Benign Breast Lesions

00:01 Here, we have fibrocystic change in a very important table that you need to make sure that you go over in greater detail.

00:08 Every single one of the histologic changes, you must know in greater detail and I’ll walk you through these.

00:13 And why? That’s because it is the most common cause of breast lumps in a female of reproductive age.

00:21 You need to also know this so that you do not order unnecessary tests.

00:26 And you need to know as to how to then examine your patients.

00:29 Presents with premenstrual breast pain, okay? Premenstrual.

00:34 Remember this is estrogen responsive.

00:37 There might be multiple lesions.

00:39 Notice that I did not say tumors.

00:41 Lesions.

00:43 Very specific about terminology here.

00:45 Often will be bilateral.

00:47 Fluctuation in size, estrogen responsive.

00:50 May be painful or painless.

00:53 Usually does not indicate increased risk of carcinoma.

00:58 I will give you an exception, okay? But luckily, these females that have the lump, there’s no increase in carcinoma, but you still always have to keep your eyes open.

01:11 Fibrosis is the first histologic change.

01:14 Where the fibrosis will be taking place will be with the stroma.

01:18 Fibrosis.

01:20 Cystic, second type of histologic change.

01:24 Take a look at the name.

01:26 Fibro-, cystic.

01:27 There you have two of the four histologic changes.

01:31 Would you please tell me as to what kind of metaplasia has taken place where it’s secreting fluid into the cyst? Can you remember apocrine metaplasia? Good.

01:42 Ductal dilation.

01:43 Cystic.

01:45 The next one is called sclerosing adenosis.

01:48 Sclerosing means what? Narrowing.

01:51 Adenosis and glandular.

01:53 Pretty much given you what you need to know.

01:55 Increased acini and there would be intralobular fibrosis.

02:01 Stop here for one second and understand that in greater detail.

02:04 The adenosis part would be the acini.

02:07 What does an acini mean? Can you think of a pipette? A pipette.

02:12 Meaning to say the proximal portion would be the bulb, the aprocrine.

02:15 Where we’ve seen this before with acini would be the pancreatic duct and salivary duct, right? In physiology, we’ve talked about the ducts in greater detail.

02:25 Here, the acini will be affected.

02:28 What’s happening? Where are we? The lobule.

02:32 Where is the lobule located in your breast apparatus? If you know it, fantastic.

02:36 If you don’t, that’s okay.

02:37 As I told you, I’ll go through the clinical markings and anatomy of your breast apparatus.

02:42 The lobule will be right in front of the stroma, just above, so pretty deep, pretty deep.

02:47 And here, you would find your fibrosis.

02:49 So you we have narrowing, sclerosing adenosis, acini.

02:53 Associated with calcifications.

02:55 Remember that we do not have breast cancer per se here.

02:59 I told you there would be an exception for perhaps the increased risk of cancer of the breast.

03:03 Here it is.

03:04 Anytime that you have hyperplasia, you can take two routes.

03:09 Hyperplasia, as the name implies, means that there’s going to be increased number and here, it will be the breast epithelium.

03:15 So epithelial hyperplasia, you follow up and make sure that you do a proper biopsy in which you then look for nuclear atypia.

03:23 If there is nuclear atypia, then you start thinking about maybe perhaps my patient may be at risk for breast cancer.

03:31 Epithelial hyperplasia, increased number of epithelial cells over more or less in the terminal duct in the lobules.

03:38 So you’re moving towards the deep portion.

03:41 There is an increased risk for carcinoma with atypical cells, that is the most important statement in this particular histologic picture.

03:51 Once again, your female here is in her reproductive age and she is young, 30 and above.

03:59 Fibrocystic change, dilation of duct, producing microcysts.

04:03 Remember once again the four histologic pictures, would be your fibrosis, your cystic, sclerosing adenosis, more so associated with calcification than epithelial hyperplasia.