Breast Pathology
/Lec.no.1
Dr. Rawaa Ghalib
Breast Pathology :::
Inflammatory Disorders
1- Acute Mastitis
Almost all cases of acute mastitis occur during the first month of breast
feeding. During this time the breast is susceptible to bacterial infection
because of the development of cracks and fissures in the nipples, from
this portal of entry, Staphylococcus aureus or, less commonly,
streptococci invade the breast tissue.
Clinically Lactation mastitis usually affects only one breast and the
symptoms can develop quickly usually the breast is erythematous and
painful
(
pain or a burning sensation continuously or while breast-feeding)
and fever is often present, if not treated the infection may spread to the
entire breast.
Most cases of lactational mastitis are easily treated with
appropriate antibiotics.
Morphology:
Gross features:
Staphylococcal infections usually produce a localized area of acute
inflammation that may progress to the formation of abscesses.
Streptococcal infections tend to cause a diffuse spreading infection that
eventually involves the entire breast.
Microscopical features:
The breast tissue is infiltrated by neutrophils and may be necrotic.
2 - Mammary Duct Ectasia
This disorder tends to occur in the fifth or sixth decade of life, usually in
multiparous women, the principal significance of this disorder is that it
produces an irregular palpable mass that mimics the mammographic
appearance of carcinoma.
Mammary duct ectasia occurs when a duct beneath the nipple becomes
dilated and filled with fluid. The duct can then become blocked or
clogged with a thick, sticky substance.
Clinically patients present with a poorly defined palpable periareolar
mass that is often associated with
nipple discharge (thick, white nipple
secretions), skin retraction, pain and erythema are uncommon.
Morphology:
Gross features:
Grey white, firm mass with dilated ducts and intraluminal secretions.
Microscopical features:
Dilation of ducts, which filled by granular debris that contains numerous
lipid-laden macrophages.
The periductal and interductal tissue contains dense infiltrates of
lymphocytes and macrophages, and variable numbers of plasma cells and
fibrosis.
3 - Fat Necrosis
The majority of affected women have a history of breast trauma or
surgery
to an area of fatty tissue, the major clinical significance of the
condition is its possible confusion with breast cancer.
Clinically Fat necrosis can present as a painless palpable mass, skin
thickening or retraction, or mammographic calcifications.
Morphology:
Gross features:
Acute lesions may be hemorrhagic and contain central areas of necrosis.
In subacute lesions there is ill-defined, small, firm, gray-white nodules
containing small chalky-white foci or dark hemorrhagic debris.
Microscopical features:
Initially there is an intense neutrophilic infiltrate mixed with
macrophages. Over the next few days proliferating fibroblasts associated
with new vessels and chronic inflammatory cells surround the injured
area.
Eventually affected area is replaced by scar tissue or is encircled and
walled off by fibrous tissue
4-Lymphocytic Mastopathy (Sclerosing Lymphocytic
Lobulitis)
This condition is
affects both young and middle-aged women and is
frequently associated with type 1 (insulin-dependent) diabetes or
autoimmune thyroid disease. Based on this association, it is hypothesized
to have an autoimmune basis. Its only clinical significance is that it must
be distinguished from breast cancer.
The lymphocytes are mainly of the
B-cell type
Clinically This condition presents with single or multiple hard palpable
masses,the masses may be bilateral and may be detected as
mammographic densities.
Morphology:
Gross features: The lesion is grey white hard,
single or multiple
mass.
Microscopical features:
They show collagenized stroma surrounding atrophic ducts and lobules.
The epithelial basement membrane is often thickened,a prominent
lymphocytic infiltrate surrounds the epithelium and small blood vessels.