Breast Conditions and Disorders Quiz

Pathology of the Female Breast I

• Congenital Anomalies:
  • Amastia: Congenital absence of one or both breasts
  • Polymastia: Abnormal number of breasts
  • Athelia: Absence of the nipple
  • Polythelia: More than two nipples

Anatomical Structures & Lesions

• Anatomical Structures:
  • Ductules (or acini)
  • Lobule
  • Terminal duct
  • Adipose tissue
  • Segmental duct
  • Lactiferous duct
  • Lactiferous sinus
  • Nipple
• Lesions:
  • Nipple adenoma
  • Paget's disease
  • Papillomas
  • Traumatic fat necrosis
  • Hyperplasia
  • Fibroadenoma
  • Most carcinomas
  • Cysts

Normal Breast Tissue

• Images of normal breast tissue are presented

Main Clinical Presentations

• Breast Pain:
  • Most breast pain is benign, but up to 10% of cases associated with cancer.
  • Breast pain can be cyclic (peaking pre-menstrually and easing with menses) or non-cyclic.
  • Cyclic pain can be unilaterally or bilaterally.
  • Non-cyclic pain has diverse causes (hormonal changes, fibroadenomas, etc.)

Nipple Discharge

• Nipple discharge is a common presenting complaint, categorized into three main types:
  • Physiological discharge: Usually bilateral, serous, and not associated with an underlying disease.
  • Galactorrhea discharge: Bilateral, milky discharge. Related to oral contraceptives, certain drugs and endocrine diseases like prolactinoma.
  • Pathologic discharge: Unilateral discharge localized to a single duct. Frequently caused by benign breast conditions, although uncommonly cancerous (only 5%). If there is a palpable mass or mammographic abnormality, biopsy is necessary.

Mastitis: Acute Mastitis

• Puerperal mastitis: An acute breast cellulitis in lactating mothers.
  • Affected breast tissue is red, warm, and tender.
  • Often no purulent nipple discharge. Infection typically surrounds the duct system.
  • Common organism: Staphylococcus aureus
  • Untreated, may progress to abscess formation.
• Non-puerperal mastitis: Typically appears as an abscess, often sub-areolar, with tenderness and erythema. Usually no widespread systemic symptoms.

Chronic Mastitis

• Less common than acute mastitis. May be specific (e.g., tuberculosis) or non-specific (following acute mastitis). Marked fibrosis can make it difficult to distinguish from cancer.

Tumor-like Lesions

• Breast Cysts:
  • Common in pre- and post-menopausal women.
  • Often indistinguishable from solid masses on physical exam, requiring imaging (ultrasound) and potentially aspiration.

Galactocele

• A special cystic swelling, usually of a lactiferous duct, that develops during lactation.
  • Caused by duct obstruction.
  • Contains creamy (milky) fluid that may turn watery.
  • May lead to infection or granulomatous inflammatory reaction.
  • Images of large galactocele are shown

Traumatic Fat Necrosis

• A lesion caused by injury to fatty breast tissue, often in the sub-areolar region, and more common in obese individuals.
  • Heavily infiltrated by foamy macrophages
  • Lipid crystals are frequently deposited stimulating a granuloma.
  • May contain calcification and manifest as a firm, ill-defined, painless breast mass which can enlarge over time.

Mammary Duct Ectasia

• Characterized by progressive dilatation of large or intermediate-sized ducts, with an associated chronic granulomatous inflammation (often marked by plasma cells and polymorphs), from an unknown cause.
  • Dilated ducts may contain cheese-like fatty material.
  • May be associated with nipple retraction.
  • Clinically similar to cancer and may require differential diagnosis.

Fibrocystic Changes (Fibroadenosis)

• A common breast lesion, typically found in women aged 35-50, but occasionally younger.
  • Often bilateral and multifocal.
  • Macroscopically, characterized by a firm, ill-defined, grayish-white fibrous tissue with cysts of varying sizes. Cysts contain yellowish serous or brown hemorrhagic fluid.
  • Microscopically, characterized by epithelial hyperplasia (including adenosis), epithelial changes (apocrine metaplasia).
  • Fibrosis.

Fibrocystic Disease of the Breast

• Images of fibrocystic disease are presented

Etiology of Fibrocystic Change

• The exact cause of fibrocystic changes is unknown, but it is assumed to be caused by hormonal imbalances, particularly oestrogen (increased) and progesterone (decreased) causing breast tissue hyperplasia, which sometimes may be atypical (precancerous).

Breast with Epitheliosis & Atypical Epithelial Hyperplasia

• Images of an example of breast with epithelial hyperplasia are presented.