Diseases of the liver and pancreas

Oral contraceptive use decreases the risk of fibrocystic disease,

• Supplies a balanced source of progesterone and estrogen

Simple Fibrocystic Change

• Is the most common type of alteration

• Characterized by

• Increase in fibrous stroma

• Associated dilatation of ducts

• Formation of cysts of various sizes

• Disorder usually multifocal and often bilateral

• Large cyst may be formed within one breast

• On palpation and gross examination

• An ill-defined diffuse increase in consistency and discrete nodularities

• Are brown to blue (blue-dome cysts), owing to the contained

semitranslucent, turbid fluid

• Microcalcifications detected by mammography

• Secretory products within cysts of the breast calcify

Mammogram

• Microcalcification

  • Cancer

  • Fibrocystic changes

Blue domed cyst

Simple Fibrocystic Change

• In smaller cysts

• Epithelium is more cuboidal to columnar

• Multilayered in focal areas

• In larger cysts

• May be flattened or may even be totally atrophic

• Apocrine metaplasia

• Cysts lined by large polygonal cells having an abundant granular, eosinophilic cytoplasm, with small, round, deeply chromatic nuclei

• Is found commonly in the normal breast

• Virtually always benign

• Epithelial overgrowth and papillary projections are common in cysts lined by apocrine epithelium

• Multiple cystic spaces Normal Lining (Left)

• Some filled with precipitated fluid and stromal fibrosis Apocrine Metaplasia (Right)

Epithelial Hyperplasia

• Fibrocystic changes can be accompanied by epithelial hyperplasia

• Has an increased risk of the subsequent development of carcinoma

• The more severe and atypical the hyperplasia, the greater the risk of developing cancer

• Gross appearance is that of accompanying fibrosis, cysts, or adenosis.

• Microscopically

• Increase in the layers of the duct-lining epithelium beyond the usual double layer

• May take the form of solid masses extending and encroaching into the duct lumen, partially obliterating it, but usually irregular lumina (so-called fenestrations) can be discerned at the periphery of the cellular masses

• Alternatively, papillary epithelial projections may grow into the lumen (ductal papillomatosis).

• If extensive, this is termed florid papillomatosis.

A.Epithelial hyperplasia

Multilayered epithelial cells, No atypia

• No increased risk of cancer

B. Florid Ductal Epithelial Hyperplasia

C. Atypical Ductal Epithelial Hyperplasia

Florid Ductal Epithelial Hyperplasia

• Epithelial Hyperplasia

• Both papillary and solid proliferations may sometimes show various degrees of cellular and architectural atypia (atypical hyperplasia).

• In general, greater cellular uniformity, more regular sharply defined gland lumina (so-called cribriform pattern), and nuclear hyperchromasia favor intraductal carcinoma.

• Atypical lobular hyperplasia

• Hyperplasias of the terminal duct and ductules (acini) that have some–but not all–the features of lobular carcinoma in situ

• Cytologically

• Atypical cells resemble those of lobular carcinoma in situ but do not fill or distend more than 50% of the terminal duct units.

• When it affects ducts (rather than only acini), is associated with an increased risk of invasive carcinoma

Atypical Ductal Epithelial Hyperplasia

• Tumors of the Breast

• Fibroadenoma

• Phyllodes Tumor

• Intraductal Papilloma

• Carcinoma

Fibroadenoma

• Most common benign tumor of the female breast

• Is a new growth composed of both fibrous and glandular tissue

• Arises from intralobular stroma

• Occurring at any age within the reproductive period of life

• More common before age 30

• Multiple small areas closely resembling a fibroadenoma are sometimes found in cases of cystic disease, termed fibroadenomatosis.

• Usually appears as a solitary, discrete, freely movable nodule within the breast

• Epithelium of the fibroadenoma is normally responsive

• Can undergo lactational change during pregnancy

• Increase in size / infarction and inflammation

• Fibroadenoma mimicking carcinoma in a pregnant woman

• Slight increase in size may occur during the late phases of each menstrual cycle

• Postmenopausally, regression or calcification may result.

•