Download presentation
1
Breast disease Dr. A. Basu MD
2
Topic General concept
4
TDLU
5
D/D of a breast Lump Abscess ( tender) Galactocele
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
6
Diseases of Breast : lecture topic
Fibrocystic changes of breast: types Inflammations Tumors of the Breast
7
Fibrocystic disease of breast
Non Proliferative change Cyst and fibrosis Proliferative change Its is a ‘Premalignant “ condition of the breast Epithelial Hyperplasia Sclerosing adenosis
8
Fibrocystic changes
9
Fibrocystic disease (Non Proliferative change)
Gross: Blue dome cyst [ 1to 5 cm]
10
Non Proliferative change : MICRO
Cystic dilation of Glands an ducts Apocrine metaplasia of the lining epithelium of the duct and glands.
11
Proliferative change Epithelial Hyperplasia Sclerosing adenosis
Subtype: Atypical Sclerosing adenosis
12
(Atypical) Epithelial Hyperplasia : More chance of carcinoma.
Normal
13
Sclerosing adenosis Excessive fibrosis of beast
Increased number of collapsed gland
14
Sclerosing adenosis clinically mimic malignancy : because it is hard and rubbery on palpation.
15
Clinical : Fibrocystic changes
Lumpy Breast
16
Inflammation of the breast
Acute mastitis ( produce breast abscess). Mammary Duct ectasia Traumatic fat necrosis.
17
Acute mastitis ( produce breast abscess).
Etiology : Early week of Nursing and dermatitis.
18
Acute mastitis
19
Mammary Duct ectasia Def : NON-inflammatory lesion.
Age : years , who has children. Cause : Accumulation of Breast secretion in Main Excretory Duct.
20
Mammary Duct ectasia: Dilated Duct , Fibrosis around the dilated duct
Mammary Duct ectasia: Dilated Duct , Fibrosis around the dilated duct. Presence of PLASMA cells and lymphocytes
21
Mammary Duct ectasia-C/F
Presents as a lump below the nipple. Cause nipple Retraction : mimic carcinoma
22
Traumatic fat necrosis
Early : Small Tender and localized lump. Later : Fibrosis and calcification occur.
23
Tumors of the Breast Fibro adenoma Phyllodes Tumors
Intraductal papilloma Carcinoma of the breast
24
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.
25
Morphology Size : 1 to 10 cm. Tumor more than 10 cm :
Giant fibro adenoma. Gross: Breast Mouse Micro: 2 features
26
Gross: Well circumscribed , tan-white
27
1. Oval round duct space
28
2. Slit like , star shaped compressed duct
29
Clinical Solitary, discreet, moveable mass ( breast mouse).
Regress after menopause and calcify. It will never become malignant.
30
Phyllodes ( leaf –like) Tumors
31
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.
32
Morphologically has a “ leaf like” appearance
33
Phyllodes tumor High-grade lesion behave aggressively and exhibit recurrence.
34
Fibroadenoma Vs Phyllodes tumor
Low cellularity High cellularity, bulky stroma. Rare mitosis High mitosis No Pleomorphism Pleomorphism Present Well circumscribed Infiltrative border
35
Intraductal papilloma
An Intraductal papilloma may be associated with a serous or bloody nipple discharge . Location : Subareolar It’s a benign lesion.
36
Intraductal papilloma arising in main lactiferous ducts
37
Carcinoma Breast Risk factors Genetics and family History
Prolonged exposure to exogenous estrogen and obesity. Alcohol consumption. Environmental
38
Risk factors Proliferative breast diseases
Carcinoma of the contra lateral breast or endometrium. Frequent in nulliparous women. Obesity
39
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).
40
Gene and Breast carcinoma
Associate with BRCA 1 and BRCA 2 gene, Over expression of c-erb –b2. HER2/neu
41
Location of breast tumor
Upper inner 10% Upper outer: 50% Central 20 Lower outer outer: 10% Lower inner: 10%
42
Classification Non Invasive Ductal carcinoma in situ (DCIS)
Lobular carcinoma in situ (LCIS) Invasive
43
Invasive Invasive ductal carcinoma ( not otherwise specified ; NOS)
Invasive lobular carcinoma Medullar carcinoma Colloid carcinoma Tubular carcinoma
44
DCIS Vs LCIS Arise from duct Arise from acini.
Associated with micro calcification Not associate with calcification High grade DSCI has bad prognosis Do not produce mass. Good prognosis
45
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.
46
Ductal carcinoma in situ (DCIS) : with micro calcification
47
Comedo subtype of DCIS : Central necrosis within the duct.
Comedocarcinoma
48
Paget disease of nipple
Extension of In situ duct carcinoma cell to the lactiferous duct and the skin of the nipple.
49
Paget disease of nipple : Clinically resemble eczema.
50
Paget cells: These cells have abundant clear cytoplasm and appear in the epidermis either singly or in clusters.
51
Paget cell stain PAS : Indicate presence of Mucin
52
Prognosis of DCIS Excellent 97% long time survival.
DCIS with micro invasion : bad prognosis.
53
Lobular carcinoma in situ
54
All acini of a breast lobe is affected
All acini of a breast lobe is affected. Cells are monomorphic ( similar size)
56
Time for Invasive carcinomas
Invasive ductal carcinoma ( not otherwise specified ; NOS) Invasive lobular carcinoma Medullar carcinoma Colloid carcinoma
57
Invasive ductal carcinoma (Scirrhous carcinoma)- 70-80%
It is carcinoma with no special type ( NOS). Constitute Majority of Breast carcinoma. They have desmoplasia (Scirrhous ). Stony hard mass, fixed to skin , underlying muscles.
58
Invasive ductal carcinoma (Scirrhous carcinoma
Lymph vascular and neural invasion common. Tumor cells frequently over express ERB B2. 2/3 rd EXPRESS HOEMONE ( ESTROGEN AND PROGESTERONE) RECEPTOR. Presence of overlying Paget’s disease : Bad prognosis.
59
Gross : IDC ; infiltrative tumor with irregular margin.
60
Gross : IDC ; infiltrative tumor with infiltrating growth .
61
Micro : IDC
62
IDC with extreme desmoplasia
63
Diagnosis Mammography Micro calcification [ red alert] FNAC Biopsy
64
Inflammatory carcinoma
It a a variant of duct carcinoma ; Shows swollen , erythematous (red) breast mimic acute inflammation.
65
Invasive lobular carcinoma : Main Features
Tumor cells are monomorphic ( similar size). Frequently bilateral and multicentric. More often spread to CSF, serosal surface and ovary. Frequently clinically silent. Express hormone receptor.
66
Invasive lobular carcinoma: monomorphic round cells
67
Invasive lobular carcinoma : microscopy : single indian file
68
Bulls eye pattern of invasion
69
Colloid carcinoma Age : Older women Growth : Slow growing,
Prognosis ; Prognosis is better than for non-mucinous, invasive carcinomas. Most express hormone receptors. Gross: Soft gelatinous.
70
Colloid carcinoma :Note the abundant bluish Mucin.
71
Medullar carcinoma-2% Incidence : Less than 5% of breast cancers ( occur with BRCA1) Morphology : Gross : 2-5 cm, fleshy masses . Micro : Sheets and nests of cells are surrounded by a lymphoid plasmacytic stroma with no desmoplasia.
72
Medullar carcinoma
73
Medullary carcinoma Prognosis : Better than for infiltrating ductal or lobular carcinoma. Lack hormone receptors.
74
Topic now Tubular carcinoma Sarcoma of breast
Features of invasive tumor Spread of breast carcinoma Staging of breast carcinoma Clinical course and prognosis Management Male Breast Miscellaneous lesions
75
Tubular carcinoma : features
Small mass , rarely palpable( 1cm size). Excellent Prognosis Lympnnode metastasis is rare. Express hormone receptor. Micro : Well formed tubules and low grade nuclei.
76
Morphology
77
Sarcoma of Breast All types of sarcoma can occur
But angiosarcoma is common.
78
Features of invasive tumor
Fixation to the tissue ( skin, muscle) Retraction of nipple. Inflammatory carcinoma. Dimpling of the skin. Lymph edema : caused by Tumor emboli in the dermal blood vessels.
79
Retraction of nipple
80
Inflammatory carcinoma: common in pregnancy (but no inflammatory cells present)
81
Tumor emboli in the dermal blood vessels: the cause of Lymphedema
82
Lymphedema following radical mastectomy: Thickened skin
83
Spread Local Lymph nodes Lung, Skeleton ( osteolytic) Brain ( CSF)
Metastasis may occur even after 15 years.
84
Internal mammary Lymph nodes Axillary Lymph nodes
Upper outer: 50% Upper inner 10% Central 20 Lower outer outer: 10% Lower inner: 10%
85
11 Prognostic factors The size of the primary tumor
Invasive Ca < 2 cm = excellent Lympnnode and number of LN involvement. Most important factor related to the prognosis of breast cancer Histological type NOS : Duct carcinoma = bad prognosis Specialized Ca : good prognosis
86
Prognostic factors Grade Well differentiate tumor = better prognosis.
Presence of both estrogen / progesterone receptor Slightly better prognosis.
87
Prognostic factors Aneuploidy If present - worse prognosis.
Over expression of ERB B2 Poorer Prognosis. Increased mitosis. Bad prognosis
88
Prognostic factors Angiogenesis +++ More chance of metastasis Protease
If increased more chance of invasion.
89
Hercepctin Monoclonal Antibody to Gene ERBB2.
It is an antitumor antibody. If response to this antibody is GOOD = GOOD prognosis.
90
Management Lumpectomy Mastectomy or breast Preservation
Hormonal and Chemotherapy. Inhibition of angiogenesis.
91
Post mastectomy Tumor deposit on scar area.
92
Breast self examination; best way to save life
93
Thank you We will now move on to Male Breast.
94
Male Breast Gyenecomastia ( Greek word) : enlargement of the male breast.
95
Proliferation of ducts in hyalinized fibrous tissue with periductal edema
96
Causes Puberty Tumors ( Leydig cell tumor of testis)
Genetic disorders ( kilnefelter syndrome) Chronic liver disease (cirrhosis) Female hormone exposure
97
Carcinoma of male breast : rare : usually duct carcinoma.
98
Thank you
Similar presentations
© 2025 SlidePlayer.com. Inc.
All rights reserved.