Breast-Pathology and pathophysiology.pptx

Pathogenesis of benign breast diseases

1. PHYSIOLOGY AND Pathophysiology OF BREAST DISORDERS DR.SENTHILKUMAR SIR’S UNIT- S2 DR.SHOBANa First year postgraduate

2. DEVELOPMENT OF BREAST Breast-modified sweat gland derived from the ectodermal milk line which starts to regress in 9 th week of gestation and finally forms both mammary glands. It remains undeveloped till puberty during which it starts to enlarge under the influence of ovarian estrogen and progesterone. The Secretory apparatus of breast consists of secretory acinus,lobules,lobes , lactiferous ducts and nipple areolar complex.

3. Breast at different physiologic stages

4. Roles of hormones in breast development Estrogen –Initiates ductal development and deposition of fat. Progesterone-Responsible for differentiation of epithelium and for lobular development and secretory function. Prolactin-Hormonal stimulus for lactogenesis in late pregnancy.

5. MILK LET DOWN REFLEX 4.OXYTOCIN-Contraction of myoepithelial cells and compression of alveoli and expression of milk through lactiferous sinuses.

6. Aberration of normal development and involution of the breast (ANDI) It includes benign breast disorders at different reproductive periods in females. Early reproductive period-15 to 25 years Mature reproductive period-25 to 40 years Involution -40 to 55 years

7. Early reproductive period (15 to 25 years) NORMAL PROCESS ABERRATION DISEASE STATE 1.Lobule formation Fibroadenoma Giant fibroadenoma 2.Stroma formation Juvenile hypertrophy Multiple fibroadenoma

8. Mature reproductive period (25 to 40 years) NORMAL PROCESS ABERRATION DISEASE STATE 1.Cyclical hormonal effect on Glandular tissue and stroma Exaggerated cyclical effects Cyclical mastalgia and nodularity-FIBROCYSTADENOSIS

9. Involution (40 to 55 years) NORMAL PROCESS ABERRATION DISEASE STATE 1.Lobular involution Microcyst,Macrocyst , Sclerosing adenosis Cystic disease 2.Ductal involution Ductal dilatation, Periductal fibrosis Periductal mastitis, Non lactational breast abscess 3.Epithelial turn over Mild Epithelial hyperplasia Epithelial hyperplasia with atypia

10. GYNAecomastia -Enlargement of Breast in males -In non obese males,breast tissue measuring at least 2 cm in diameter. -Physiologic Gynecomastia occurs in three phases: Neonatal period,Adolescence and Senescence.

11. Pathophysiology of Gynecomastia Excess estrogen states A.Gonadal origin True hermaphrodite Gonadal stromal neoplasms- Leydig cell,sertoli cell,granulosa theca cell Germ cell tumors – choriocarcinoma,seminoma,Embryonal carcinoma B.Non testicular tumors Adrenal cortical neoplasms Lung carcinoma Hepatocellular carcinoma

12. C.Endocrine disorders -Hyperthyroidism, Hypothyroidism D.Diseases of the liver -Non alcoholic and alcoholic cirrhosis E.Nutrition alteration states

13. 2.Androgen deficiency states A. Senescence B.Hypoandrogenic states(Hypogonadism) Klinefelter syndrome Kallmann syndrome Congenital anorchia ACTH deficiency Cryptochidism

14. Orchitis Trauma Irradiation C.Renal failure 3.Pharmacological cause Drugs with Estrogenic activity Drugs which inhibit synthesis of testosterone.

15. Drugs with Estrogenic activity Digitalis Estrogens Anabolic steroids Marijuana

16. Drugs that inhibit action/synthesis of testosterone Cimetidine Ketoconazole Spironolactone Diazepam Anti neoplastic agents

17. Grading of Gynecomastia

18. Treatment Testosterone administration in androgen deficiency Specific therapy in endocrine disorders Discontinue drugs if pharmacologic cause If progressive and not responding to other treatments -SURGICAL THERAPY Local excision Liposuction Subcutaneous mastectomy

19. Thanking you