PATH 728 Chapter 19 DISEASES OF THE BREAST

Carcinoma: Second only to lung cancer as the leading cause of cancer death in women. Risk factors include geography (North American > Asia), age (over age 50, a breast mass is most likely to be cancer), genes (BRCA-1 gene carries an 80% risk of breast cancer by age 65 years), history (nulliparity, preexisting breast disease, and maternal or sib history of breast cancer [soft factors include smoking, obesity and alcohol abuse])

DISEASES OF THE BREAST See Figure 19-23 regarding breast lumps. Fibrocystic change: FC the most common cause of breast diseases. Found in 60-80% of female breasts at autopsy. Contraceptives seem to decrease the risk of FC. Probably related to exaggerations is response to menstrual cycle. Small risk of malignant transformation. Since they occur as a palpable mass, the big concern is differentiating these from carcinoma. There are 2 types: 1. Nonproliferative fibrocystic change: The most common form. There is increased fibrous stroma and dilation of gland ducts leading to cyst formation. Contents of cysts may calcify and become visible on mammmograms. 2. Proliferative fibrocystic change: Here, there is proliferation of ductal epithelium. These proliferative changes span the spectrum from nothing to worry about to those that carry a risk of malignancy. When no atypia to the proliferating epithelium is seen the increased risk of developing carcinoma is 1-2x normal. With atypia the increased risk is 5x normal. The only reliable way to differentiate fibrocystic change from carcinoma is via biopsy.

Morphology: Half of breast cancers occur in upper outer quadrant of the breast, 20% in central area and the rest divided into the other segments. 90% breast carcinomas are from duct epithelial origin.

Growth pattern: There are 2 groups-- noninvasive ( mostly intraductal lesions) and invasive (infiltrating). Ductal carcinomas that have invaded account for 70% of all breast Ca.

Clinical features: retraction or dimpling of the skin, lymphedema, peau dorange, and calcification on mammography (80%).
Tumors of the Breast: The most common breast neoplasms are of epithelial origin. There are benign and malignant vatieties. Fibroadenoma: The most common benign tumor of the breast. Absolute or relative estrogen increase thought to be a big factor. Occur in younger women (age 30 peak age). May regress after menopause. Malignant transformation uncommon. Detected as freely movable, solitary nodules.

Prognosis: the 2 extremes Invasive lesions less than 2cm. and no positive nodes have an 87% 5 yr. survival. When distant metastases have occurred, 5 yr. survival is 13%.

Intraductal papilloma: Solitary lesion dont usually undergo malignant transformation.

MALE BREAST Gynecomastia: may be from a variety of estrogen sources (tumors, digitalis, old age and obesity. Carcinoma: while uncommon in males (1:125 ratio) they behave badly (50% have widespread mets at the time of diagnosis).