Pathology of the Breast: Benign and Premalignant Flashcards
Benign Lesions of the Breast
- Fibrocystic Changes (nonproliferative)
- Proliferative Changes
- Intraductal Papilloma
Benign Lesions of the Breast - Fibrocystic Changes (nonproliferative)
•include
- cysts
- apocrine metaplasia
- fibrosis
- adenosis
- THE most common breast disorder and the #1 cause for biopsy
- painful
- FCC represents a clinical problem as many as 50% of women, generally between ages 20 -45
- Etiology: Hormonal imbalance and/or abnormal end-organ sensitivity
- no increased risk of breast cancer
Benign Lesions of the Breast - Fibrocystic Changes (nonproliferative) - Cysts abd Apocrine Metaplasia
Benign Lesions of the Breast - Fibrocystic Changes (nonproliferative) - Fibrosis
Benign Lesions of the Breast - Fibrocystic Changes (nonproliferative) - Adenosis
•Increase in the number of glands(acini) per lobule
Benign Lesions of the Breast - Proliferative Changes
- Moderate or florid epithelial hyperplasia (>4 cell layers)
- Sclerosing adenosis (at least 2X normal acini in terminal duct)
- Radial scar
Benign Lesions of the Breast - Proliferative Changes - Floral Ductal Hyperplasia
Benign Lesions of the Breast - Proliferative Changes - Sclerosing Adenosis
• Radiologic findings
- Microcalcifications
- Area of architectural distortion
- Mass
• Histologic findings
- Lobulocentric
- Increased numbers of glands with sclerotic intralobular stroma
- Distorted, elongated &/or obliterated glands & tubules
Benign Lesions of the Breast - Proliferative Changes - Radial Scar
•Radiologic findings
-Stellate or spiculated lesions with radiolucent central area
Benign Lesions of the Breast - Proliferative Changes - Radial Scar Histologic Findings
- Central zone of fibroelastosis from which ducts & lobules radiate
- Benign ducts and lobules with dual cell layer
Benign Lesions of the Breast - Intraductal Papilloma
- Clinical presentation: Clear or bloody nipple discharge.
- Morphology: Grows in major lactiferous ducts just deep to nipple. Composed of fibrovascular cores lined by benign epithelium.
- Significance: Rule out carcinoma
- Solitary
- Lactiferous sinuses of nipple
- 80% spontaneous unilateral nipple discharge
- <1 cm diameter
- No well defined increased RR
Biphasic Tumors
The 2 breast specific biphasic tumors arise from glands and stroma of lobule.
- Fibroadenoma
- Phyllodes Tumor
Biphasic Tumors - Fibroadenoma
- Most common benign tumor of female breast; can be bilateral & multiple
- Frequently <30 years, premenopausal
- Presents as palpable mobile mass in young women
- Waxes and wanes during menstrual cycle since hormonally sensitive
- Gross: Well-circumscribed, rubbery, grayish white
- Morphology: even distribution of glands and stroma. Delicate, often myxoid stroma enclosing glandular and cystic spaces lined by bilayered epithelium; stroma becomes hyalinized with aging
•Treatment: Simple excision.
-No well-defined risk of breast cancer
Biphasic Tumors - Fibroadenoma Radiologic and Gross
Biphasic Tumors - Fibroadenoma Histologic
Biphasic Tumors - Phyllodes Tumor
- Rare tumor
- Most present in 6th decade
- Presents as Fast growing palpable mass
- Gross: Few cm to huge, bulbous protrusions and slit-like spaces (phyllodes is Greek for “leaflike”)
- Morphology: Stroma overgrows glandular component. Categorized as benign, borderline and malignant based upon: cellularity, mitotic rate and nuclear atypia, tumor margins: circumscribed or infiltrative
- Most are benign and indolent but rarely can behave aggressive with features of soft tissue sarcoma
- Treatment: Wide excision to prevent local recurrence
Biphasic Tumors - Phyllodes Tumor Radiologic
• Bulky mass with rapid growth
Gynecomastia
- Clinical: Unilateral or bilateral subareolar enlargement due to conditions leading to a decrease in testosterone compared to estrogen (medications, drugs, liver failure, tumors etc.)
- Morphology: Proliferation of breast ducts and stroma.
- Significance: Not associated with cancer
Benign Breast Changes - Inflammatory Conditions - Acute Mastitis
- Acute mastitis is essentially limited to the lactating breast.
- It presents with a painful, erythematous breast, usually with fever.
- Staphylococcus aureus or streptococci are the usual bacteria and are responsive to antibiotics.
- Inflammatory breast cancer can mimic acute mastitis and should be suspected in any nonlactating woman with the clinical appearance of mastitis
Benign Breast Changes - Inflammatory Conditions - Periductal Mastitis
- Periductal mastitis (recurrent subareolar abscess) presents as a painful erythematous subareolar mass that often recurs.
- More than 90% of patients are smokers.
- The morphology is duct rupture with intense chronic and granulomatous inflammation in response to spilled entrapped keratin that accumulates from keratinizing squamous epithelium extending to an abnormal depth in the nipple ducts.
- Treatment is surgical although antibiotics may be indicated if there is superimposed infection.
Benign Breast Changes - Inflammatory Conditions - Fat Necrosis
•Fat necrosis can present as a painless palpable mass or mammographic abnormality with calcifications that can be confused with breast cancer. May have a history of trauma.
Benign Breast Changes - Inflammatory Conditions - Mammary Duct Ectasia
- Mammary duct ectasia occurs in the 5th- 6th decades, in multiparous women and presents with painful periareolar redness and induration, often with thick white nipple secretions.
- It is not associated with cigarette smoking.
- Treatment is surgical drainage or excision. Need to rule out carcinoma.
