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