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1、医学课件,1,DISEASES OF THE BREAST,医学课件,2,Lecture Objectives,At the end of the lecture the student should be able to:1. Discuss the etiology/pathologic features of different forms of benign non-neoplastic and neoplastic breast disease.2. List the benign breast diseases that increase a patients risk of de
2、veloping breast cancer and classify these conditions by the degree of risk.,医学课件,3,Lecture Objectives,At the end of the lecture the student should be able to:3. Outline other risk factors predisposing to breast cancer & incidence/prevalence of breast cancer.4. Classify breast cancer into histologic
3、subtypes and describe the pathologic features of each.5. List the prognostic factors for breast cancer.,医学课件,4,CLINICAL PRESENTATION,Palpable lumpInflammatory massNipple dischargeNon-palpable abnormality,METHODS OF DIAGNOSIS,FNACIncisional biopsyExcisional biopsyImage-guided biopsy,Jamaican Breast D
4、isease Study 2000-2 Clinical Findings,医学课件,7,BENIGN BREAST DISEASE,医学课件,8,INFLAMMATION, Acute Mastitis Most clinically important form of mastitisBreast-feeding cracks/fissures in the nipples bacterial infection (esp. Staph. aureus),医学课件,9,INFLAMMATION, Acute MastitisUsually unilateralacute inflammat
5、ion in the breast can lead to abscess formationTreatment = surgical drainage (often under general anesthesia) and antibiotics,医学课件,10,INFLAMMATION, Mammary Duct Ectasia5th and 6th decadesAffects mainly large ducts Periductal chronic inflammation destruction and dilation of the ducts with fibrosisThe
6、 underlying cause is unknown,医学课件,11,INFLAMMATION, Mammary Duct EctasiaPoorly defined periareolar mass; can be confused clinically/radiologically with carcinomaCan also present as a thick, cheesy nipple discharge +/- massPeriductal fibrosis skin retraction,医学课件,12,INFLAMMATION, Fat NecrosisUncommon
7、lesion; may be a history of trauma, prior surgical intervention or radiation therapyCharacterized by a central focus of necrotic fat cells with lipid-laden macrophages and neutrophils,医学课件,13,INFLAMMATION, Fat Necrosis Chronic inflammation with lymphs and multinucleated giant cellsMajor clinical sig
8、nificance is its possible confusion with carcinoma (e.g. fibrosis clinically palpable mass / Ca2+ seen on mammography),医学课件,14,NON-PROLIFERATIVE (“FIBROCYSTIC”) CHANGES,Most common breast disorderAlterations present in most women No associated risk of progression or cancer? Due to hormonal imbalance
9、s,医学课件,15,NON-PROLIFERATIVE (“FIBROCYSTIC”) CHANGES, Pathologic features:Cystic changeApocrine metaplasiaAdenosisFibrosis,医学课件,16,医学课件,17,医学课件,18,NON-PROLIFERATIVE (“FIBROCYSTIC”) CHANGES,Usually diagnosed 20 to 40 years Present as palpable lumps, nipple discharge or mammographic densities/calcifica
10、tions Often multifocal and bilateral general “lumpiness”,医学课件,19,PROLIFERATIVE DISEASE WITHOUT ATYPIA, Epithelial Hyperplasia number of layers of cells lining ducts and aciniInvolved ducts and acini are filled with overlapping,proliferating cells,医学课件,20,医学课件,21,PROLIFERATIVE DISEASE WITHOUT ATYPIA,
11、 Sclerosing AdenosisCharacterized by #acini + stromal fibrosis within lobules Can be assoc with calcifications which may be detected on mammography,医学课件,22,ATYPICAL HYPERPLASIA,Epithelial hyperplasia characterized atypical architectural and/or cytologic featuresCan affect ductsatypical ductal hyperp
12、lasia, or lobulesatypical lobular hyperplasia,医学课件,23,ATYPICAL HYPERPLASIA,Atypical features resemble but fall short of in-situ cancer No diagnostic clinical or radiologic features Incidence with use of screening mammography and number of breast biopsies,医学课件,24,BENIGN TUMOURS, FibroadenomaMost comm
13、on benign tumourCircumscribed lesion composed of both proliferating glandular and stromal elements,医学课件,25,医学课件,26,医学课件,27,BENIGN TUMOURS, FibroadenomaPatients usually present 30 years Classic presentation is that of a firm, mobile lump (“breast mouse”)Giant forms can occur, especially in younger pa
14、tients,医学课件,28,BENIGN TUMOURS, FibroadenomaCan be associated with proliferative changes in the adjacent breast tissueApprox. 20% of lesions are complex fibroadenomas characterized by certain specific histologic features,医学课件,29,BENIGN TUMOURS, Duct PapillomaBenign papillary epithelial tumour; occurs
15、 mainly in large ductsPapillae are fibrovascular stalks lined by layers of proliferating epithelial and myoepithelial cellsMost patients present with a serous or bloody nipple discharge,医学课件,30,医学课件,31,RELATIVE RISK FOR INVASIVE BREAST CANCER FOR BENIGN BREAST LESIONS,医学课件,32,RISK FOR INVASIVE BREAS
16、T CANCER,v No Increased Risk (NIR)Mastitis Fat necrosis Mammary duct ectasia Non-proliferative (“fibrocystic”) disease Fibroadenoma (simple),医学课件,33,RISK FOR INVASIVE BREAST CANCER,v Slightly Risk (SIR)= Risk 1.5-2 Times Moderate/florid hyperplasia Sclerosing adenosis Fibroadenoma (complex) Duct papilloma,医学课件,34,RISK FOR INVASIVE BREAST CANCER,v Moderately Risk (MIR) = Risk 4-5 TimesAtypical ductal hyperplasiaAtypical lobular hyperplasia,
