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Block 2 PATH Exam -- Breast Pathology Lecture


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Terminal Duct Lobular Unit
lobule + terminal duct
Path of excretion
Terminal duct --> Lactiferous duct
Lactiferous duct --> Lactiferous sinus
Lactiferous sinus --> Collecting Duct
Acute Mastitis
Usually occurs with breast feeding
Most common pathogen is Staph Aureus
Antibiotics avoid abscess development
Granulomatous Mastitis
Etiology includes:

Foreign material
Mycobacterial infection
Mammary Duct Ectasia
Dilated large and intermediate ducts filled with histiocytes and secretions
Typically occurs in older women
May simulate cancer if there is a rupture
Fat Necrosis
May simulate cancer (forms a mass)
Etiology is usually trauma
Fibrocystic changes
Not a "disease"
Usually 20 - 50 yr old women (very common)
May simulate carcinoma
Dilation of terminal ducts with cyst formation
Apocrine metaplasia
Sclerosing Adenosis -- proliferation and distortion of ducts and acini
Risk for cancer determined by presence of ductal hyperplasia
Ductal Hyperplasia
Often accompanies fibrocystic changes
Histology -- increased epithelial cells within ducts
Atypical hyperplasia --> increased risk for cancer
Radial Scar
Fibroelastic core with radiated ducts and lobules
May simulate carcinoma, but is BENIGN
Common (20 - 35 yo)
Enlarged during pregnancy, regress with age
May simulate carcinoma
Elongated ducts in loose fibromyxoid stroma
Intraductal Papilloma
Average age of 50 yo
Arises in large (nipple discharge) or small ducts (younger pts.)
BENIGN, but sometimes associated with DCIS elsewhere
Nipple Papilloma
Average age 4th - 5th decades
Arises in ducts WITHIN NIPPLE
May simulate Paget's disease
Carcinoma In Situ
Lesion composed of malignant neoplastic epithelial cells
Confined within the basement membrane
Precursor to invasive carcinoma (NOT ALL cases progress)
Ductal CIS
Malignant ductal-type cells confined within the BM
Markedly increased risk in ipsilateral breast
Slightly increased risk in contralateral breast
Risk of progression to invasive cancer directly proportional to cytologic grade
High grade cytology + comedo necrosis
Comedo necrosis --> hard plug of sebum and dead skin
Associated with a higher risk of development of invasive carcinoma
Lobular CIS
Malignant lobular-type cells confined within the BM
Generally MULTIFOCAL (70%)
Frequently BILATERAL (30-40%)
Markedly increased risk in BOTH ipsi/contralateral breasts
Paget's Disease
CIS confined within the NIPPLE
Presents as nipple with ulceration/eczema-like changes
Usually associated with an underlying carcinoma
Most common malignancy in women
Invasive Breast Carcinoma
Morphologic types of Invasive Carcinoma
DUCTAL -- vast majority (50-70%); Presents as mass; variety of architectures
LOBULAR -- 5-10%; Often does NOT present with mass; Diffuse growth; arranged in CORDS
Inflammatory Carcinoma
NOT a distinct histological type
Refers to erythematous changes and dermal lymphatic spread of tumor
Very ominous prognosis (death within 2 yrs)
Routes of spread for invasive carcinoma
Direct invasion
Lymphatic (AXILLARY lymph nodes most common)
Phylloides Tumor
"Leaf-like" appearance
Median age of 45 yo
High-grade -- prone to local recurrence and occasional metastasis
Male Breast Cancer
1% of all breast carcinomas
Higher risk in Kleinfelter's
Age -- Elderly
Nipple discharge is a worriesome sign

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