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Questions and Answers
What characterizes galactorrhea discharge?
What characterizes galactorrhea discharge?
Which of the following statements regarding breast pain is correct?
Which of the following statements regarding breast pain is correct?
What is the typical presentation of puerperal mastitis?
What is the typical presentation of puerperal mastitis?
Which type of nipple discharge is most likely to be associated with an underlying disease?
Which type of nipple discharge is most likely to be associated with an underlying disease?
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What is a common causative organism of puerperal mastitis?
What is a common causative organism of puerperal mastitis?
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In which condition would duct ectasia most likely be a contributing factor?
In which condition would duct ectasia most likely be a contributing factor?
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Which statement about non puerperal mastitis is accurate?
Which statement about non puerperal mastitis is accurate?
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Which type of breast pain is generally relieved with the onset of menses?
Which type of breast pain is generally relieved with the onset of menses?
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Which characteristic is NOT typically associated with mammary duct ectasia?
Which characteristic is NOT typically associated with mammary duct ectasia?
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What is the primary cause of traumatic fat necrosis in breast tissue?
What is the primary cause of traumatic fat necrosis in breast tissue?
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Which type of breast lesion is most commonly bilateral and multifocal in women aged 35 to 50?
Which type of breast lesion is most commonly bilateral and multifocal in women aged 35 to 50?
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Which of the following is a diagnostic method for breast cysts?
Which of the following is a diagnostic method for breast cysts?
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What type of fluid is initially contained in a galactocele?
What type of fluid is initially contained in a galactocele?
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Which of the following features could raise suspicion of breast carcinoma in cases of nipple retraction?
Which of the following features could raise suspicion of breast carcinoma in cases of nipple retraction?
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What histological feature is indicative of fibrocystic changes?
What histological feature is indicative of fibrocystic changes?
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Which of the following is a potential consequence of a galactocele?
Which of the following is a potential consequence of a galactocele?
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Study Notes
Pathology of the Female Breast I
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Congenital Anomalies:
- Amastia: Absence of one or both breasts.
- Polymastia: Abnormal number of breasts.
- Athelia: Absence of the nipple.
- Polythelia: More than two nipples.
Anatomical Structures & Lesions
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Anatomical Structures:
- Ductules/Acinus
- Lobule
- Terminal duct
- Adipose tissue
- Segmental duct
- Lactiferous duct
- Lactiferous sinus
- Nipple
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Lesions:
- Nipple adenoma
- Paget's disease
- Papillomas
- Traumatic fat necrosis
- Hyperplasia
- Most carcinomas
- Fibroadenoma
- Cysts
Normal Breast Tissue
- Images of normal breast tissue are presented.
Main Clinical Presentations
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Breast pain:
- Most breast pain has a benign cause, but ~10% of breast cancers are associated with pain.
- Pain can be cyclic (maximal premenstrually, relieved with menses, can be unilateral or bilateral) or non-cyclic (various causes, e.g., hormonal fluctuations, benign tumors, cysts, duct ectasia and trauma).
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Nipple discharge:
- A common complaint classified into three main groups:
- Physiological: Usually bilateral, serous, not associated with disease
- Galactorrhea: Bilateral milky discharge; various causes (oral contraceptives, other drugs, endocrine disorders such as prolactinoma)
- Pathological: Unilateral, localized to a single duct, often cause by benign conditions even if blood is present. Breast cancer accounts for only 5% of cases, with a range of 3-11% of women with breast cancer having associated nipple discharge.
- A common complaint classified into three main groups:
Mastitis
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Acute Mastitis:
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Puerperal Mastitis:
- Acute cellulitis (inflammation) of the breast in lactating mothers.
- Affected area is red, warm, and tender.
- Usually no purulent discharge (pus) from the nipple as the infection is around the duct system, not within it.
- High fever and chills, flu-like body aches are common.
- Staphylococcus Aureus is the most common bacteria.
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Non-Puerperal Mastitis:
- Commonly appears as an abscess (pus-filled cavity) that is often subareolar (under the areola) with tenderness and erythema (redness.)
- Usually without systemic symptoms.
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Puerperal Mastitis:
Chronic Mastitis
- Relatively uncommon. Possible causes include tuberculosis or non-specific conditions (following acute mastitis with marked fibrosis, potentially mistaken for cancer).
Tumour-like Lesions
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Breast Cysts:
- Common in pre- and postmenopausal women.
- Physical examination often cannot distinguish cysts from solid masses.
- Imaging (ultrasound) and aspiration are often necessary for diagnosis.
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Galactocele:
- A special cystic swelling of a lactiferous duct that occurs during lactation.
- It follows obstruction of the duct.
- It contains creamy (milky) fluid, which may become watery and infected.
- May induce a granulomatous inflammatory response.
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Traumatic fat necrosis:
- Results from injury to the fatty tissue of the breast (commonly in obese individuals in the sub-areolar region.)
- Characterized by foam macrophages, lipid crystals, granulomatous reaction (especially foreign body giant cell reaction.), and calcification.
- Firm, ill-defined, painless mass.
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Mammary duct ectasia:
- Progressive dilation of large or intermediate ducts for unknown reasons.
- Surrounding chronic granulomatous inflammatory reaction with many plasma cells and polymorphs.
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Fibrocystic changes (fibroadenosis):
- Common, occurring predominantly in women aged 35-50, though sometimes earlier.
- Often bilateral, multifocal, not always constant.
- Macroscopically: Firm, ill-defined, grayish to white fibrous tissue with cysts of varying sizes .
- Microscopically: Cysts contain yellowish serous, or brown hemorrhagic fluid. Epithelial linings of the ducts and ductules are dilated and show cystic changes, sometimes with abnormal epithelial cell changes (such as apocrine metaplasia). Fibrosis also present--fibrous proliferation of peri-ductal connective tissue which can be loose or dense.
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The true cause of fibrocystic changes is hormonal imbalance (increased estrogen and decreased progesterone). Sometimes, the epithelial hyperplasia is atypical with abnormal increase in mitotic activity. This may be a pre-malignant condition.
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Description
Test your knowledge on the pathology of the female breast, covering congenital anomalies, anatomical structures, lesions, and clinical presentations. This quiz will challenge your understanding of both normal and abnormal breast features.
