Breast Lump
Dr. Santosh Goit
Clinical Pathologist
1. Benign (Non-Cancerous) Lesions:
• These are most common and usually not life-threatening.
Fibroadenoma:
• Most common benign tumor, especially in young women
• Well-circumscribed, mobile lump
• Pathology: fibrous and glandular tissue
Fibrocystic Changes:
• Common in premenopausal women
• Lumpy, tender breasts, especially before menstruation
• Pathology: cysts, fibrosis, apocrine metaplasia
Breast Cyst:
• Fluid-filled sac
• May be simple or complex on ultrasound
Fat Necrosis:
•Often follows trauma or surgery
•May mimic cancer clinically
•Pathology: necrotic fat with inflammation and calcifications
Intraductal Papilloma:
•Small, benign tumor in the duct
•May cause nipple discharge
•Pathology: papillary structures with fibrovascular cores
2. Malignant (Cancerous) Lesions
• Require more aggressive treatment; often diagnosed via core needle biopsy or
surgical excision.
Invasive Ductal Carcinoma (IDC)
• Most common type (~70–80%)
• Arises from the ducts, invades surrounding tissue
• Pathology: irregular glandular/tubular structures infiltrating stroma
Invasive Lobular Carcinoma (ILC)
• Less common, harder to detect on imaging
• Pathology: small, uniform cells in single-file lines
Ductal Carcinoma In Situ (DCIS)
• Non-invasive; confined to ducts
• High risk of becoming invasive if untreated
• Pathology: malignant cells filling ductal spaces
Lobular Carcinoma In Situ (LCIS)
•Marker of increased cancer risk in both breasts
•Not a true cancer, but a risk factor
•Pathology: abnormal lobular cells confined to lobules
Triple-Negative Breast Cancer
•Lacks estrogen receptor (ER), progesterone receptor (PR), HER2
•More aggressive
•Pathology: high-grade cells, frequent mitoses
Inflammatory Breast Cancer
•Rare, aggressive, presents with skin changes
•Pathology: cancer cells invade dermal lymphatics
Fibroepithelial tumors and hamartomas of breast:
• Fibroadenoma and has a wide age distribution from pre-pubescent to post-
menopausal.
• Made up of proliferative components of both glands and stroma of terminal duct
lobular units, fibroadenoma has two well defined patterns.
• Intracanalicular pattern: occurs when stroma compresses epithelium into
elongated slit-like closed lumens.
• This pattern of growth can sometime mimic Phyllodes Tumor.
• Pericanalicular pattern: results when stroma expands to push lumens of lobular
units away from each other but does not cause glandular compression.
FIBROCYSTIC CHANGE
• Fibrocystic change is most common benign breast condition producing vague ‘lumpy’
breast rather than palpable lump in breast.
• Incidence reported to range from 10-20% in adult women, most often between 3rd
and 5th decades of life, with dramatic decline in its incidence after menopause
suggesting role of estrogen in its pathogenesis.
• Previously termed fibrocystic disease but is currently considered as an exaggerated
physiologic phenomena and not a disease.
Fibrocystic change of histologic entity characterized by following features:
i) Cystic dilatation of terminal ducts.
ii) Relative increase in inter- and intralobular fibrous tissue.
iii) Variable degree of epithelial proliferation in the terminal ducts.
MORPHOLOGY
Three principal nonproliferative morphologic changes:
(1) cystic change, often with apocrine metaplasia
(2) fibrosis
(3) adenosis
1. Cysts:
• Small cysts form by dilation of lobules and coalesce to form larger cysts.
• Unopened cysts contain turbid, semitranslucent brown- or blue-colored fluid.
• Cysts are lined either by a flattened atrophic epithelium or by metaplastic apocrine
cells.
• Cells have abundant granular, eosinophilic cytoplasm and closely resemble normal
apocrine epithelium of sweat glands.
• Calcifications are common.
• Diagnosis is confirmed by disappearance of mass after fine-needle aspiration of its
contents.
2. Fibrosis:
• Cysts frequently rupture, releasing secretory material into adjacent stroma.
• Resulting chronic inflammation and fibrosis contribute to palpable nodularity of
breast.
3. Adenosis:
• Adenosis is defined as an increase in number of acini per lobule.
• It is a normal feature of pregnancy.
• In nonpregnant women, adenosis can occur as a focal change.
Apocrine cysts
(A) Clustered, rounded calcifications are seen in a specimen radiograph. (B) Gross appearance of typical cysts
filled with dark, turbid fluid contents. (C) Cysts are lined by apocrine cells with round nuclei and abundant granular
cytoplasm. Note luminal calcifications, which form on secretory debris.
Fat Necrosis
• Present as a painless palpable mass, skin thickening or retraction, or
mammographic densities or calcifications.
• About half of affected women have a history of breast trauma or surgery.
MORPHOLOGY
• Acute lesions are hemorrhagic and contain central areas of
liquefactive fat necrosis with neutrophils and macrophages.
• Over next few days proliferating fibroblasts and chronic
inflammatory cells surround injured area.
• Subsequently, giant cells, calcifications and hemosiderin and
lesion is replaced by scar tissue or encircled by fibrous tissue.
• Ill-defined, firm, gray-white nodules containing small chalky-
white foci are seen grossly.
INTRADUCTAL PAPILLOMA
• Intraductal papilloma is a benign papillary tumor occurring most commonly in lactiferous
duct or lactiferous sinus near nipple.
• Clinically, it produces serous or serosanguineous nipple discharge.
• It is most common in 3rd and 4th decades of life.
MORPHOLOGY:
Gross:
• Solitary, small, less than 1 cm in diameter, located in major mammary ducts close to
nipple.
• Less commonly, multiple papillomatosis related to papillary carcinoma.
Histopathology:
• Characterized by multiple papillae having well-developed fibrovascular stalks attached to
ductal wall and covered by cuboidal epithelial cells supported by myoepithelial cells.
• Intraductal papillary carcinoma is distinguished from intraductal papilloma in having
cellular atypia, pleomorphism, absence of myoepithelial cells, multilayering and
Intraductal papilloma
Central fibrovascular core extends
from wall of duct.
Papillae arborize within lumen and
are lined by myoepithelial and
luminal cells.
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