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Diseases of the liver and pancreasDiseases of the Breast Normal Anatomy and Major Lesions
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səhifə | 9/19 | tarix | 26.03.2018 | ölçüsü | 1,15 Mb. | | #33477 |
| 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 -
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 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 -
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 -
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 -
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 -
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
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