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.