Benign Lesions of the Breast (Practical

Benign Lesions of the Breast
1-Papillomas
are benign neoplastic papillary growth composed of multiple branching fibrovascular cores, each having a connective tissue axis lined by (luminal and myoepithelial cells).
Growth occurs within a dilated duct. Large duct papillomas are usually solitary and situated in the lactiferous sinuses of the nipple. Small duct papillomas are commonly multiple and located deeper within the ductal system as seen in picture1,2.
Small duct papillomas have been shown to be a component of proliferative breast disease and increase the risk of subsequent carcinoma.

2-Fibroadenoma :
It’s the most common benign lesion found in the breast of woman of all ages but most often in woman under thirty .

Clinically: single mobile lamp in the breast and increased estrogenic activity may play a role in their development .

Macroscopically :the nodule is usually single ,mobile, firm ,white ,1-10 cm in diameter,encapsulated as seen in picture 3.

Microscopically : there is proliferation of both epithelial and stromal components .
Epithelial form glandular structure lined by single layer or multiple layers of cells that are regular and intact basement membrane .

There is two patterns of growth
1-Pericanalicular pattern : rounded duct usually small with stroma surrounded them as seen in picture 4..
2- Intracanalicular pattern : the ducts appear elongated compressed by extensive proliferation of stromal elements.
stromal elements :-there is loose fibroblastic stroma .
















Carcinoma of the Breast
is the most common malignancy of the breast, in women. .
Risk Factors.
The most common risk factors for the development of breast cancer,.
• Age. Breast cancer is rarely found before the age of 25 years except in certain familial cases.. Seventy-seven per cent of cases occur in women over 50 years of age.
• Age at Menarche. Women who reach menarche when younger than 11 years of age have a 20% increased risk
• Race.
• Estrogen Exposure
• Radiation Exposure
• Carcinoma of the Contralateral Breast or Endometrium
• Diet
• Obesity
• Environmental Toxins
CLASSIFICATION OF BREAST CARCINOMA
Almost all breast malignancies are adenocarcinomas, all other types (i.e., squamous cell carcinomas, phyllodes tumors, sarcomas, and lymphomas) making up fewer than 5% of the total.
Carcinomas are divided into in situ carcinomas and invasive carcinomas.
Carcinoma in situ refers to a neoplastic population of cells limited to ducts and lobules by the basement membrane.

Carcinoma in situ was classified as ductal or lobular on the carcinoma in situ

Ductal Carcinoma in Situ (DCIS; Intraductal Carcinoma)
The number of cases of DCIS has rapidly increased in the past two decades frequently presents as mammographic calcifications). Less typically, DCIS presents as a mammographic density or palpable mass or nipple discharge.

DCIS consists of a malignant population of cells limited to ducts and lobules by the basement membrane. The myoepithelial cells are preserved, although they may be diminished in number as seen in picture in picture 5. Cribriform Pattern
Is characterized by neoplastic malignant cells with low-grade malignant cells , no area of central necrosis and no calissification .These surounded an empty space called Swiss chasse appearance as seen in picture in picture 6
Fibrosis and chronic inflammation are also present


Invasive (Infiltrating) Carcinoma
invasive carcinoma almost always presents as a palpable mass. By the time a cancer becomes palpable, over half the patients will have axillary lymph node metastases.
Larger carcinomas may be fixed to the chest wall or cause dimpling of the skin. Lymphatics may become so involved as to block the local area of skin drainage and cause lymphedema and thickening of the skin, a change referred to as peau d orange. Tethering of the skin to the breast by Cooper ligaments mimics the appearance of an orange peel s seen in picture 7.
Invasive Lobular Carcinoma

The incidence of lobular carcinomas has been reported to be increasing among postmenopausal women It has been suggested that this increase may be related to the use of postmenopausal hormone replacement therapy.
Morphology.
Grossly, most tumors are firm to hard with an irregular margin. Occasionally, the tissue may feel diffusely thickened and a discrete tumor mass cannot be defined. s seen in picture 7.
Microscopically:
malignant small cells that have oval or round nuclei with small nucleoli that do not adhere to one another often only one cell in width (in the form of a single file) or in loose clusters or sheets). The desmoplastic response may be minimal or absent s seen in picture 8..