NON NEOPLASTIC NON INFLAMMATORY LESIONS OF THE BREAST

GALACTOCELE
Cystic dilation of
breast ducts
occurring during
lactation
Due to obstruction of
breast ducts by
inflammation and
fibrosis with
accumulation of milk
Pathogenesis :
1. Inflammation
with fibrosis
2. Obstruction of
the duct
3. Accumulation of
milk
Acute phase :
1. Lesion is tender.
Then it will
subside
2. CT shows
collection of
milky fluid
Later on :
1. Contents will be
inspissated and
cheesy
2. May rupture
causing a local
inflammatory
reaction
forming well
defined mass
breast cancer

FIBROCYSTIC CHANGE / DISEASE

DEFINITION :
Spectrum of macroscopic and microscopic changes in exaggerated response towards normal level of cyclic hormonal stimulation that occur
in normal menstrual phase
CHARACTERISTIC :

Cystic dilation of terminal ducts

Relative increase in inter and intralobular fibrous tissue
Variable degree of epithelial proliferation in the terminal ducts
[ some subset of changes have an increased risk of development of breast cancer]
1. NON PROLIFERATIVE FIBROCYSTIC CHANGES
2. PROLIFERATIVE CHANGES
2 types :
Cystic and fibrosis
1. EPITHELIAL HYPPERPLASIA:
Very common benign morphologic changes
a) mild hyperplasia
Between age 25-45 years old
b) moderate and florid (severe)
Usually bilateral ; one breast may be more diseased than the other one
hyperplasia
GROSSLY :
1. Firm irregular whitish mass that contain cysts of variable sizes and filled with serous turbid fluid c) atypical hyperplasia
2. Unopened cyst ; brown blue (blue dome cyst)
2. SCLEROSING ADENOSIS :
3. Usually multifocal and bilateral
- benign proliferation of small
MICROSCOPIC :
ductules or acini
1. Cyst formation ; variable in size and shape
- interlobular fibrosis may
Smaller cyst; lined by cuboidal columnar epithelium. Multilayered in focal areas
compress the duct
Larger cyst; lined by flattened / atrophic epithelium
Apocrine metaplasia lining epithelium of most cyst completely benign
[ cuboidal / columnar epi. transform to large polygonal cells with abundant granular
CLINICALLY:
oesinophilic cytoplasm]

Bilateral breast nodularity

Intraluminal papillary projection may be present
with premenstrual tension
Calcification of the serous fluid are common microcalcification (may benign /

Pain in the breast

malignant)

Discharge of scanty
2. Fibrosis :
serous/serosangeous fluid
Stroma is composed of compressed fibrous tissue having lost its normal myxoid
from nipple
appearance

Commonest breast mass

Lymphocytic infiltration of stroma is common
below age 35

CLINICAL SIGNIFICANCE:

Complete benign and no relation

to malignant ;
Cystic changes
Apocrine metaplasia
Mild epithelium hyperplasia

1.5-2 X risk malignant:

Moderate florid
hyperplasia without atypical
Sclerosing adenoma

4-5 X risk malignant;

Atypical epithelium
hyperplasia

NON NEOPLASTIC INFLAMMATORY LESIONS OF THE BREAST

INFLAMMATION
LESIONS
Incident

ACUTE MASTITIS & BREAST ABSCESS

Cause

Infection of :
Staphylococcus aureus
Streptocooci
That pass through the cracks of the nipple
Obstruction of duct system by
inspissated secretion with stasis of
secretion
Breast engorged with milk good
medium for multiplication of
organism & suppuration will occur
Staph infection single / multiple
abscess
Strep infection wide spread
suppuration throughout entire
breast
Swollen and red

Characteristic

Grossly

Early weeks of nursing

CHRONIC MASTITIS
(1. Mammary duct ectasia, Plasma cell mastitis)
Predominantly in postmenopausal women
RARELY OCCUR

Dilation of the collecting ducts in subaerolar

region
The ducts are filled with inspissated secretion
obstruction of their lumina

FAT NECROSIS
After radiation therapy / antecedent trauma to
the breast
Trauma ; common in seat belt
Irradiation
Rupture of fat cell necrosis mass

Necrosis of fat by trauma / irradiation

Release of fat particles
Elicit chronic inflammation

Well define grayish nodule with chalky white

foci
Later will surrounded / replaced by fibrous
tissue
The lesion reveals :
Center of necrotic fat cells surrounded by
lipid-laden macrophages, neutrophils,
lymphocytes and foreign body giants cell
Calcium salts appear later
Replaced by scar tissue

Microscopic

Diffuse infiltration by acute

inflammatory cells
** treated by surgical drainage and
antibiotic therapy
** resolution RAREly by fibrosis as
fibrosis may cause retraction of skin of
the nipple
** Have a risk to inflammatory carcinoma

CLINICALLY:
*Fibrosis may lead to
Indurations and retraction of the
nipple, mimicking the changes
causes by carcinomas
* painless breast mass

Ducts are dilated and filled with granular

debris that contain lipid-laden macrophages
Ductal rupture periductal collections of
inflammatory cells mainly lymphocytes &
plasma cells with fibrosis

2. GRANULAMATOUS MASTITIS (TB Mastitis)

Tubercle bacilli reach breast lymph node / lung
/ blood
Should be put in the differential diagnosis of
breast mass
Mass stimulating cancer
Its a specific type of chronic inflammation

CLINICALLY;
Included in the differential
diagnosis of breast mass
** Painless mass
stimulating breast cancer