00:01
I told you earlier
that I would walk you
through the clinical
anatomy of breast cancer.
00:05
On the left is your nipple
and as you move from the nipple
all the way down to stroma,
we’ll take a look at various
pathologies underneath.
00:14
With the nipple, two major
issues that could occur.
00:17
You can have Paget’s disease or
you could have acute mastitis.
00:22
Acute mastitis, you might
have an abscess formation.
00:25
If there’s abscess
formation, close your eyes,
what does the breast look
like in a female there?
The center area might be a little
bit yellowish and purulent
and the surrounding tissue,
inflammatory, will be erythematous.
00:37
Then you have Paget’s
disease of the nipple.
00:39
And we’ll talk about that in
greater detail. We have to.
00:41
This is mammary type, obviously.
00:44
From your nipple, you’ll then
move into lactiferous sinus.
00:47
The major pathology that we
discussed in lactiferous sinus thus far
is intraductal papilloma.
00:54
Would you please take
a look at how close
your lactiferous sinus
is to the nipple.
00:59
So therefore any lesion
or pathology to the sinus
is then going to result in --
80% of your patient,
what kind of discharge?
Bloody or serous.
01:08
You could also have the mastitis
that may affect this area as well,
but superficially.
Superficially.
01:14
After this, we’ll
get into our ducts.
01:16
You have a big major and you
have a little terminal duct.
01:20
Group them together, please.
And you call them ductal.
01:24
In the previous discussion,
we began with malignancy.
01:26
We looked at ductal
carcinoma in situ.
01:29
That means that the ducts here,
if they undergo cancerous change
with maybe ductal hyperplasia
and specifically I told
you about comedocarcinoma
that the basement membrane
is going to be intact.
01:42
But that’s where you’d find
your ductal carcinoma in situ.
01:45
And then if you finally go
distally, you see these lobules?
There down distal,
down by the stroma or
back deep by the stroma.
01:54
And then we’ll talk about
lobular carcinoma in situ
and invasive lobular cancer.
02:01
What’s then hanging
on to the breast?
Or should I say the breast is
then implanted onto the stroma.
02:08
So think of this as being kind
of like your scaffolding.
02:11
The stroma here,
a couple of important benign
tumors that we have discussed.
02:17
Fibroadenoma, how old
is your patient?
Young, estrogen-responsive,
and with fibroadenoma,
you’re thinking about
fibrous change.
02:28
Is it small or
big, fibroadenoma?
A small tumor.
02:33
Phyllodes tumor.
02:35
Age range?
Elderly, postmenopausal.
Commonly sixth decade.
02:40
In terms of the size of the
tumor, small or large?
Large.
02:44
What about it’s increased
risk of cancer?
Much greater than fibroadenoma.
02:50
I asked you kindly to make sure
that you compare and contrast
phyllodes and fibroadenoma.
02:54
I’ve just given you
brief little points.
02:56
Let’s continue, please.
02:58
Spend a little bit time
make sure that you’re
completely comfortable
up and down the
breast apparatus.