What are the most important breast diseases in various age groups?
25-55: fibrocystic changes
> 45: breast cancer
What is acute mastitis, and when does it usually occur?
Typically occurs during lactation. It may present at diffuse swelling, multiple nodules, or large abcess.
staph and strep
How do hormones affect breasts in women and men?
Epithelial cells lining the ducts and acini, and intralobular connective tissue respond to sex hormones.
Lack of estrogen >> atrophy
Enlarge during puberty
What is gynecomastia?
Usually occurs due to excess estrogens
How common is fibrocystic change of the breast and how does it present clinically?
Affects 50% of women
Affects 10-15% clinically
Usually affects both breasts, may have one-sided pain, nodularity, sensitivity.
What are the pathologic features of fibrocystic breast change?
Fibrosis: loose intralobular connective tissue is replaced by dense connective tissu, rich in collagen but unresponsive to hormones.
Dilated ducts: entrapped in connective tissue strands and form cysts >> interruption of blood supply >> degenerative changes, necrosis, calcification
Proliferative breast disease: epithelium proliferates >> sclerosis adenosis
What is fibroadenoma, and how does it present clinically?
Most common benign tumor
- 2-5 cm
- encapsulated, round, lobulated
- 2 components: fibrous stroma and glandular epithelium
What are the risk factors for breast cancer?
- Whites (esp jews)
- Mother/sister with breast cancer
- early menarch
- late menopause
- no children
- late age at 1st pregnancy
What is the most common microscopic type of breast cancer?
80% are invasive ductal carcinoma
Most occur in the upper lateral quadrant
Macro: tumor appears grayish white because of abundance of CT between tumor cells
Micro: strands of cancer cells surrounded by abundant collagenous connective tissue
Correlate the macroscopic and microsocopic pathology of infiltrating duct carcinoma.
Form a strong desmoplastic reaction = dense connective tissue
How does breast cancer metastasize?
most = axillary area
Common distant sites = lungs, liver, bones, brain, adrenals
How is breast cancer usually diagnosed?
Mammography = noninvasive, painless procedure with x-ray. FNA requires local anesthesia. Surgical biopsy is performed in OR under general anesthesia.
What are the diagnosis and survival rates of breast carcnoma diagnosed in various clinical stages of the disease?
Stage 0: 92%
Stage I: 87%
Stage II: 75%
Stage III: 45%
Stage IV: 13%