(From Middle Robbins by Brian Buschman)
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Fibrocystic change is simply a fibrotic change in the breast which makes a lump, but that is the extent of the problem.
1) Nonproliferative change is the MC fibrocystic change and is usually bilateral and shows the fibrocystic change forms filled cysts with n epithelial boarder from the ducts.
2) Proliferative change has proliferated ductal epithelial often with nearby fibrotic change. This can be either benign or pre-malignant.
3) Sclerosing adenosis has a hard rubbery feel just like carcinoma but it’s from back to back glands with proliferative ducts. They may have fibrotic tissues pressing on them collapsing the ducts.
Different types have different relation to carcinoma. The rare atypical hyperplasia has a tie to carcinoma but most fibrocystic changes do not.
Mastitis is rare but it’s MCC is cracked nipples in the first few weeks of nursing. Staphylococcal infections may induce abscesses when they are the cause of mastitis.
It may also be a result of the beginnings of milk production called duct ectasia. It can cause retraction of the nipple just like carcinoma of the breast.
Fibroadenomas are the MC breast tumor. They are hard movable masses that appear in the 30’s. They have a capsule and a fibroblastic stroma. They almost never become malignant.
Phyllodes tumors are benign tumors that grow to be quite large. They grow out of normal tissue and are easily removed.
Intraductal papillomas are growth of ducts where most are solitary legions. They present with:
1) Serous or bloody discharge.
2) Small subareolar tumors.
3) Possibly nipple retraction.
They are usually benign but can become malignant.
Carcinoma of the breast is usually found in the upper-outer quadrant and it is usually of ductal origin.
There are two types:
1) Intraductal carcinoma is the most common type of noninvasive breast cancer. They go all up and down the ducts but by definition they do not penetrate the ducts.
2) Lobar carcinoma in situ arises in the terminal ducts (acini) and they are often bilateral. They often progress to become invasive ductal carcinoma.
1) Invasive ductal carcinoma NOS is the MC breast cancer. It has a stony, hard consistency with a gritty texture. The middle can become necrotic and calcified. Extension can cause dimpling and/or nipple retraction. It extends into surrounding tissues.
2) Paget’s disease of the breast gets slightly older women. It is an intraductal carcinoma that extends into the skin of the nipple. The skin fissures and opens a woman up to bacterial infection. It is full of Paget cells which are epithelia with perinuclear halos.
3) Medullary carcinomas are large soft tumors made up of undifferentiated cells. They show an immune response which is a good sign because it show the body is trying to fight them.
4) Colloid (mucous) carcinomas are very rare. There are not many mucus secreting tumors in the breast. It has a good prognosis.
Infiltrating lobular carcinomas are rubbery discrete masses. They often have features of both ductal and lobular patterns. They are usually bilateral.
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