Pathology of the breast

Dr. Ann saparamadu

Normal breast
Duct lobular unit

Duct lobular unit

lobule

Classification of breast disease

1. Inflammatory disorders
- acute pyogenic mastitis
- mammary ductectasia
- fat necrosis
2. Benign proliferate breast diseases
- fibrocystic change
- benign tumours - Fibroadenoma
- duct papilloma
- nipple adenoma
3. Breast carcinoma
- malignant tumours
4. Stromal tumours
- phylloides tumours

Clinical features of breast diseases

Lump mobile
lumpiness
ill-defined softfirm - carcinoma
Nipple discharge
ductectasia
duct papilloma
carcinoma
Nipple eczema
- nipple adenoma

fibroadenoma *
fibrocystic disease *
fibrocystic change * ill-defined
clear/blood stained

- Pagets disease *

Inflammatory diseases
1. Acute pyogenic mastitis
Acute inflammatory lesion
Usually in post partum period
Staphylococcus aureus commonest
Usually confined to a segment
Streptococcus pyogenes - wide spread
inflammation and systemic symptoms
Leads to breast abscess

Inflammatory diseases
1. Fat necrosis
Localized area of inflammation following
trauma
Necrosis fat cells induce inflammation and
repair
Fat necrosis
Fibrosis in repair gives rise to firm
irregular lump
Mimics malignancy

Fat necrosis
microscopy

Inflammatory diseases
3 Ductectasia
Abnormal progressive dilatation of large breast
ducts
Destruction of periductal elastic tissue
Accumulate secretory products and shed epithelium
in the lumen
Induces chronic inflammation and fibrosis
Clinically - perimenopausal age, nipple discharge
firm ill defined lump mimics malignancy
No risk of malignancy

Classification of breast disease

1. Inflammatory disorders
- acute pyogenic mastitis
- mammary ductectasia
- fat necrosis
2. Benign proliferate breast diseases
- fibrocystic change
- benign tumours - Fibroadenoma
- duct papilloma
- nipple adenoma
3. Breast carcinoma
- malignant tumours
4. Stromal tumours
- phylloides tumours

Proliferative diseases
Fibrocystic disease(fibroadenosis)
Most frequent disorder of the female breast
Starts in early middle age, peaks at perimenopausal
period and reduce in post menopausal period
Manifest clinically in 10% but asymptomatic in 40%
Synonyms - Fibroadenosis, cystic mastopathy
chronic mastitis
Aetiology - poorly understood
- imbalance of oestrogen and
progesterone

Fibrocystic change
Characterized by hyperplastic overgrowth of
components of the mammary units
Epithelial overgrowth
- increase acini adenosis
- epithelial proliferation
- papillomatosis
Fibrous overgrowth ( specialized hormone
responsive breast supporting stroma)
- fibrosis

Fibrocystic change
Depends on the underlying pathology
adenosis
epithelial hyperplasia
paillomatosis
apocrine metaplasia
sclerosing adenosis
cysts
fibrosis

Fibrocystic change

Fibrocystic change
Clinical importance
many women have periodic discomfort
anxiety due to lump/ lumpiness
clinically mimics a carcinoma
One component, epithelial hyperplasia leads
has a higher risk of malignancy

Epithelial hyperplasia

Gynaecomastia

Normally male breast has only ducts

Common proliferative disorder of the male breast
Clinically firm mobile disc beneath the nipple
Common in adolescents and old age
De3pends on oestrogen
hyperthyroidism, pituitary disorders, tumours of the
testis and adrenals, stilbestrol therapy, Klinfelters
cirrhosis, drugs

Gynaecomastia
micro

Benign tumours
1

Fibroadenoma
Commonest type of benign tumour
Common in young
Peak in the third decade
Solitary / Multiple
Arise from breast lobule

Fibroadenoma
micro

Benign tumours
2.

Duct papilloma
Middle aged women
Blood stained discharge
Usually a solitary lesion
Less common

Duct papilloma
micro