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Pathology - Radial scar Definition • A benign sclerosing breast lesion distinguished by a central area of scarring encircled by a radiating margin of proliferative glandular tissue. Radial scars vary in size from minuscule microscopic lesions to bigger, clinically discernible masses. Lesions above 1 cm in size are occasionally referred to as 'complex sclerosing lesions.' Epidemiology • Radial scars are rather prevalent lesions. • Incidence rates fluctuate significantly based on their definition. The aetiology and pathophysiology of radial scars remain mostly unknown. One concept posits that they signify a reparative process in reaction to regions of tissue injury in the breast. Presentation • Large radial scars are typically identified on mammography as stellate or spiculated masses. They can nearly replicate the appearance of a cancer. Macroscopy • Radial scars present as stellate, firm lumps that appear to infiltrate the adjacent parenchyma. • They can be readily mistaken for invasive carcinomas upon macroscopic examination. Histopathology • Radial scars are symmetrical, stellate lesions of the breast with a distinctive zonal architecture. The lesion's center (the nidus) consists of tight collagen bundles and elastic tissue containing entrapped, randomly organized tubules. • Encircling the nidus are radially oriented clusters of ducts and lobules, each directed towards the center of the lesion. The ducts and lobules in this region generally display pronounced benign alterations, such as fibrocystic change, sclerosing adenosis, and significant usual epithelial hyperplasia. Prognosis: Radial scars are classified as benign lesions; yet, their existence is linked to a twofold elevated risk of later breast cancer development 
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Pathology - Intraductal papilloma A benign papillary tumor originating in the ductal system of the breast. Papillomas may arise throughout the ductal system, with a preference for either small terminal ductules (peripheral papillomas) or big lactiferous ducts (central papillomas). Epidemiology • Prevalent. • Predominantly observed in women aged 40 to 59. Aetiology • Considered to be neoplastic proliferations of glandular and stromal breast tissue. Presentation • The majority of women with central papillomas have nipple discharge. • Minor peripheral papillomas typically manifest as a breast lump. Macroscopy: Large papillomas appear as fragile lumps within an enlarged duct. Cytopathology • Smears obtained from nipple discharge may exhibit branching papillaroid clusters of epithelial cells indicative of the diagnosis. Histopathology • A papillary mass is observed with a ductal space. • The papillae are broad and rounded, allowing the fronds to interlock seamlessly. • Each frond is rich in stroma, consisting of blood vessels and fibrous tissue. • The epithelium enveloping the fronds is bilayered, comprising inner columnar epithelial cells and outer myoepithelial cells. Prognosis: Benign lesions; nonetheless, several studies indicate that women with papillomas exhibit a twofold greater chance of developing future invasive breast cancer.  Pathology - Fibroadenoma Definition • A benign fibroepithelial tumor of the breast. Epidemiology: Prevalent. • Predominantly affects young women aged 20 to 30 years. Aetiology • The majority of experts consider them to be neoplastic proliferations of fibroblasts inside the specialized connective tissue of the intralobular stroma. Pathogenesis • The proliferating neoplastic fibroblasts inside the intralobular stroma entrap and compress terminal duct lobular units and interlobular stroma, resulting in the formation of a well-defined nodular mass. Macroscopy • Well-defined, movable breast masses often measuring 3 cm or less. • The cut surface is generally solid, whorled, and grey-white in hue. Cytopathology • Aspirates exhibit cellularity, featuring numerous branching sheets of cohesive, bland ductal epithelial cells alongside a substantial presence of naked bipolar nuclei in the background. • Fragments of stromal material may also be observed. Histopathology • Histological examination reveals a well-circumscribed multinodular tumor distinct from the adjacent breast tissue. Each nodule comprises an enlarged myxoid intralobular stromal compartment populated by inconspicuous spindled fibroblastic cells. The terminal duct lobular unit is constricted into narrow channels. • Narrow strands of interlobular stroma exist between each nodule of the fibroadenoma. • Mature lesions frequently exhibit fibrosis and calcification. Prognosis: • Benign lesions exhibiting no potential for malignant behavior. Surgical excision through straightforward 'shelling out' is nearly invariably curative with minimal likelihood of recurrence. Phyllodes tumors Phyllodes tumors are a category of potentially aggressive fibroepithelial neoplasms. These are rare tumors that often manifest as a progressively enlarging breast lump in women over 50 years of age. Some are believed to originate from pre-existing fibroadenomas. Macroscopically, the tumors typically present as big, fleshy, lobulated masses exhibiting regions of cystic alteration. Histologically, these are fibroepithelial tumors characterized by the excessive proliferation of neoplastic stromal cells, resulting in a disordered and heterogeneous morphology of the epithelial component. The stroma exhibits variability in cellularity and the composition of the extracellular matrix. Substantial stromal nodules extending into cystic cavities generate distinctive 'leaf-like' projections. All phyllodes tumors possess the potential for local recurrence and are typically managed with extensive local resection. In actuality, the majority do not reappear, even after uncomplicated enucleation. Phyllodes tumors may acquire the ability to spread, however this occurrence is exceedingly rare.  Pathology - Fibrocystic change Definition: A series of modifications in the breast that represent natural, but amplified, reactions to hormonal influences. Epidemiology • Highly prevalent. • Present in over one-third of premenopausal adult females. Aetiology • A condition driven by hormonal factors in response to estrogens. Pathogenesis • The mechanism remains rather ambiguous; nevertheless, some researchers hypothesize that the initial event involves apocrine metaplasia of the breast ducts. • The secretions generated by these cells result in ductal dilatation and cyst development. Presentation • The primary characteristic is breast nodularity and lumpiness. • Cyclical discomfort may also be present. Macroscopy • The breast tissue exhibits a firm, rubbery consistency. • Cysts are typically discernible, presenting a brown or bluish coloration. Cytopathology • Aspirates from cysts reveal debris, foamy macrophages, and apocrine cells. • Aspirates from non-cystic regions consist of cohesive fragments of bland ductal epithelial cells with numerous background naked bipolar nuclei. Histopathology • Characterized by several histological alterations, including cystic transformation, apocrine metaplasia, adenosis, moderate epithelial hyperplasia, and stromal hyperplasia. Prognosis: Benign with no elevated risk for later invasive breast carcinoma.  Pathology - Fat tissue necrosis Definition: An inflammatory response to injured adipose tissue. Epidemiology: Prevalent. Aetiology: Trauma to the breast. • Following surgical intervention or radiation. Pathogenesis • Compromised adipocytes release their lipid contents, provoking an inflammatory response that leads to the formation of a palpable mass. Presentation • The majority present with a breast mass that is firm and indurated.Can closely resemble breast carcinoma in clinical presentation. Macroscopy • The breast tissue exhibits yellow-white flecks of discolouration. Cytopathology: FNA cytology reveals foamy macrophages, multinucleated large cells, and background detritus. Histopathology: Degenerating adipocytes are observed, encircled by foamy macrophages, multinucleated giant cells, lymphocytes, and plasma cells. Subsequent alterations encompass fibrosis and calcification. Prognosis: Benign with no elevated risk of breast cancer.  Pathology - Acute mastitis Definition • Acute inflammation of the breast. Epidemiology • Prevalent. • The majority are linked to either lactation or duct ectasia. Microbiology • Staphylococci and streptococci in nursing women. • Staphylococci or anaerobic bacteria in females with duct ectasia. Pathogenesis Cracks in the skin are believed to facilitate bacterial entry into the breast, while milk stasis encourages the onset of illness. The most prevalent presentation is a painful, erythematous breast. • The establishment of an abscess may result in a breast mass. Macroscopy A pronounced region of acute mastitis may yield a discernible bulk. • Purulent exudate may be evident alongside abscess development. Cytopathology Fine needle aspiration (FNA) of an inflammatory breast mass typically produces purulent material that microscopically reveals a high concentration of neutrophils. Histopathology • Acute inflammation is evident inside the breast parenchyma. The convergence of the acute inflammatory process may result in the formation of an abscess cavity. The neighboring breast tissue may exhibit lactational alterations or duct ectasia. Prognosis: Drainage and suitable antibiotic therapy typically lead to resolution.  Pathology - Duct ectasia Inflammation and dilatation of big mammary ducts Epidemiology: Prevalent among adult women throughout all age groups. Etiology • Ambiguous. Although infection may complicate duct ectasia, it does not appear to be the primary cause. Presentation • Nipple discharge is the predominant presenting symptom. The discharge may be transparent, creamy, or blood-tinged. More severe cases may result in pain, a palpable breast lump, and nipple retraction. Macroscopy: The subareolar ducts exhibit visible dilation and are filled with viscous secretions. Cytopathology Smears derived from a nipple discharge sample exhibit proteinaceous debris and macrophages. Ductal epithelial cells are typically absent. Histopathology • The subareolar ducts are distended and contain proteinaceous substances and macrophages. • Periductal chronic inflammation and fibrosis are also observed. Prognosis: Duct ectasia is a nonmalignant disorder with no elevated risk of cancer.  Pathology - Pre eclampsia Definition: Proteinuria and hypertension brought on by pregnancy. The study of epidemiology • About 5% of pregnancies are complicated. • More common in mothers who are expecting their first child. The cause • The main underlying issue is abnormal placentation The pathogenesis Intradecidual spiral arteries and basal arteries fail to physiologically convert into big, low resistance vessels due to abnormally shallow trophoblast invasion; maternal blood pressure increases in an effort to make up for this, but the overall effect is placental ischaemia. • The ischemic placenta releases toxins that harm endothelium when they reach the mother's circulation. • Widespread fibrin thrombi formation in the microcirculation and the danger of cerebral hemorrhage, heart failure, liver failure, and renal failure are indicators of the progression to eclampsia. Presentation: The majority of women receive a diagnosis when regular prenatal monitoring detects proteinuria and hypertension after 20 weeks of pregnancy. Macroscopy: Generally speaking, placentas are smaller than those from typical pregnancies. • Placental infarcts occur considerably more frequently. The study of histopathology • Villous cytotrophoblasts are more numerous and prominent in placental villi, and the basement membrane thickens unevenly. Villous blood arteries are frequently tiny and undetectable. Failure of trophoblast physiological conversion is seen in maternal decidual arteries. Atherosis, or intramural buildup of lipid-laden macrophages, and fibrinoid necrosis of the artery wall are also seen in a small percentage of cases. • Enlarged "bloodless" glomeruli with inflated endothelial cells are visible in the kidneys. In more severe situations, fibrin microthrombi may be observed inside glomerular capillary loops. • In severe cases, the liver may exhibit hepatic necrosis, hemorrhage, and fibrin thrombi in the hepatic sinusoids. Prognosis The sole treatment for pre-eclampsia is delivery. It is necessary to balance the dangers to the mother and the fetus from an early delivery. Because of the disease's unpredictable behavior and quick progression, patients need to be regularly watched for indications of decline.  Pathology - hydatidiform Moles Definition: An aberrant proliferation of trophoblasts is a hallmark of a particular type of gestational trophoblastic illness. There are two kinds of moles: partial moles and complete moles. The study of epidemiology In the western world, about one out of every 1000 pregnancies is molar. In regions of the Far East, where incidence rates might reach 1 in 80, they are far more prevalent for unclear reasons. Genetics: All chromosomes in whole moles are derived from their fathers, and they are often diploid (46 XX or 46 XY). Partial moles are triploid (69 XXY, 69 XXX, or 69 XYY) with one set of mother chromosomes and two sets of paternal chromosomes. They develop when a haploid sperm fertilizes an anucleate ovum, then copies its genetic material. They are produced when two sperm fertilize an ovum. Presentation: The majority have an early miscarriage. Typically, molar pregnancy is diagnosed after a histological analysis of the removed products of conception; there is no clinical suspicion of molar pregnancy. The majority of molar products of conception are quite ordinary in terms of macroscopy. • Villi that are clearly hydropic may be seen in cases that appear late. Histopathology • Villi with a distinctive lobulated "budding" architecture are seen in whole moles. The myxoid stroma of the villi contains karyorrhectic debris and collapsed empty blood vessels. Sheets of pleomorphic extravillous trophoblast may be present, along with aberrant non-polar trophoblastic hyperplasia. A noticeable implantation site reaction is frequently observed, although the typical trophoblast blockage of multiple blood arteries is absent. Villi with uneven, "dentate," or "geographic" contours are detected in partial moles. Villous blood arteries containing nucleated fetal red blood cells and noticeable villous pseudo-inclusions are present in the frequently fibrotic villi. There is abnormal non-polar trophoblastic hyperplasia, although it is typically localized and less noticeable than in whole moles. With typical trophoblast blockage of decidual blood arteries, the implantation site is typically inconspicuous. Prognosis: B HCG levels quickly return to normal after molar tissue evacuation, which is typically curative. Persistent prenatal trophoblastic illness, which complicates around 15% of full moles and 1% of partial moles and necessitates chemotherapy to cure, is indicated by persistent B HCG levels. Choriocarcinoma during pregnancy Choriocarcinoma is an uncommon but extremely dangerous trophoblastic tumor that is another kind of prenatal trophoblastic illness. Half of them arise from a previous hydatidiform mole, whereas the other half happen after a non-molar miscarriage or a normal pregnancy. According to histology, choriocarcinomas are made up of a combination of syncytiotrophoblast and cytotrophoblast, which usually form bilaminar structures. Chorionic villi are by definition missing. Due to their high tendency for vascular invasion, choriocarcinomas can spread quickly to several distant locations. Thankfully, most women have a fairly excellent prognosis and pregnant choriocarcinomas react very well to chemotherapy.  Pathology – Ectopic Pregnancy Definition: When a fertilized ovum implants abnormally outside of the uterus. Almost all of them take place in the ampullary region of the Fallopian tubes. Rarely, other locations include the abdominal cavity and ovaries. The study of epidemiology • The incidence is 12 per 1000 pregnancies annually and is on the rise. The cause • The most frequent risk factor is tubal scarring from prior PID episodes. • Endometriosis and prior tubal surgery are additional risk factors. • Roughly half happen for no apparent reason. The pathogenesis • There is severe bleeding into the Fallopian tube when trophoblasts are implanted there. • The tubal wall may rupture abruptly or gradually; the embryo may become dislodged and be absorbed by the wall or shed. Presentation: • Sudden rupture results in an acute abdomen with peritonism and shock; • Typical presentation is progressively growing stomach discomfort and vaginal bleeding. 2. If a woman of reproductive age experiences stomach pain, take the diagnosis into consideration. Macroscopy • There is a noticeable dilatation and congestion of the affected Fallopian tube. • Friable material and blood fill the tubal lumen. Histopathology: The Fallopian tube contains chorionic villi and infiltrating extravillous trophoblasts. Prognosis: If the diagnosis is made and the proper treatment is administered, the prognosis is favorable. • A increased risk of subsequent ectopic pregnancies is linked to having one ectopic pregnancy.  |
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