Modified sweat glands'

1
Introduction

• Modified sweat glands.
• Lobes and lobules of gland
• in fat tissue stroma.
• Ducts emerge from acini of glands
• Smaller ducts join to form lactiferous ducts
• Lactiferous ducts merge just beneath the nipple
  to form a lactiferous sinus.
• Then individually open on nipple

2
Disorders

• Congenital
• Aplasia turners, Juvenile hypertrophy
• Inflammatory
• Infections acute/chronic Trauma Fat necrosis
• Duct ectasia discharge, sinus
• Fibrocystic disease common painful lumps
• Neoplastic
• Benign - Fibroadenoma
• Malignant Ca

3
Fibrocystic Disease

• Fibroadenosis, Fibrocystic change, etc.
• Commonest lump, 10-50 women
• ? Hormonal
• Periodic discomfort pain.
• Eipethilial hyperplasia premalignant
• Irregular palpable lumps mimic ca.
• Adenosis hyperplasia - cysts papillomatosis
  metaplasia fibrosis.

4
Benign Neoplasms

• Fibroadenoma
• Duct Papilloma
• Adenoma
• Connective tissue tumors
• Features (Fibroadenoma)
• Young age 3rd decade.
• Single, rounded, mobile, painless lumps.
• No scarring or calcification.
• Slit like glands in Fibrous stroma

5
Breast Carcinoma

• 20 of all cancers in women
• Commonest cause of death - 35-55y
• In UK 1 in 10-12 chances
• 1 in 8 women in US
• Less incidence in Asia
• Majority of cancers arise in the ducts.
• Very rare before age 25

6
Risk Factors

• Female sex..!, Age, Obesity, high fat diet
• Maternal relative with breast cancer.
• Longer reproductive span.
• Nulliparity, Oral contraceptives
• Later age at first pregnancy.
• Atypical epithelial hyperplasia.
• Previous breast cancer/Endometrial Ca.
• Geographic factors - country
• BRCA1 and BRCA2 genes

7
Clinical Features

• Physiologic vs Pathologic changes
• Lump / lumps
• Lumps are much more common than Ca
• Characters of lump and age
• Discharge in many conditions.
• Hard, soft, inflammation
• Skin fixation / Skin retraction

8
Diagnosis

• Mammorgraphy
• Ultrasound
• Fine Needle Aspiration Biopsy
• Core Biopsy
• Excision Biopsy
• Frozen section
• Immunoperoxidase,
• Molecular techniques Gene detection.

9
Histological Types
10
Spread of Breast Carcinoma
11
Estrogen Receptor Prognosis

• Estrogen receptor expression is proportional to
  differntiation of tumor
• inversly proportional to prognosis and response
  to tamoxifen (receptor antagonist) therapy.
• Demonstrated by Immunoperoxidase special stain.

12
HER2

• The HER2 proto-oncogene encodes a cell surface
  receptor that is overexpressed in approximately
  25-30 of breast cancers.
• Trastuzumab (Herceptin) is the first monoclonal
  antibody that targets the extracelluar domain of
  the HER2 protein, and inhibits growth of breast
  cancer cells that over express this protein.