LYMPHATIC DRAINAGE AXILLARY (MOSTLY) INTERNAL MAMMARY SUPRACLAVICULAR
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1 BREAST
2
3 LYMPHATIC DRAINAGE AXILLARY (MOSTLY) INTERNAL MAMMARY SUPRACLAVICULAR
4 HISTOLOGY LOBE: (10 in whole breast) LOBULE: (many per lobe) ACINUS/I, aka ALVEOLUS/I: (many per lobule) DUCT(S): INTRA- or INTER- LOB(UL)AR, leading to the lactiferous ducts in the nipple
5 L O B E
6 LOBULE
7
8 One single ACINUS (alveolus) Epithelial cells MYO-epithelial cells
9 THREE NORMAL PHASES ACTIVE: about Gland/Stroma ratio LACTATING: Mostly Glands (like thyroid!!!), >>>50/50 ATROPHIC: mostly stroma, <<<50/50
10
11
12
13
14 The most important thing to understand breast pathology is to get a solid IMAGE of the NORMAL breast lobule----acini, STROMA, BOUNDARIES
15 BREAST PATHOLOGY DEVELOPMENTAL: DEGENERATION: INFLAMMATION: NEOPLASM:
16 DEVELOPMENTAL MILKLINE REMNANTS ACCESSORY (axillary) BREAST TISSUE NIPPLE INVERSION MACROMASTIA
17
18
19 ACCESSORY (axillary) BREAST TISSUE
20 1) CONGENITAL 2) ACQUIRED: CARCINOMA 3) ACQUIRED: PIERCING
21
22 DEGENERATION ATROPHY
23
24 INFLAMMATION ACUTE, staph most common PERIDUCTAL DUCT-ECTASIA FAT NECROSIS, usually trauma LYMPHOCYTIC, i.e., diabetic GRANULOMATOUS, sarcoid, TB, etc., but mostly idiopathic
25 ACUTE MASTITIS
26
27
28 INFLAMMATION? Peau d orange
29
30
31 PERIDUCTAL INFLAMMATION
32 DUCTESIA
33 Ductesia CYSTS
34 CUBOIDAL RED COLUMNAR COLUMNAR i.e. APOCRINE
35 FAT NECROSIS
36 FAT NECROSIS
37 LYMPHOYCYTIC MASTITIS (DIABETIC MASTOPATHY)
38 GRANULOMATOUS MASTITIS
39 Benign epithelial Benign stromal Premalignant Malignant epithelial (ductal, lobular) (adenocarcinomas) (insitu, infiltrating) Malignant stromal
40 CLINICAL PRESENTATIONS, palpable or mammographic NIPPLE DISCHARGE PAIN
41 BENIGN EPITHELIAL, aka, FIBROCYSTIC disease NON-proliferative epithelium: i.e., cysts, fibrosis, adenosis PROLIFERATIVE epithelium: hyperplasia, sclerosing adenosis, papilloma, fibroadenoma ATYPICAL epithelium
42 CYST
43
44 CYST, GROSS CYST, MICROSCOPIC
45 ADENOSIS acini/lobule
46 FIBROSIS + CYSTS = FIBROCYSTIC DISEASE
47 BENIGN EPITHELIAL, aka, FIBROCYSTIC disease NON-proliferative epithelium: i.e., cysts, fibrosis, adenosis PROLIFERATIVE epithelium: hyperplasia, sclerosing adenosis, papilloma, fibroadenoma ATYPICAL epithelium
48 DUCTAL HYPERPLASIA
49 SCLEROSING ADENOSIS
50 COMPLEX SCLEROSING ADENOSIS (RADIAL SCAR)
51 SCLEROSING ADENOSIS
52 FIBROADENOMA: 1) EXTREMELY WELL DEFINED 2) YOUNGER WOMEN 3) ALWAYS BENIGN 4) CAN FIBROSE OR CALCIFY WITH AGE
53 PAPILLOMA
54 PAPILLOMA
55 PAPILLOMA
56 BENIGN EPITHELIAL, aka, FIBROCYSTIC disease NON-proliferative epithelium: i.e., cysts, fibrosis, adenosis PROLIFERATIVE epithelium: hyperplasia, sclerosing adenosis, papilloma, fibroadenoma ATYPICAL epithelium
57 FEATURES OF ATYPIA LOSS OF STROMA BETWEEN ACINI SWISS CHEESE HYPERPLASIA* CRIBRIFORMING** CELLULAR PLEOMORPHISM CELLULAR HYPERCHROMASIA INCREASED/ABNORMAL MITOSES* ROMAN BRIDGES*** NECROSIS*** ( COMEDO-carcinoma )
58 NORMAL DUCT NORMAL ACINUS ATYPICAL HYPERPLASIA of DUCT ATYPICAL HYPERPLASIA, LOBULE
59
60
61 DCIS
62 DCIS, microcalcifications
63 DCIS, microcalcifications
64
65 DCIS, ROMAN BRIDGES
66 NORMAL lobule
67
68 CIS
69 Usually hangs around MANY MANY years before it infiltrates, in contrast to DCIS The BEST management may be judicious neglect, i.e., observation If it does infiltrate, however, it is at least as bad as DCIS infiltrating, or probably WORSE, showing indian files
70 BREAST CANCER RISK FACTORS Age Menarche Age, early menarche is a risk First Live Birth First-Degree Relatives with Breast Cancer Breast Biopsies Race (caucasian the highest) Estrogen Exposure, prolonged, early menarche, late menopause Radiation Exposure Carcinoma of the contralateral breast or endometrium Geographic Influence Diet (high fat diet is riskiest) Obesity Exercise Lack of breast feeding is a risk, Lack of prior pregnancy is a risk. Environmental Toxins Tobacco ABORTIONS?
71 BREAST CANCER PROGNOSTIC FACTORS STAGING, especially POS or NEG lymph nodes, TNM, etc. AGE GENERAL HEALTH and IMMUNITY Histologic degree of differentiation, i.e., GRADING ERA/(PRA) Her2, aka Her2-Neu
72 STAGING, TNM, based on biologic behavior IN-SITU EARLY disruption of the basal lamina, i.e., basement membrane STROMAL infiltration LYMPHATIC vessels SENTINAL lymph node metastasis MORE lymph node metastases Adjacent structures, skin, ie, inflammatory DISTANT, METASTASES, LIVER, BONE, LUNGS, BRAIN, EVERYWHERE
73 Total Cancers Per Cent In Situ Carcinoma * Ductal carcinoma in situ, DCIS 80 Lobular carcinoma in situ, LCIS 20 Invasive Carcinoma No special type carcinoma ("ductal") 79 Lobular carcinoma 10 Tubular/cribriform carcinoma (Better prognosis than average) Mucinous (colloid) carcinoma (Better prognosis than average) Medullary carcinoma (Better prognosis than average) 2 Papillary carcinoma 1 Metaplastic carcinoma, (Squamous) 6 2
74 HISTOLOGIC TIDBITS INFILTRATING DUCTAL INFILTRATING LOBULAR (INDIAN FILE) TUBULAR (LOOKS LIKE SCLEROSIS, BUT NO BASEMENT MEMBRANE) MUCINOUS (COLLOID) MEDULLARY (LOTS of LYMPHOCYTES)
75 INFILTRATING DUCTAL
76 INFILTRATING LOBULAR CA., INDIAN FILE PATTERN
77
78 INFILTRATING DUCTAL CA., TUBULAR PATTERN or TYPE
79 INFILTRATING DUCTAL CA., MUCINOUS (COLLOID) PATTERN or TYPE
80 INFILTRATING DUCTAL CA.,
81 NEOPLASIA, STROMAL Cysto- SARCOMA PHYLLODES (aka, PHYLLODES TUMOR), Looks like a giant fibroadenoma, really NOT a sarcoma SARCOMAS, true, are RARE!!!!
82 FIBROADENOMA
83 MALE BREAST GYNECOMASTIA (related to hyperestrogenism) CARCINOMA (1% of )
84 GYNECOMASTIA (NO lobules)
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