Materiały źródłowe

• #1 Breast lumps pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Breast_lumps_pathophysiology

  Breast development is influenced by different hormones such as estrogen, progesterone, prolactin, and estradiol. The pathophysiology of breast lumps depends on the histological subtypes. Histological findings of breast lumps are different from each other which lead to diagnosis. It is thought that breast lumps are the result of hormonal events and genetic mutations. Estrogen and progesterone may increase risk of benign proliferative disease to 74% and benign breast lesion in post-menopausal women receiving estrogen with or without progesteron for more than 8 years raise by 1.7 fold. Gene mutations are classified into 3 categories based on cancer risk such as BRCA1, BRCA2, TP53 considered as high risk mutations, Homozygous ataxia-telangiectasia, somatic mutation in CHEK2, BRIP1, PALB2 moderate risk mutations, and low risk genes mutation are not determined yet.

• #2 Breast Abscesses and Masses: Background, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/781116-overview

  Breast masses are broadly classified as benign or malignant. Common causes of benign breast lesions include fibrocystic disease, fibroadenoma, intraductal papilloma, and abscess. Malignant breast disease encompasses many histologic types that include, but are not limited to, in situ ductal or lobular carcinoma, infiltrating ductal or lobular carcinoma, and inflammatory carcinoma. The main concern of many women presenting with a breast mass is the likelihood of cancer. Reassuringly, most breast masses are benign. […] When the lactiferous duct lining undergoes epidermalization, keratin production may cause plugging of the duct, resulting in abscess formation. […] This may explain the high recurrence rate (an estimated 39%-50%) of breast abscesses in patients treated with standard incision and drainage, as this technique does not address the basic mechanism by which breast abscesses are thought to occur.

• #3 Fibrocystic breasts – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/fibrocystic-breasts/symptoms-causes/syc-20350438

  The exact cause of fibrocystic breast changes isn’t known, but experts suspect that reproductive hormones especially estrogen play a role. […] Fluctuating hormone levels during the menstrual cycle can cause breast discomfort and areas of lumpy breast tissue that feel tender, sore and swollen. Fibrocystic breast changes tend to be more bothersome before your menstrual period and ease up after your period begins. […] When examined under a microscope, fibrocystic breast tissue includes distinct components such as: fluid-filled round or oval sacs (cysts), a prominence of scar-like fibrous tissue (fibrosis), overgrowth of cells (hyperplasia) lining the milk ducts or milk-producing tissues (lobules) of the breast, enlarged breast lobules (adenosis).

• #4 Breast lumps pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Breast_lumps_pathophysiology

  Breast development is influenced by different hormones such as estrogen, progesterone, prolactin, and estradiol. The pathophysiology of breast lumps depends on the histological subtypes. Histological findings of breast lumps are different from each other which lead to diagnosis. It is thought that breast lumps are the result of hormonal events and genetic mutations. Estrogen and progesterone may increase risk of benign proliferative disease to 74% and benign breast lesion in post-menopausal women receiving estrogen with or without progesteron for more than 8 years raise by 1.7 fold. Gene mutations are classified into 3 categories based on cancer risk such as BRCA1, BRCA2, TP53 considered as high risk mutations, Homozygous ataxia-telangiectasia, somatic mutation in CHEK2, BRIP1, PALB2 moderate risk mutations, and low risk genes mutation are not determined yet.

• #5 Breast cancer – Wikipedia

  https://en.wikipedia.org/wiki/Breast_cancer

  The major causes of sporadic breast cancer are associated with hormone levels. Breast cancer is promoted by estrogen. This hormone activates the development of breast throughout puberty, menstrual cycles and pregnancy. The imbalance between estrogen and progesterone during the menstrual phases causes cell proliferation. Moreover, oxidative metabolites of estrogen can increase DNA damage and mutations. Repeated cycling and the impairment of repair process can transform a normal cell into pre-malignant and eventually malignant cell through mutation. […] Normal cells will self-destruct (programmed cell death) when they are no longer needed. Until then, cells are protected from programmed death by several protein clusters and pathways. One of the protective pathways is the PI3K/AKT pathway; another is the RAS/MEK/ERK pathway. Sometimes the genes along these protective pathways are mutated in a way that turns them permanently „on”, rendering the cell incapable of self-destructing when it is no longer needed. This is one of the steps that causes cancer in combination with other mutations.

• #6 Fibrocystic Breast Disease: Causes, Symptoms, and Diagnosis

  https://www.healthline.com/health/fibrocystic-breast-disease

  Fibrocystic breast disease can cause the breasts to feel lumpy. […] Although it isnt harmful to have fibrocystic breasts, this condition can make the detection of breast cancer more challenging. […] Your breast tissue changes in response to the hormones made by the ovaries. If you have fibrocystic breasts, you may have more pronounced changes in response to these hormones. This can result in swelling and tender or painful breast lumps. […] Fibrocystic breast disease doesnt increase your risk of getting cancer, but the changes in your breasts can make it more difficult for you or your doctor to identify potentially cancerous lumps during breast exams and on mammograms. […] The specific cause of fibrocystic breast disease isnt fully understood. However, doctors suspect that estrogen and other reproductive hormones play a role.

• #7 Breast lumps pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Breast_lumps_pathophysiology

  It is understood that breast lumps are the result of hormonal events: Prevalence of benign breast lesion in post-menopausal women receiving estrogen with or without progesteron for more than 8 years raise by 1.7 fold. Estrogen and progesterone increase rate of benign proliferative breast disease to 74%. Anti-estrogen drugs such as tamoxifen, decrease prevalence of breast lesions such as adenosis, cysts, hyperplasia, duct ectasia to 28%. […] Although estrogen receptors (ER) and progesterone-receptor (PR) attributed to weak prognosis, they may predict patients’ response to endocrine therapy. Assessment of presence of ER and PR are required in invasive breast cancers. ER-positive result is present in 70% of breast cancers and PR-positive result is present in 60% of breast cancers. […] HER2/neu is a proto-oncogene which involves in breast regulatory pathways such as proliferation, cell motility and invasion. In 10% to 34% of breast cancers, overexpression and amplification of HER2 is reported. In 90% of cases, overexpression, amplification, and surface membrane protein expressions of HER2/neu may be seen.

• #8 Fibrocystic Breast Disease: Causes, Symptoms, and Diagnosis

  https://www.healthline.com/health/fibrocystic-breast-disease

  Fibrocystic breast disease can cause the breasts to feel lumpy. […] Although it isnt harmful to have fibrocystic breasts, this condition can make the detection of breast cancer more challenging. […] Your breast tissue changes in response to the hormones made by the ovaries. If you have fibrocystic breasts, you may have more pronounced changes in response to these hormones. This can result in swelling and tender or painful breast lumps. […] Fibrocystic breast disease doesnt increase your risk of getting cancer, but the changes in your breasts can make it more difficult for you or your doctor to identify potentially cancerous lumps during breast exams and on mammograms. […] The specific cause of fibrocystic breast disease isnt fully understood. However, doctors suspect that estrogen and other reproductive hormones play a role.

• #9 Fibrocystic breasts – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/fibrocystic-breasts/symptoms-causes/syc-20350438

  The exact cause of fibrocystic breast changes isn’t known, but experts suspect that reproductive hormones especially estrogen play a role. […] Fluctuating hormone levels during the menstrual cycle can cause breast discomfort and areas of lumpy breast tissue that feel tender, sore and swollen. Fibrocystic breast changes tend to be more bothersome before your menstrual period and ease up after your period begins. […] When examined under a microscope, fibrocystic breast tissue includes distinct components such as: fluid-filled round or oval sacs (cysts), a prominence of scar-like fibrous tissue (fibrosis), overgrowth of cells (hyperplasia) lining the milk ducts or milk-producing tissues (lobules) of the breast, enlarged breast lobules (adenosis).

• #10 Breast Cyst – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK562196/

  Cysts seem to form as a result of fibrosis in breast tissue development and subsequent failure in the continuous process of the lobule and terminal ductule formation. The physical mechanism is that fibrosis causes thickening of the epithelium, and thus the developing lobule involutes early in its development. This causes the typical surrounding stroma to disappear and the adjoining ductule to break down, resulting in an aberrant epithelial lined fold, which becomes walled off entirely. The epithelial fold becomes dilated with epithelial acinar secretions and matures into a self-contained fluid-filled cavity. […] This underlying process of fibrosis likely stems from an overproduction of estrogen and suppression of progesterone, leading to hyperproliferation of the connective tissue, causing increased epithelial thickness. This theory is supported by the regression of fibrocystic changes in postmenopausal women.

• #11 Breast Cyst – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK562196/

  Cysts seem to form as a result of fibrosis in breast tissue development and subsequent failure in the continuous process of the lobule and terminal ductule formation. The physical mechanism is that fibrosis causes thickening of the epithelium, and thus the developing lobule involutes early in its development. This causes the typical surrounding stroma to disappear and the adjoining ductule to break down, resulting in an aberrant epithelial lined fold, which becomes walled off entirely. The epithelial fold becomes dilated with epithelial acinar secretions and matures into a self-contained fluid-filled cavity. […] This underlying process of fibrosis likely stems from an overproduction of estrogen and suppression of progesterone, leading to hyperproliferation of the connective tissue, causing increased epithelial thickness. This theory is supported by the regression of fibrocystic changes in postmenopausal women.

• #12 Fibrocystic breasts – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/fibrocystic-breasts/symptoms-causes/syc-20350438

  The exact cause of fibrocystic breast changes isn’t known, but experts suspect that reproductive hormones especially estrogen play a role. […] Fluctuating hormone levels during the menstrual cycle can cause breast discomfort and areas of lumpy breast tissue that feel tender, sore and swollen. Fibrocystic breast changes tend to be more bothersome before your menstrual period and ease up after your period begins. […] When examined under a microscope, fibrocystic breast tissue includes distinct components such as: fluid-filled round or oval sacs (cysts), a prominence of scar-like fibrous tissue (fibrosis), overgrowth of cells (hyperplasia) lining the milk ducts or milk-producing tissues (lobules) of the breast, enlarged breast lobules (adenosis).

• #13 Breast cancer – Wikipedia

  https://en.wikipedia.org/wiki/Breast_cancer

  The major causes of sporadic breast cancer are associated with hormone levels. Breast cancer is promoted by estrogen. This hormone activates the development of breast throughout puberty, menstrual cycles and pregnancy. The imbalance between estrogen and progesterone during the menstrual phases causes cell proliferation. Moreover, oxidative metabolites of estrogen can increase DNA damage and mutations. Repeated cycling and the impairment of repair process can transform a normal cell into pre-malignant and eventually malignant cell through mutation. […] Normal cells will self-destruct (programmed cell death) when they are no longer needed. Until then, cells are protected from programmed death by several protein clusters and pathways. One of the protective pathways is the PI3K/AKT pathway; another is the RAS/MEK/ERK pathway. Sometimes the genes along these protective pathways are mutated in a way that turns them permanently „on”, rendering the cell incapable of self-destructing when it is no longer needed. This is one of the steps that causes cancer in combination with other mutations.

• #14 Breast cancer – Wikipedia

  https://en.wikipedia.org/wiki/Breast_cancer

  Mutations that can lead to breast cancer have been experimentally linked to estrogen exposure. Additionally, G-protein coupled estrogen receptors have been associated with various cancers of the female reproductive system including breast cancer. […] Abnormal growth factor signaling in the interaction between stromal cells and epithelial cells can facilitate malignant cell growth. In breast adipose tissue, overexpression of leptin leads to increased cell proliferation and cancer. […] Some mutations associated with cancer, such as p53, BRCA1 and BRCA2, occur in mechanisms to correct errors in DNA. The inherited mutation in BRCA1 or BRCA2 genes can interfere with repair of DNA crosslinks and double-strand breaks (known functions of the encoded protein).

• #15 Breast cancer – Wikipedia

  https://en.wikipedia.org/wiki/Breast_cancer

  The major causes of sporadic breast cancer are associated with hormone levels. Breast cancer is promoted by estrogen. This hormone activates the development of breast throughout puberty, menstrual cycles and pregnancy. The imbalance between estrogen and progesterone during the menstrual phases causes cell proliferation. Moreover, oxidative metabolites of estrogen can increase DNA damage and mutations. Repeated cycling and the impairment of repair process can transform a normal cell into pre-malignant and eventually malignant cell through mutation. […] Normal cells will self-destruct (programmed cell death) when they are no longer needed. Until then, cells are protected from programmed death by several protein clusters and pathways. One of the protective pathways is the PI3K/AKT pathway; another is the RAS/MEK/ERK pathway. Sometimes the genes along these protective pathways are mutated in a way that turns them permanently „on”, rendering the cell incapable of self-destructing when it is no longer needed. This is one of the steps that causes cancer in combination with other mutations.

• #16 Breast cancer – Wikipedia

  https://en.wikipedia.org/wiki/Breast_cancer

  Mutations that can lead to breast cancer have been experimentally linked to estrogen exposure. Additionally, G-protein coupled estrogen receptors have been associated with various cancers of the female reproductive system including breast cancer. […] Abnormal growth factor signaling in the interaction between stromal cells and epithelial cells can facilitate malignant cell growth. In breast adipose tissue, overexpression of leptin leads to increased cell proliferation and cancer. […] Some mutations associated with cancer, such as p53, BRCA1 and BRCA2, occur in mechanisms to correct errors in DNA. The inherited mutation in BRCA1 or BRCA2 genes can interfere with repair of DNA crosslinks and double-strand breaks (known functions of the encoded protein).

• #17 Breast cancer – Wikipedia

  https://en.wikipedia.org/wiki/Breast_cancer

  Mutations that can lead to breast cancer have been experimentally linked to estrogen exposure. Additionally, G-protein coupled estrogen receptors have been associated with various cancers of the female reproductive system including breast cancer. […] Abnormal growth factor signaling in the interaction between stromal cells and epithelial cells can facilitate malignant cell growth. In breast adipose tissue, overexpression of leptin leads to increased cell proliferation and cancer. […] Some mutations associated with cancer, such as p53, BRCA1 and BRCA2, occur in mechanisms to correct errors in DNA. The inherited mutation in BRCA1 or BRCA2 genes can interfere with repair of DNA crosslinks and double-strand breaks (known functions of the encoded protein).

• #18 Ultrasound of hypoechoic mass or a solid Breast Lump with Moose and Doc

  https://breast-cancer.ca/ultrahypo-echosolid/

  Hypoechoic means an area looks darker on ultrasound than the surrounding tissue. The surrounding tissue therefore looks brighter/lighter shades of grey. Does hypoechoic mean cancer? No. […] A hypoechoic mass means that it is solid, rather than liquid. That is basically all the word means, that the lump or lesion is not a cyst. […] So, a lack of clear, smooth margins, heterogeneous echo patterns, and an increase in the anterioposterior dimension can indicate a higher probability of malignancy in solid breast nodules. […] The absence of a well-circumscribed margin, heterogenous echo patterns, as well as an increased anterioposterior dimension to the image do tend to indicate a higher probability of malignant cancer in solid breast nodules. […] The most typical sonographic presentation of a malignant breast mass would probably be an irregular, heterogeneous, hypoechoic mass with spiculations and angular margins.

• #19 Ultrasound of hypoechoic mass or a solid Breast Lump with Moose and Doc

  https://breast-cancer.ca/ultrahypo-echosolid/

  Hypoechoic means an area looks darker on ultrasound than the surrounding tissue. The surrounding tissue therefore looks brighter/lighter shades of grey. Does hypoechoic mean cancer? No. […] A hypoechoic mass means that it is solid, rather than liquid. That is basically all the word means, that the lump or lesion is not a cyst. […] So, a lack of clear, smooth margins, heterogeneous echo patterns, and an increase in the anterioposterior dimension can indicate a higher probability of malignancy in solid breast nodules. […] The absence of a well-circumscribed margin, heterogenous echo patterns, as well as an increased anterioposterior dimension to the image do tend to indicate a higher probability of malignant cancer in solid breast nodules. […] The most typical sonographic presentation of a malignant breast mass would probably be an irregular, heterogeneous, hypoechoic mass with spiculations and angular margins.

• #20 Ultrasound of hypoechoic mass or a solid Breast Lump with Moose and Doc

  https://breast-cancer.ca/ultrahypo-echosolid/

  If a solid breast nodule appears on ultrasound to be taller-than-wide, this is suspicious of malignancy. […] Hypoechoic breast lesions are suspicious for malignancy and on ultrasound imaging they will tend to look darker than the surrounding isoechoic fat. […] Microlobulations on breast ultrasound indicate the presence of lots of very small (1mm to 2 mm) lobulations on the surface of a solid breast nodule. So, these lobulations will be quite similar to mammogram findings. As the number of these microlobulations increase, the probability that the breast mass is malignant also increases. […] If a breast lesion shows posterior acoustic shadowing on ultrasound this means that there is something about the mass or around the mass which attenuates (reduces) the sonic beam strength in comparison to normal adjacent tissues.

• #21 Ultrasound of hypoechoic mass or a solid Breast Lump with Moose and Doc

  https://breast-cancer.ca/ultrahypo-echosolid/

  Posterior acoustic shadowing is suspicious for malignancy, but tends to be associated with low to intermediate grade breast tumors. […] In terms of the suggested BI-RADS descriptors for malignant breast nodules, spiculated margins have a positive predictive value for malignant breast cancer of about 85%. […] Masses showing an irregular shape or non-parallel orientation are also quite suggestive of malignancy, with a positive predictive value in the 62% to 69% range. […] Other studies place a higher predictive value on the presence of an irregular border (about 88% predictive of malignancy). In addition increase in vascularity in the hypoechoic mass predicts malignancy about 82% of the time. […] Breast lesions which appear as having a marked and uniform hyperechogenicity are highly predictive of a benign lesion. This feature typically represents normal fibrous changes within the breast.

• #22 Ultrasound of hypoechoic mass or a solid Breast Lump with Moose and Doc

  https://breast-cancer.ca/ultrahypo-echosolid/

  Posterior acoustic shadowing is suspicious for malignancy, but tends to be associated with low to intermediate grade breast tumors. […] In terms of the suggested BI-RADS descriptors for malignant breast nodules, spiculated margins have a positive predictive value for malignant breast cancer of about 85%. […] Masses showing an irregular shape or non-parallel orientation are also quite suggestive of malignancy, with a positive predictive value in the 62% to 69% range. […] Other studies place a higher predictive value on the presence of an irregular border (about 88% predictive of malignancy). In addition increase in vascularity in the hypoechoic mass predicts malignancy about 82% of the time. […] Breast lesions which appear as having a marked and uniform hyperechogenicity are highly predictive of a benign lesion. This feature typically represents normal fibrous changes within the breast.

• #23 Ultrasound of hypoechoic mass or a solid Breast Lump with Moose and Doc

  https://breast-cancer.ca/ultrahypo-echosolid/

  The compressibility of a breast lesions on ultrasound refers to changes in the shape of a lesion as a result of the pressure applied by the probe. A solid, likely malignant, breast lesion will not compress at all from the pressure of the probe. […] However, a tumor of benign fibrous or glandular tissue, such as a fibroadenoma, will show some soft tissue compressibility. […] If the findings of ultrasound imaging of suspicious breast nodules where expressed as an odds ratio (the odds of a person with these features as having breast cancer, as compared to an breast ultrasound where these features are not present) it may be suggested that breast lesions without a well-circumscribed margins are almost 17 times more likely to indicate malignant breast cancer.

• #24 Diabetic mastopathy: a breast carcinoma mimic | HKMJ

  https://www.hkmj.org/abstracts/v25n3/251.htm

  Diabetic mastopathy is a rare fibro-inflammatory disease of the breast. Its exact pathogenesis is not well understood but likely multifactorial, probably related to an inflammatory or immunological reaction. […] Clinically, diabetic mastopathy often presents as a hard, painless, irregular breast mass that can also be multiple and bilateral (60% of the cases). […] Clinical examination and imaging studies cannot differentiate diabetic mastopathy from breast carcinoma, and ultimately the diagnosis can only be made on histology from core or excisional biopsy. […] Diabetic mastopathy is a benign entity without malignant potential and should therefore be treated conservatively. […] In summary, diabetic mastopathy is an uncommon but important benign entity that can mimic breast carcinoma clinically and radiologically.

• #25 Diabetic mastopathy: a breast carcinoma mimic | HKMJ

  https://www.hkmj.org/abstracts/v25n3/251.htm

  Diabetic mastopathy is a rare fibro-inflammatory disease of the breast. Its exact pathogenesis is not well understood but likely multifactorial, probably related to an inflammatory or immunological reaction. […] Clinically, diabetic mastopathy often presents as a hard, painless, irregular breast mass that can also be multiple and bilateral (60% of the cases). […] Clinical examination and imaging studies cannot differentiate diabetic mastopathy from breast carcinoma, and ultimately the diagnosis can only be made on histology from core or excisional biopsy. […] Diabetic mastopathy is a benign entity without malignant potential and should therefore be treated conservatively. […] In summary, diabetic mastopathy is an uncommon but important benign entity that can mimic breast carcinoma clinically and radiologically.

• #26 Fibroadenoma of the breast: what it is, its types, symptoms, diagnosis and treatment

  https://medconsonline.com/en/blog/fibroadenoma-of-the-breast

  The exact causes of these breast tumors are unknown, but several factors are thought to contribute to their development. […] Reproductive hormone imbalance: abnormal estradiol and progesterone ratio with increased levels of the former. The hormone dependence of fibrous glandular overgrowths is proved, in particular, by the fact that their size partially changes during the menstrual cycle and increases during pregnancy, while regression symptoms (reduction in size, calcification, etc.) often occur in postmenopause. […] Familial predisposition: it is known that if fibroadenomas or other benign breast disorders are present in close relatives, the risk of developing these conditions is increased. […] Local growth factors: by promoting the proliferation of stromal tissue and glandular components, local growth factors can stimulate the growth of breast lumps.

• #27 Fibroadenoma of the breast: what it is, its types, symptoms, diagnosis and treatment

  https://medconsonline.com/en/blog/fibroadenoma-of-the-breast

  Injury: it is hypothesized that damage to the organ can induce local tissue changes leading to the development of benign lesions. […] Diet and lifestyle: although there is no direct link, some studies suggest that certain dietary and lifestyle factors, such as a high-fat diet, can affect hormone levels and, consequently, stimulate the development of breast nodules. […] Other possible causes that are still being debated include certain immunosuppressant drugs and viral infections such as the Eppstein-Barr virus.

• #28 Case: Fat Necrosis of the Breast – Radiology | UCLA Health

  https://www.uclahealth.org/departments/radiology/education/breast-imaging-teaching-resources/cases/case-fat-necrosis-breast

  Fat necrosis arises from the disruption of adipose tissue integrity, leading to the release of free fatty acids. Trauma, ischemia, and inflammatory processes can initiate this cascade. The necrotic fat then undergoes a series of changes, including liquefaction and encapsulation. Fibrosis can develop around the area of liquefied fat and can either surround or replace the area of necrotic adipose tissue. Eventually, the rim and internal contents of the fat necrosis may calcify, resulting in characteristic benign imaging findings. […] Understanding the epidemiology, pathophysiology, and characteristic imaging findings of fat necrosis is essential for radiologists.

• #29 Case: Fat Necrosis of the Breast – Radiology | UCLA Health

  https://www.uclahealth.org/departments/radiology/education/breast-imaging-teaching-resources/cases/case-fat-necrosis-breast

  Fat necrosis arises from the disruption of adipose tissue integrity, leading to the release of free fatty acids. Trauma, ischemia, and inflammatory processes can initiate this cascade. The necrotic fat then undergoes a series of changes, including liquefaction and encapsulation. Fibrosis can develop around the area of liquefied fat and can either surround or replace the area of necrotic adipose tissue. Eventually, the rim and internal contents of the fat necrosis may calcify, resulting in characteristic benign imaging findings. […] Understanding the epidemiology, pathophysiology, and characteristic imaging findings of fat necrosis is essential for radiologists.

• #30 Breast Abscesses and Masses: Background, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/781116-overview

  Breast masses are broadly classified as benign or malignant. Common causes of benign breast lesions include fibrocystic disease, fibroadenoma, intraductal papilloma, and abscess. Malignant breast disease encompasses many histologic types that include, but are not limited to, in situ ductal or lobular carcinoma, infiltrating ductal or lobular carcinoma, and inflammatory carcinoma. The main concern of many women presenting with a breast mass is the likelihood of cancer. Reassuringly, most breast masses are benign. […] When the lactiferous duct lining undergoes epidermalization, keratin production may cause plugging of the duct, resulting in abscess formation. […] This may explain the high recurrence rate (an estimated 39%-50%) of breast abscesses in patients treated with standard incision and drainage, as this technique does not address the basic mechanism by which breast abscesses are thought to occur.

• #31 Breast Abscesses and Masses: Background, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/781116-overview

  Breast masses are broadly classified as benign or malignant. Common causes of benign breast lesions include fibrocystic disease, fibroadenoma, intraductal papilloma, and abscess. Malignant breast disease encompasses many histologic types that include, but are not limited to, in situ ductal or lobular carcinoma, infiltrating ductal or lobular carcinoma, and inflammatory carcinoma. The main concern of many women presenting with a breast mass is the likelihood of cancer. Reassuringly, most breast masses are benign. […] When the lactiferous duct lining undergoes epidermalization, keratin production may cause plugging of the duct, resulting in abscess formation. […] This may explain the high recurrence rate (an estimated 39%-50%) of breast abscesses in patients treated with standard incision and drainage, as this technique does not address the basic mechanism by which breast abscesses are thought to occur.

• #32 Breast Abscesses and Masses: Background, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/781116-overview

  Mastitis is usually seen in lactating women, but the presence in a nonlactating woman should spur evaluation for an inflammatory carcinoma, newly onset diabetes, infection with Mycobacterium tuberculosis, and other idiopathic causes. […] Development of mastitis has been correlated with an increased risk of developing breast cancer. […] The recurrence rate of breast abscess is high (39%-50%) when treated with standard incision and drainage, and studies have shown even higher recurrence rates in women undergoing fine-needle aspiration. […] Nonpuerperal abscesses recur more frequently, especially when associated with non-staphylococcal species (50% recurrence rate).

• #33 Breast Cyst – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK562196/

  Fibrocystic changes are categorized into nonproliferative changes, proliferative changes without atypia, or proliferative changes with atypia. Nonproliferative changes include simple cysts and are entirely benign. Proliferative changes may include varying degrees of solid components like adenosis, sclerosis, fibrosis, as well as epithelial hyperplasia or metaplasia and apocrine metaplasia. Epithelial atypia is referred to as atypical ductal or lobular hyperplasia and is a risk factor for the development of breast cancer.

• #34 Common Breast Problems | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0415/p505.html

  Breast masses are associated with an increased risk of breast cancer.2,3,5 Patients presenting with a palpable breast mass should be evaluated with a detailed history, clinical breast examination (CBE), and, for almost all women, imaging.68 […] Although CBE has poor predictive value for determining whether a breast mass is cancerous, some features of breast masses may help distinguish between benign and malignant lesions. Benign masses are more likely to be smaller, mobile, smooth, and regular. Malignant masses are typically larger, fixed, hard, and heterogeneous in texture.6 […] Because of the imperfect sensitivity and specificity of CBE and imaging, patients should be referred for tissue sampling if suspicious findings are noted at any stage of the evaluation, regardless of benign findings at other stages. A highly suspicious breast mass found on CBE should be biopsied regardless of imaging findings, and suspicious masses on imaging should be biopsied even if the CBE suggested benign findings.79

• #35 Common Breast Problems | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0415/p505.html

  Breast masses are associated with an increased risk of breast cancer.2,3,5 Patients presenting with a palpable breast mass should be evaluated with a detailed history, clinical breast examination (CBE), and, for almost all women, imaging.68 […] Although CBE has poor predictive value for determining whether a breast mass is cancerous, some features of breast masses may help distinguish between benign and malignant lesions. Benign masses are more likely to be smaller, mobile, smooth, and regular. Malignant masses are typically larger, fixed, hard, and heterogeneous in texture.6 […] Because of the imperfect sensitivity and specificity of CBE and imaging, patients should be referred for tissue sampling if suspicious findings are noted at any stage of the evaluation, regardless of benign findings at other stages. A highly suspicious breast mass found on CBE should be biopsied regardless of imaging findings, and suspicious masses on imaging should be biopsied even if the CBE suggested benign findings.79

• #36 Common Breast Problems | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0415/p505.html

  In most cases, a core needle biopsy should be performed for evaluation of a suspicious mass. Compared with fine-needle aspiration, core needle biopsy has superior sensitivity, specificity, and ability to detect possible malignant invasion.12 […] Noncyclic/focal mastalgia should trigger diagnostic imaging because of its rare but occasional association with underlying malignancy.8 Imaging may also identify a benign, treatable cause of noncyclic/focal pain.12,24 The risk of malignancy in patients with breast pain after normal CBE and mammography findings is approximately 0.5%.8,12 […] Pathologic discharge is generally spontaneous and unilateral, and originates from a single duct opening on a nipple. It may be bloody, serous, serosanguineous, or watery.30 The differential diagnosis includes intraductal papilloma, ductal ectasia, and breast carcinoma.30 If discharge is deemed pathologic, age-appropriate diagnostic imaging with mammography and/or ultrasonography is indicated.30 Studies have shown a low risk of malignancy when diagnostic studies are negative.

• #37

  https://www.ijsurgery.com/index.php/isj/article/view/4851

  The pathogenesis involves disturbance in the breast physiology extending from an extreme normality to well defined disease processes. […] Our study indicates that FNAC is diagnostically more accurate, safe, cost effective and OPD procedure, however when FNAC was inconclusive, biopsy is the best choice for breast tumors.

• #38 Breast lumps pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Breast_lumps_pathophysiology

  It is understood that breast lumps are the result of hormonal events: Prevalence of benign breast lesion in post-menopausal women receiving estrogen with or without progesteron for more than 8 years raise by 1.7 fold. Estrogen and progesterone increase rate of benign proliferative breast disease to 74%. Anti-estrogen drugs such as tamoxifen, decrease prevalence of breast lesions such as adenosis, cysts, hyperplasia, duct ectasia to 28%. […] Although estrogen receptors (ER) and progesterone-receptor (PR) attributed to weak prognosis, they may predict patients’ response to endocrine therapy. Assessment of presence of ER and PR are required in invasive breast cancers. ER-positive result is present in 70% of breast cancers and PR-positive result is present in 60% of breast cancers. […] HER2/neu is a proto-oncogene which involves in breast regulatory pathways such as proliferation, cell motility and invasion. In 10% to 34% of breast cancers, overexpression and amplification of HER2 is reported. In 90% of cases, overexpression, amplification, and surface membrane protein expressions of HER2/neu may be seen.

• #39 Breast lumps pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Breast_lumps_pathophysiology

  Breast development is influenced by different hormones such as estrogen, progesterone, prolactin, and estradiol. The pathophysiology of breast lumps depends on the histological subtypes. Histological findings of breast lumps are different from each other which lead to diagnosis. It is thought that breast lumps are the result of hormonal events and genetic mutations. Estrogen and progesterone may increase risk of benign proliferative disease to 74% and benign breast lesion in post-menopausal women receiving estrogen with or without progesteron for more than 8 years raise by 1.7 fold. Gene mutations are classified into 3 categories based on cancer risk such as BRCA1, BRCA2, TP53 considered as high risk mutations, Homozygous ataxia-telangiectasia, somatic mutation in CHEK2, BRIP1, PALB2 moderate risk mutations, and low risk genes mutation are not determined yet.

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