Diseases of the liver and pancreas


Diseases of the Breast Normal Anatomy and Major Lesions



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Diseases of the Breast

Normal Anatomy and Major Lesions

Congenital Anomalies




Supernumerary Nipples or Breasts

  • Result from the persistence of epidermal thickenings along the milk line

  • Extends from the axilla to the perineum

  • Below and above adult breast in the anterior axillary fold



Accessory Axillary Breast Tissue

  • May give rise to tumors that appear to be outside the breast

  • Are commonly misidentified as

  • Lesions of the axillary lymph nodes

  • Metastases from an occult breast cancer

Congenital Inversion of Nipples

    • Occurs in many women, particularly with large/pendulous breasts

    • Is corrected during the growth activity of pregnancy

    • By simple traction on the nipples

  • Clinical significance:

  • Failed attempts at nursing

  • Confused with acquired retraction of the nipple observed in

  • Mammary cancer
  • Inflammation of the breasts

Inflammation of breast

  • Acute Mastitis and Breast Abscess

  • Mammary Duct Ectasia

  • Fat Necrosis

Acute Mastitis and Breast Abscess

  • Vulnerable to bacterial infection by the development of cracks and fissures in the nipples

  • During the early weeks of nursing

  • Predisposing factors

  • Eczema

  • Other dermatologic conditions

  • Staphylococcus aureus usually

  • Streptococci less commonly

Acute Mastitis and Breast Abscess

  • Usually the disease is unilateral

  • Staphylococcus - a localized area of acute inflammation that may progress to the formation of single or multiple abscesses

  • Streptococcus - a diffuse spreading infection that eventually involves the entire organ

  • Surgical drainage and antibiotic therapy may limit the spread of the infection

  • With extensive necrosis

  • Destroyed breast substance is replaced by fibrous scar as a permanent residual of the inflammatory process

  • A localized area of increased consistency

  • Sometimes accompanied by retraction of the skin or the nipple

  • May later be mistaken for a neoplasm

Mammary Duct Ectasia

Characterized by:

  • Dilatation of ducts

  • Inspissation of breast secretions

  • A marked periductal and interstitial chronic granulomatous inflammatory reaction, sometimes associated with large numbers of plasma cells (plasma cell mastitis)

  • Occurs in the fifth or sixth decade of life

  • Usually in multiparous women

  • Results from obstruction of ducts due to inspissation of secretions

  • Clinical significance: Can be mistaken for a carcinoma clinically, grossly, and by mammography

Mammary Duct Ectasia

  • Usually affects a single area of the breast substance drained through one of the major excretory ducts

  • A poorly defined area of induration, thickening, or ropiness results

  • On section, thick, cheesy material can be extruded from the ducts by slight pressure



  • Dilated ducts filled by granular, necrotic, acidophilic debris that contains principally lipid-laden macrophages

  • Destruction of the ductal epithelium

  • Peri-ductal infilteration with leucocytes

Fat Necrosis

  • Focal necrosis of fat tissues in the breast, followed by an inflammatory reaction

  • Is an uncommon lesion

  • Occurs as an isolated, sharply localized process in one breast

  • Almost all patients give a history of

  • Trauma

  • Prior surgical intervention

  • Radiation therapy

  • Clinical significance: Its possible confusion with a tumor, when fibrosis has created a clinically palpable mass, and focal calcification is seen on mammography.


  • Lipid laden macrophages in necrosis of breast tissue

Fibrocystic Changes (Fibrocystic Disease)

  • Three dominant patterns of morphologic change:

  • Cyst formation and fibrosis (simple fibrocystic change and gross cysts)

  • Epithelial hyperplasia (ductal and lobular)

  • Sclerosing adenosis

  • A common feature is palpable lump in most of them

  • Incidence and Pathogenesis

  • Together these variants compose the single most common disorder of the breast

  • Account for >50% of all surgical operations on the breast

  • Is unusual before adolescence

  • Is diagnosed frequently between the ages of 20 and 40, peaks at or just before the menopause

  • Rarely develops after the menopause

  • Hormonal imbalances are considered to be basic to the development

    • Excess estrogens

      • Functioning ovarian tumors

    • Deficiency of progesterone

      • In anovulatory women


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