Breast Situational

SITUATIONAL ANALYSIS BREAST PATHOLOGY by MARY ANN O. CABRERA, M.D. EMMANUEL R. DE LA FUENTE, M.D.

Objectives : 3. Recognize non-neoplastic and neoplastic diseases of the female and male breast 5. Correlate clinical manifestations of breast diseases with the pathologic findings 7. Discuss the etiopathogenesis of common breast disease 9. Discuss pathologic factors that affect prognosis and response to modalities of treatment

SITUATION 1 A 22-year-old woman has given birth to a healthy term baby following an uncomplicated pregnancy. She has been breast feeding for 2 months and notices that her right breast has gradually become swollen and painful to touch over the past week. On physical examination her temperature is 38.20 C.

Which of the two pictures is compatible with the patients’ condition? Describe the lesions in the pictures. Give the basis of your choice.

Describe the two pictures. Which among the two correlates with the patient’s condition?

1. Give your diagnosis of the case. 3. What is the most common risk factor in the development of this lesion? 3. Give the complications if untreated.

SITUATION 2 A 20-year-old woman notes a mass in her right breast during self-examination. Her physician confirms the presence of 2 x 1 cm well-circumscribed movable firm mass in the upper outer quadrant. There is no nipple discharge nor pain. No axillary lymphadenopathy is noted. The overlying skin of the breast appears normal. Mammography confirms the presence of a rounded density with no microcalcifications. The mass is excised.

Briefly describe the two gross specimens. Which of the above is more consistent with the patient’s history and physical findings? Give reasons for your choice.

1. 2. 3. 4.

Match these lesions with the previous gross specimens. Which of these two lesions is a tumor? Is the tumor malignant or benign? Give basis. Which of these lesions carries a greater risk of evolving into malignancy? Explain. 5. Discuss the pathogenesis of these lesions.

SITUATION 3 A 52-year-old woman feels a lump in her left breast. On physical examination, her physician palpates a 2.5 cm non-movable hard mass. A biopsy is performed.

Indicate and describe the lesion. Is it benign or malignant? Give the basis.

Which of the two lesions is consistent with the previous gross picture? Indicate and describe.

The patient was advised mastectomy, but due to fear and anxiety the patient went home to the province and was treated by a “herbolario”. Two years after she returns to Manila and seeks consultation.

This is how the breast looks like upon seeing by the attending physician. Describe the gross findings. Discuss the evolution of the lesion.

1. What are the risk factors in the development of breast carcinoma? 2. What are the tumor markers that would help in the diagnosis ? 3. What is the role of hormone receptor assays? 4. Give the most common pattern of spread of this tumor.

SITUATION 4 A 42 year old male patient is diagnosed to have cirrhosis due to excess intake of alcohol for the past 20 yrs. His breasts are noted to be symmetrically enlarged.

Discuss the etiopathogenesis of the breast enlargement.

Describe the histologic picture of this patient’s breast? Is this benign or malignant?

The more serious specie.