Benign Epithelial Lesions
: (1) nonproliferative breast changes,
(2) proliferative breast disease,
(3) atypical hyperplasia.
NONPROLIFERATIVE BREAST CHANGES (FIBROCYSTIC CHANGES)
There are three principal patterns of morphologic change: (1) cyst formation, often with apocrine metaplasia; (2) fibrosis; and (3) adenosis
Cysts. Small cysts form by the dilation and unfolding of lobules. When cystic lobules coalesce, larger cysts are formed.. Cysts are lined either by a flattened atrophic epithelium or by cells altered by apocrine metaplasia.
? Fibrosis. Cysts frequently rupture, with release of secretory material into the adjacent stroma. The resulting chronic inflammation and fibrous scarring contribute to the palpable firmness of the breast
? Adenosis. Adenosis is defined as an increase in the number of acini per lobule
PROLIFERATIVE BREAST DISEASE WITHOUT ATYPIA
This group of disorders is characterized by proliferation of ductal epithelium and/or stroma without cellular abnormalities suggestive of malignancy. The following entities are included in this category: (1) moderate or florid epithelial hyperplasia, (2) sclerosing adenosis, (3) complex sclerosing lesions, (4) papillomas, and (5) fibroadenoma with
Epithelial Hyperplasia
Epithelial hyperplasia is defined by the presence of more than two cell layers. Hyperplasia is moderate to florid when there are more than four cell layers. The proliferating epithelium,
Sclerosing Adenosis.
The acini are compressed and distorted in the central portions of the lesion but characteristically dilated at the periphery. Myoepithelial cells are usually prominent.