breast disease pathology & imaging

7/29/2019 Breast Disease Pathology & Imaging

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Diseases of the breast


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Breast diseases 20072

IndexBreast Injuries

Breast abscess

Normal anatomy & mammography

Fibrocystic disease

Simple cysts

Mammary duct ectasia

Breast neoplasms (Classification)

Duct papilloma

Breast lipoma

Fibroadenoma

Phylloides tumour

Cancer Breast

Ductal CA (Path)

Lobular CA (Path)

Pagets disease

Triple assessment

Mammography

Isotope bone scan

Staging of CA breast

Ca breast gross pathology


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Diagnosis of breast masses

Triple

assessment

Clinical Imaging Histopathology

Index


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Breast InjuriesBlunt breast trauma can produce

1-Breast Hematoma

Following blunt traumaor breast surgery .

Old organizedHematoma withoutoverlying skin bruisingis difficult to diagnosecorrectly except by

biopsy.

DD cancer breast

2-Traumatic Fat Necrosis

Trauma Fat NecrosisRelease of Fatty Acids F.A. +Ca Ca Soaps (FBG)

Painless irregular hard masswith no LN in the axilla with skintethering and even nippleretraction

Trauma history is a trap,Mammography is not conclusive

DD cancer breast

Biopsy: Foamy fat laden macrophages

Index


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Breast heamatoma following surgery

Index


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Acute Inflammation of the Breast

Etiology:organisms, predisposing factors,routes of infect.

Pathology: sites: (pre,intra or

retromammary)

Breast Abscess

Stages:Milk engorgement:Dull ache pain,shivering, low grade fever wedge shaped

tender induration no signs of inflammation

Cellulites: Burning pain, high grade

persistent fever diffuse swelling withtender red induration

Pus formation:Throbbing pain ,Hecticfever local signs localized to one sector&

overlying skin pitting oedema

Index


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Sites:

Premammary

Intramammary

Retromammary

Breast Abscess

Etiology:

Organisms:

Predisposing factors:

Routes of infect:

Treatment:Early & After pus formation

(stop lactation)

Hilton method

Index


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A thin skin margin with no retraction of either skin or nipple. The glandular tissue is interspersed with fat

and there are relatively regular bands of suspensory ligaments known as Cooper's ligaments. Note that

the radiograph showsno dominant or irregular massandno evidence of any microcalcifications,both are findings which may be observed in carcinomas.

Illustration & Mammography of normal breast

Index


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The normal mammography image shows a thin, regular skin line with a diffuse, even,

soft tissue density of the general glandular tissue and fatty structures organized in a

relatively regular way by Cooper's ligaments

Normal mammography (craniocaudal)

Index


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Normal variations

Fatty breast Dense breastIndex


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PathologyThe disease consists of 4

features that vary in extent

and degree

Adenosis,Epitheliosis (atypical

epithelial hyperplasia),Papillomatosis,Fibrosis sometimes-extensive forming hardmass (sclerosingadenosis) simulatingcancer.Cyst formation.

Risk of malignancy.

Fibrocystic Disease

Fibroadenosis

Index


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Gross appearance of fibrocysticchanges in the breast.

Fibrocystic disease ofthe Lt. breast

Fibrocystic

Disease

Index


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Simple cysts

Multiple circumscribed low soft tissue

dense lesions seen in both breasts

Ultrasound showing the typical

features of a simple cyst: a well

defined, anechoic (black) lesionwith posterior echoic

accentuation (white)

Index


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Mammary Duct EctasiaPeriductal or plasma cell mastitis

What is ectasia?As a woman approaches menopause the

mammary ducts, which are located under the

nipple, become dilated . This dilation is called

ectasia.

Ectasia is a benign (non-cancerous) breastcondition.

Ectasia can lead to a blockage of the ducts. As

a result, fluid may become pooled and leak into

the surrounding tissue causing chronic

inflammation. If an infection, (also referred to asperiductal mastitis) occurs, it may cause scar

tissue to develop, thus drawing the nipple

inward. In addition, this infection may cause

breast pain and thick, sticky nipple discharge

Index


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Breast NeoplasmClassification

Benign

Epithelial

Duct PapillomaMesenchymalLipoma Fibroma

MixedFibroadenoma

Malignant

CARCINOMALymphoma,Sarcoma

Index


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Duct PapillomaPathology Situated in one of the major

ducts near its orifice usually single butmay be multiple and peripheral (MultiplePapillomatosis)

Clinical Pictureyoung adult female (30-45)

presenting with blood discharge fromthe nipple, on examination a fresh drop ofblood is seen on pressure at a certain point or apalpable small fusiform retroareolar mass is felt(retention cyst due to obstruction of the duct byclotted blood) pressure on it produces the

discharge. InvestigationsBenzedine test discharge is

+ve for blood.

Galactography using lipiodol shows regularfilling defect

Treatment microdochectomy Index


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Lipoma in the breastA large circumscribed radiolucent mass with

a thin capsule (arrow) and coarse

calcification

Index


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Fibroadenoma

Index
http://www.emedicine.com/cgi-bin/foxweb.exe/makezoom@/em/makezoom?picture=/websites/emedicine/ped/images/Large/2762FIBRO3.jpg&template=izoom2


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A benign fibroadenoma of the breast is distinguished by its sharp margins and lack of

microcalcifications.

There is no skin retraction or extensions into the parenchymal tissue.

Fibroadenoma

Index


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Fibroadenoma

Mammography showed 9 mm solid nodule

Ultrasound showed oval, hypoechoic andhomogeneous mass, suggesting a benign lesion

Index


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Phylloides Tumour

Index


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Cancer Breast

Index


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PathologyDuctal Carcinoma

In situ ductal

carcinoma

Invasive ductalcarcinoma

Inflammatory

carcinoma

Index


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Pathology

Lobular carcinoma

Lobular Carcinoma In Situ (LCIS) RR10premenoposal 1% in biopsiesMulticenteric, bilateral

Invasive lobular carcinoma (ILC) 10%

Bilateral in 25% of casesPrognosis remains unaffected when thesecond tumour is not synchronus.

Index


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Pathology

Pagets Disease

Index


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Diagnosis of cancer breast

Open biopsy with frozen section MRI (Indications)

Bone scan (Indications)

Index


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Fine needle

aspiration cytology True cut tissue

biopsy

Open biopsy with

frozen section

Histopathological assessment:

Index


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Radiologicalassessment:

Breast US

Breast ultrasound is used as the initial method for evaluating the following symptomatic patients:

The young patient under 30 years of age.

The pregnant patient.Follow-up of patients with fibrocystic disease (3-6 month intervals).

Breast ultrasound is used as a complementary examination to mammography in the following

situations:

Evaluation of dense breast tissue.

Evaluation of a mass demonstrated on mammography.

Guidance of biopsy needle or needle localization (see cyst aspiration image) Index


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Radiological assessment:

Mammography

Index


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Breast diseases 200730 Invasive duct carcinoma giving a speculate mass on mamography

Mammography :

Cancer breast

Index


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Small (7mm) infiltrativeductal carcinoma

Index


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Mammography demonstrating a

focal area of soft tissue density

measuring 0.8 x 2.0 cm.

Architectural distortion and

microcalcifications are also

noted.

The mass is categorized as

'highly suspicious' for

malignancy

Pathology confirmed aninfiltrating, moderately

differentiated adenocarcinomawith an extensive intraductal component

Index


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Malignant masses are often characterized by irregular tented boundaries with retraction of other

fibrous structures and may be accompanied by local skin thickening or microcalcifications

Notice the

retracted

nipple

Index


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Breast diseases 200734 Cranio-codal view Medio-lateral view

Mammography showing microcalcification

Close-up view

Index


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Ductal carcinoma insitu (high grade comedo type)

Irregular linear branching microcalcification

Index


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Cluster of very small microcalcifications with or without increased local density of the

breast is an important image finding indicating malignancy.

The finding merits specific attention even if it is not accompanied by any other of the

typical findings in carcinoma such as skin retraction or irregular mass boundary

Microcalcifications in intra-ductcarcinoma

Index


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Large malignant mass with skin retraction

Mammography : Cancer breast

Index


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Vertebral metastasis from cancer

breast

Isotope bone scan

Normal Multiple bone metastasis

Index

S i f B C


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Staging of Breast Cancer

TNM ClassificationT = TumourT0 Carcinoma in situ

T1 Less than 2cm

T2 Tumor diameter 2-5cm

T3 Larger than 5cm

T4 Any size invadingskin,,chest wall

N = NodesN0 Nonpalpable axillary LN

N1 Ipsilateral mobile LN

N2 Ipsilateral fixed LN

N3 Supraclav.Int mammarycontralateral axillary LN

M = MetastasesM0 No metastases

M1 Distant metastases

Manchester Classification

Stage I Mass confined to the breast, skininvolvement over and smaller

Stage II Same + palpable mobile one groupof LN in Ipsilateral axilla

Stage III Same + one of the following:1- Skin invasion larger than size of the mass

2- Mobile more than one group Ax.LN

3- Mass fixed to underlying muscles&fascia

Stage IV Same + one of the following:1-Marked skin affection nodules,ulcer

2-Fixed Ipsilateral.ax.LN.

3- Ipsilateral.supraclavicular LN

4- Mass fixed to chest wall.

5- Distant deposits,otherbreast,contralateral.axilla

Index

B i


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Peau d'orange"

Breast carcinoma

Index

B t i


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Breast carcinoma

This is an old specimenand the adipose tissue

has become rather dark

It shows an ill defined

grayish tumour in the

breast, through which

run yellow streaks ofnecrosis.

The nipple is retracted

& the tumour isinfiltrating the

underlying pectoral

muscle.

Index

B t i


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Breast carcinoma

Pectoralis muscle

Tumour

Axillary LNs

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