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Breast disease pathology & imaging
1.
Diseases of the
breast
2.
© Breast diseases
20072 Index Breast 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) Paget’s disease Triple assessment Mammography Isotope bone scan Staging of CA breast Ca breast gross pathology
3.
© Breast diseases
20073 Diagnosis of breast masses Triple assessment Clinical Imaging Histopathology Index
4.
© Breast diseases
20074 Breast Injuries Blunt breast trauma can produce 1-Breast Hematoma Following blunt trauma or breast surgery . Old organized Hematoma without overlying skin bruising is difficult to diagnose correctly except by biopsy. DD cancer breast 2-Traumatic Fat Necrosis Trauma Fat Necrosis Release of Fatty Acids F.A. + Ca Ca Soaps (FBG) Painless irregular hard mass with no LN in the axilla with skin tethering and even nipple retraction Trauma history is a trap, Mammography is not conclusive DD cancer breast Biopsy: Foamy fat laden macrophages Index
5.
© Breast diseases
20075 Breast heamatoma following surgery Index
6.
© Breast diseases
20076 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 with tender red induration Pus formation: Throbbing pain ,Hectic fever local signs localized to one sector& overlying skin pitting oedema Index
7.
© Breast diseases
20077 Sites: Premammary Intramammary Retromammary Breast Abscess Etiology: Organisms: Predisposing factors: Routes of infect: Treatment: Early & After pus formation (stop lactation) Hilton method Index
8.
© Breast diseases
20078 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 shows no dominant or irregular mass and no evidence of any microcalcifications, both are findings which may be observed in carcinomas. Illustration & Mammography of normal breast Index
9.
© Breast diseases
20079 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
10.
© Breast diseases
200710 Normal variations Fatty breast Dense breast Index
11.
© Breast diseases
200711 Pathology The disease consists of 4 features that vary in extent and degree Adenosis, Epitheliosis (atypical epithelial hyperplasia), Papillomatosis, Fibrosis sometimes- extensive forming hard mass (sclerosing adenosis) simulating cancer. Cyst formation. Risk of malignancy. Fibrocystic Disease Fibroadenosis Index
12.
© Breast diseases
200712 Gross appearance of fibrocystic changes in the breast. Fibrocystic disease of the Lt. breast Fibrocystic Disease Index
13.
© Breast diseases
200713 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) lesion with posterior echoic accentuation (white) Index
14.
© Breast diseases
200714 Mammary Duct Ectasia Periductal 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) breast condition. 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 as periductal 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
15.
© Breast diseases
200715 Breast Neoplasm Classification Benign Epithelial Duct Papilloma Mesenchymal Lipoma Fibroma Mixed Fibroadenoma Malignant CARCINOMA Lymphoma, Sarcoma Index
16.
© Breast diseases
200716 Duct Papilloma Pathology Situated in one of the major ducts near its orifice usually single but may be multiple and peripheral (Multiple Papillomatosis) Clinical Picture young adult female (30-45) presenting with blood discharge from the nipple, on examination a fresh drop of blood is seen on pressure at a certain point or a palpable small fusiform retroareolar mass is felt (retention cyst due to obstruction of the duct by clotted blood) pressure on it produces the discharge. • Investigations Benzedine test discharge is +ve for blood. Galactography using lipiodol shows regular filling defect • Treatment microdochectomy Index
17.
© Breast diseases
200717 Lipoma in the breast A large circumscribed radiolucent mass with a thin capsule (arrow) and coarse calcification Index
18.
© Breast diseases
200718 Fibroadenoma Index
19.
© Breast diseases
200719 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
20.
© Breast diseases
200720 Fibroadenoma Mammography showed 9 mm solid nodule Ultrasound showed oval, hypoechoic and homogeneous mass, suggesting a benign lesion Index
21.
© Breast diseases
200721 Phylloides Tumour Index
22.
© Breast diseases
200722 Cancer Breast Index
23.
© Breast diseases
200723 Pathology Ductal Carcinoma In situ ductal carcinoma Invasive ductal carcinoma Inflammatory carcinoma Index
24.
© Breast diseases
200724 Pathology Lobular carcinoma • Lobular Carcinoma In Situ (LCIS) RR10 premenoposal 1% in biopsies Multicenteric, bilateral • Invasive lobular carcinoma (ILC) 10% Bilateral in 25% of cases Prognosis remains unaffected when the second tumour is not synchronus. Index
25.
© Breast diseases
200725 Pathology Paget’s Disease Index
26.
© Breast diseases
200726 Paget’s disease of the nipple
27.
© Breast diseases
200727 Advancer Paget’s disease of the nipple with axillary LNs
28.
© Breast diseases
200728 Diagnosis of cancer breast Open biopsy with frozen section MRI (Indications) Bone scan (Indications) Index
29.
© Breast diseases
200729 Fine needle aspiration cytology True cut tissue biopsy Open biopsy with frozen section Histopathological assessment: Index
30.
© Breast diseases
200730 Radiological assessment: 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
31.
© Breast diseases
200731 Radiological assessment: Mammography Index
32.
© Breast diseases
200732 Invasive duct carcinoma giving a speculate mass on mamography Mammography : Cancer breast Index
33.
© Breast diseases
200733 Small (7mm) infiltrative ductal carcinoma Index
34.
© Breast diseases
200734 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 an infiltrating, moderately differentiated adenocarcinoma with an extensive intraductal component Index
35.
© Breast diseases
200735 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
36.
© Breast diseases
200736 Cranio-codal view Medio-lateral view Mammography showing microcalcification Close-up view Index
37.
© Breast diseases
200737 Ductal carcinoma insitu (high grade comedo type) Irregular linear branching microcalcification Index
38.
© Breast diseases
200738 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-duct carcinoma Index
39.
© Breast diseases
200739 Large malignant mass with skin retraction Mammography : Cancer breast Index
40.
© Breast diseases
200740 Vertebral metastasis from cancer breast Isotope bone scan Normal Multiple bone metastasis Index
41.
© Breast diseases
200741 Staging of Breast Cancer TNM Classification T = Tumour T0 Carcinoma in situ T1 Less than 2cm T2 Tumor diameter 2-5cm T3 Larger than 5cm T4 Any size invading skin,,chest wall N = Nodes N0 Nonpalpable axillary LN N1 Ipsilateral mobile LN N2 Ipsilateral fixed LN N3 Supraclav.Int mammary contralateral axillary LN M = Metastases M0 No metastases M1 Distant metastases Manchester Classification Stage I Mass confined to the breast, skin involvement over and smaller Stage II Same + palpable mobile one group of 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,other breast,contralateral.axilla Index
42.
© Breast diseases
200742 “Peau d'orange" Breast carcinoma Index
43.
© Breast diseases
200743 Breast carcinoma This is an old specimen and the adipose tissue has become rather dark It shows an ill defined grayish tumour in the breast, through which run yellow streaks of necrosis. The nipple is retracted & the tumour is infiltrating the underlying pectoral muscle. Index
44.
© Breast diseases
200744 Breast carcinoma Pectoralis muscle Tumour Axillary LNs Index
45.
© Breast diseases
200745 Advanced fungating cancer breast Advanced CA breast with malignant ulcer & nipple retraction
46.
© Breast diseases
200746 Bilateral (axillary) accessory breasts
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