Transcript DISEASES OF THE BREAST - DENTISTRY 2012

DISEASES OF THE BREAST
DR HEYAM AWAD
FIBROCYSTIC CHANGE
• THE MOST COMMON BREAST ABNORMALITY
IN PREMENOPAUSAL WOMEN.
• SECONDARY TO CYCLIC CHANGES OCCURING
DURING MENSTRUAL CYCLE.
• PROLIFERATIVE AND NONPROLIFERATIVE
CHANGES.
NONPROLIFERATIVE CHANGES IN CF
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CYSTS AND FIBROSIS.
MULTIFOCAL AND BILATERAL .
ILLDEFINED AREAS WITH INCREASED DENSITY.
CYSTS CAN HAVE APOCRINE METAPLASIA.
FIBROCYSTIC CHANGE
PROLIFERATVE LESIONS
• EPITHELIAL HYPERPLASIA AND SCLEROSING
ADENOSIS.
• EPITHELIAL HYPERPLASIA: MORE THAN TWO
CELL LAYERS.
• MILD TO FLORID.
• TYPICAL OR ATYPICAL.
ATYPICAL HYPERPLASIA
• DUCTAL OR LOBULAR.
• INCREASED RISK OF INVASIVE CARCINOMA.
SCLEROSING ADENOSIS
• PROLIFERATION OF SMALL DUCTULES AND
ACINI WITH FIBROSIS.
• GROSSLY THEY ARE HARD AND MIMIC
CARCINOMA.
SCLEROSING ADENOSIS
RELATIONSHIP WITH CARCINOMA
• MINIMAL OR NO RISK: FIBROSIS, CYSTIC
CHANGE, APOCRINE METAPLASIA AND MILD
HYPERPLASIA.
• SLIGHT RISK ( 1.5- 2 FOLD) : MODERATE TO
FLORID HYPERPLASIA, SCLEROSING ADENOSIS.
• HIGH RISK ( 5 FOLD) ATYPICALHYPERPLASIA.
TUMORS
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FIBROADENOMA.
PHYLLOIDES TUMOR.
INTRADUCTAL PAPILLOMA
CARCINOMA
FIBROADENOMA
• THE MOST COMMON BENIGN TUMOR OF THE
FEMALE BREAST.
• EPITHELIUM LINED GLANDS IN A FIBROUS
STROMA.
• ONLY THE STROMAL CELLS ARE NEOPLASTIC
AND MONOCLONAL
FIBROADENOMA
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PRESENTS IN YOUNG WOMEN.
PEAK .. 3RD DECADE.
SOLITARY, DISCRETE , MOBILE MASSES.
ESTROGEN CONTRIBUTE TO THEIR
DEVELOPMENT.
• ENLARGE LATE IN THE MENSTRUAL CYCLE AND
IN PREGNANCY.
• REGRESS AFTER MENOPAUSE.
FIBROADENOMA
PHYLLODES TUMOR
• BIPHASIC.
• STROMA MORE CELLULAR AND MORE
ABUNDANT THAN IN FIBROADENOMA.
• EPITHELIUM… LEAF LIKE PATTERN.
• LESS COMMON THAN FIBROADENOMA.
PHYLLODES
• THE MAJORITY ARE BENIGN.
• MALIGNANT LESIONS INVADE LOCALLY AND
MAY RECUR.
• ONLY 15% ARE FULLY MALIGNANT
• FEATURES OF MALIGNANCY… INCREASED
STROMAL CELLULAITY, ANAPLASIA, HIGH
MITOTIC RATE, INFILTRATVE MARGINS
INTRADUCTAL PAPILLOMA
• PREMENOPAUSAL WOMEN.
• USUALLY SOLITARY.
• CLINICALLY.. SEROUS OR BLOODY NIPPLE
DISCHARGE, SMALL SUBAREOLAR TUMOR,
AND RARELY AS NIPPLE RETRACTION
CACINOMA
• THE SECOND LEADING CAUSE OF CANCER
DEATH.
• LIFE TIME RISK IS 1 IN 8.
• DEATH RATE DECREASED FROM 30_ 20%
DURING THE LAST THREE DECADES.
CARCINOMA.. RISK FACTORS
• AGE… 75% OF CASES OLDER THAN 50 YEARS.
5% YOUNGER THAN 40.
• GEOGRAPHIC VARIATIONS… HIGH IN NORTH
AMERICA AND EUROPE,LOW IN ASIA AND
AFRICA.
ENVIRONMENTAL FACTORS , NOT GENETIC…
DIET, NURSING HABITS, REPRODUCTIVE
PATTERNS.
RISK FACTORS
FAMILY HISTORY
• FIRST DEGREE RELATIVE…RELATIVE RISKM:1.2
–3
• PREMEOPAUSAL… 3
• PREMENOPAUSAL AND BILATERAL… 8.5 – 9
• POSTMENOPAUSAL… 1.5
• POSTMEOPAUSAL AND BILATEAL… 4- 5.5
RISK FACTORS
• MENSTRUAL HISTORY… EARLY MENARCHE
AND LATE MENOPAUSE.
• PREGNANCY.. NULLIPAROUS AND OLD
PRIMIGAVIDA.
• BENIGN BREAST DISEASE… SIMPLE
HYPERPLASIA, ATYPICAL HYPERPLASIA .
RISK FACTORS
HORMONAL..
• HORMONE REPLACEMENT .. INCREASES RISK.
• OCD… NO EFFECT.
PATHOGENESIS
THEE FACTORS…
• GENETIC CHANGES.
• HORMONAL INFLUENCE.
• ENVIRONMENTAL FACTORS.
GENETICS
• HER 2 PROTO-ONCOGENE.
• AMPLIFICATION OF MYC AND RAS GENES.
• ONE THIRD OF HERIDITARY BREAST CANCER
HAVE BRCA 1 AND BRCA2 MUTATIONS.
• BRCA 1 @ 2 ARE TUMOR SUPRESSOR GENES.
HORMONAL EFFECT
• HORMONAL IMBALANCE…. INCREASED
ESTROGEN UNOPPOSED BY PROGESTERONE.
ENVIRONMENTAL FACTORS
• VARIABLE RATES AMONG GENETICALLY
HOMOGENOUS GROUPS.
MORPHOLOGY
• UPPER OUTER QUADRANT IS THE MOST
COMMON SITE.
• DIVIDED INTO IN-SITU AND INVASIVE LESIONS.
• IN SITU: DCIS AND LCIS.
• INVASIVE: DUCTAL OR LOBULAR…. OTHER
RARE TYPES EXIST
INVASIVE VDUCTAL CARCINOMA
• 70 _ 80% OF TUMORS.
• ASSOCIATED WITH DCIS OR RARELY WITH LCIS.
• TWO THIRDS EXPRESS ESTROGEN OR
PROGESTERONE .
• ONE THIRD OVER EXPRESS HER2.
IDC
INVASIVE LOBULAR
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TWO THIRDS ASSOCIATED WITH LCIS.
ALMOST ALL EXPRESS ER AND PR.
ONLY RARELY EXPRESS HER 2
CAN BE MULTICENTRIC AND BILATERAL IN
10_20% OF CASES.
ILC
CLINICAL COURSE
• 50% HAVE LYMPH NODE METS AT TIME OF
DIAGNOSIS.
• METS TO LUNGS, LIVER, ADRENALS AND
BONE.
• METS CAN APPEAR MANY YEARS AFTER
APPARENTLY CONTROLLED DISEASE.
MALE BREAST
• GYNAECOMASTIA: ENLAGEMENT IN
RESPONSE TO ESTROGEN.
• MOST IMPORTANT CAUSE IS LIVER CIRRHOSIS.
• ANABOLIC STEROIDS CAN ALSO CAUSE IT.
MALE BREAST
• CANCER IS RARE.
• ADVANCED AGE.
• SPREAD EASILY TO SKIN AND THORACIC WALL