Benign Breast Lesions PDF

Pathology of benign breast lesions  Clinical Presentations of Breast Disease 2- Mass >2cm 1- Pain (mastalgia) Cyst 95% benign Fibroadenoma...

Pathology of benign breast lesions  Clinical Presentations of Breast Disease 2- Mass >2cm 1- Pain (mastalgia) Cyst 95% benign Fibroadenoma Carcinoma Milky discharge Bloody or serous Galactorrhea discharge Pituitary adenoma 3- Nipple discharge Cyst Hypothyroidism Anovulation Intra-ductal papilloma Mediations NON-NEOPLASTIC BREAST LESIONS Inflammation Galactocele Fat necrosis Benign epithelial lesions  Mastitis Acute Chronic mastitis mastitis (abscess) Granulomatous Periductal Plasma cell mastitis mastitis mastitis (mammary duct ectasia)  Mastitis 1-Acute mastitis and breast abscess Etiology; Acute pyogenic infection Risk factor; First few weeks of lactation. Mode of spread; directly through cracks and fissures in the nipple. Pathogenesis; localized area of acute inflammation, if not treated → single or multiple breast abscesses. C\P: severe pain, redness, hotness, swelling, stretched red skin. Treatment; antibiotic treatment. If abscess: surgical incision and drainage. 2- Granulomatous mastitis 1-Systemic disease; sarcoidosis 2- Foreign bodies: (silicone breast implants) 3- Infections (mycobacteria (TB) or fungi) Periductal mastitis Location ; (nipple ducts) Risk factor; Smoking (90% of cases). CP; painful subareolar mass. Pathogenesis: Squamous metaplasia of nipple ducts → duct dilation →rupture →chronic & granulomatous inflammation.  Mammary duct ectasia (plasma cell mastitis) Location ; peri areolar Risk factor; NO relation to Smoking. Age; multiparous women , 50 - 70 years. CP: ill-defined, painless mass, viscous white nipple secretions. Pathogenesis; inspissation of secretions → duct dilation without squamous metaplasia → periductal inflammation [plasma cells ] → fibrosis and skin retraction. Fat Necrosis CP; painless palpable mass, skin thickening or nipple retraction, mammographic density, or calcifications. Etiology; trauma or surgery. Histologically, hemorrhage & acute inflammation → fat necrosis → chronic inflammation + giant cells and hemosiderin → scar tissue, dystrophic calcification. Not related to cancer Galactocele Risk factor; lactation Pathogenesis; mammary duct is obstructed and dilated to form a thin-walled cyst filled with milky fluid. It may be secondary infected.  risk of developing Benign epithelial lesions breast cancer Proliferative Proliferative Non - disease with proliferative disease without atypia atypia disease Fibrocystic changes Fibroadenosis Precancerous  Benign epithelial lesions Fibrocystic changes; C/P: lumpy bumpy breasts Adenosis: increased numbers of acini per lobule Cysts: lining flat or apocrine (apocrine metaplasia) Fibrosis: ruptured cyst May calcification  Benign epithelial lesions Proliferative disease without atypia ; Epithelial hyperplasia > 2 layers without cytological or architectural atypia Sclerosing adenosis: increase acini per lobules (central compression , peripheral dilatation. Papillomas: epithelial growth with fibrovascular core (80% nipple discharge) Complex sclerosing lesions (sclerosing adenosis + papillomas)  Benign epithelial lesions Proliferative with atypia- Atypical ductal hyperplasia – Atypical lobular hyperplasia Closely resembles lobular\ductal carcinoma in situ epithelial cells are monomorphic  Benign breast tumors Stromal origin Epithelial origin Fibroadenoma Phyllodes Duct papilloma Fibroadenoma It is the most common benign tumor of the female breast. Age;15 to 30 years of age, any age during reproductive life. Clinically, a solitary, freely mobile nodule within the breast. Grossly, a small (2-4 cm diameter), well-encapsulated, spherical, or discoid mass. C/S is firm, grey-white, and may show slit-like spaces formed by compressed ducts. Microscopically, the tumor has circumscribed borders with low cellularity, and rare mitoses. The arrangements between fibrous overgrowth and ducts may produce two patterns that may coexist in the same tumor. These are intracanalicular and peri canalicular patterns  Phyllodes tumor (phyllodes=leaf-like) An uncommon tumor with aggressive behavior. Age; between 30 to 70 years of age. Grossly, large, 10-15 cm, round to oval, bosselated, not fully encapsulated. C/S grey, white with cystic cavities, areas of hemorrhages, necrosis, and degenerative changes. Histologically more cellular connective tissue, stromal overgrowth, nodules of proliferating stromal cells that are covered by epithelium. Behavior; benign, border line, malignant (2%, sarcomatous, send metastasis) ? Mitoses, atypia, cellularity, infiltrative margins. Intraductal papilloma A benign papillary tumor, commonly in lactiferous duct near the nipple. Clinically, serous or serosanguineous nipple discharge. Grossly, it is usually solitary, small, less than 1 cm in diameter. Histologically, multiple papillae having well-developed fibrovascular stalks attached to the ductal wall and covered by benign cuboidal epithelial cells supported by myoepithelial cells.  Benign breast lesions Benign Epithelial Benign Inflammatory Non -inflam lesions tumors Acute mastitis, abscess: Fibroadenoma: Fat necrosis Non proliferative: Lactating, pyogenic, AB, drainage common, Trauma fibrocystic reproductive age, Giant cells (adenosis, cyst, Chronic mastitis: mobile, firm, ductal calcification fibrosis, apocrine) Granulomatous mastitis: T.B, & stromal Nipple retraction Proliferative sarcoidosis, fungal, silicon proliferation, without atypia: Periductal: nipple ducts, never malignant Galactocele sclerosing adenosis, squamous metaplasia, Phyllodes: large, Lactating papillomas or both granuloma stromal overgrowth Milk filled cyst Proliferative with Plasma cell mastitis: duct may malignant atypia: ADH, ALH ectasia, large ducts Papilloma: ductal (precancerous) FIBROSIS & NIPPLE RETRACTION covering & FV core, nipple discharge THANK YOU