BREAST

PATHOLOG
Y
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INVERTED NIPPLE
An inverted nipple is a condition defined as
the nipple, which is retracted inwards,
rather than pointing outwards, as is seen in
normal anatomy. It can occur in both sexes
and can be congenital or acquired.
The appearance can be psychologically disturbing, as
well as being problematic during breastfeeding in
nursing women. As many as 10% to 20% of females are
born with one or more inverted nipples, and they may
be completely asymptomatic until breastfeeding.
2 TYPES OF NIPPLE INVERSION
Congenital nipple inversion is mainly diagnosed during a
wellness regular physical by a pediatrician or general
practitioner as the patient approaches puberty. Many inverted
nipples present in pre-pubescent patients will resolve
spontaneously during puberty. They do not tend to cause any
problems then and are usually observed until
puberty/adolescence for resolution.
2 TYPES OF NIPPLE INVERSION
Pathological/acquired nipple inversion after puberty or breast
development is more worrisome for malignancy or other
abnormalities. This is generally associated with nipple discharge
(serous/bloody), nipple erosion, or a breast lump. It is important
to obtain a detailed personal and family history in both male and
female patients of any breast malignancy, as well as any
confounding trauma history to the breast or chest, as scarring and
fat necrosis can mimic malignancy.
GRADES OF INVERTED NIPPLES
Grade 1 inverted nipples - These are called “shy nipples.” They
have minimal or no fibrosis and demonstrate a soft-tissue
sufficiency. The lactiferous ducts are normal, even with the
retraction. These nipples are very amenable to manipulation and
maintain projection for a considerable time, thus enabling
breastfeeding easily, although initiation may pose some
difficulty.
GRADES OF INVERTED
NIPPLES
Grade 2 inverted nipples – They demonstrate fibrosis of a
moderate degree. On tissue examination, smooth muscle
bundles are seen encasing the fibrous stroma. The milk ducts
are retracted. The nipples can be pulled out but retract back
soon after. Breastfeeding is possible, but the baby may have
difficulty latching on to the nipple. The decision to lyse the
fibrous bands surrounding the lactiferous ducts is
individualized. Most of the cases do not need surgical
correction.
GRADES OF INVERTED
NIPPLES
Grade 3 inverted nipples – The fibrosis seen is remarkable,
and there is severe soft tissue deficiency. Lactiferous ducts are
tiny, constricted, and retracted to a considerable extent.
Histologically, the terminal ductal units are fibrosed and
atrophied. These nipples cannot be pulled out and often
mandate surgical correction. Breastfeeding is nearly
impossible. These patients do experience a wide variety of
associated problems like rashes, sore nipples, and recurrent
mastitis.
TREATMENT
Management mainly depends on the grade of inversion. Over the years,
there has been a wide variety of surgical and non-surgical techniques
utilized to treat nipple inversion with satisfactory and non-satisfactory
results. Non-invasive/ conservative techniques were implemented mainly
for grade 1 inverted nipples with considerable success and grade 2 with
partial success. Invasive/ surgical procedures are primarily indicated for
grade 3 and persistent grade 2 inversions. As such, no standardized
technique has been implemented.
POLYMASTIA (SUPERNUMERARY
BREAST)
Rare breast malformation characterized by
the presence of accessory breast with a
complete ductal system, areola, and nipple
in addition to two normal breasts.
SYMPTOMS:
- swelling and tenderness of the affected region
- thickening of the axilla
- restriction in the range of arm motion
LOCATION

Supernumerary Breast tissue is

usually found within the milk line
extending from the axilla to pubic
region.
KAJAVA CLASSIFICATION
Class I consists of a complete breast including glandular tissue,
nipple, and areola.
Class II consists of only glandular tissue and nipple, without areola.
Class III consists of only glandular tissue and areola, without nipple.
Class IV consists of only glandular tissue.
Class V consists of only nipple and areola, without glandular tissue.
Class VI consists of only the nipple.
Class VII consists of only the areola.
Class VIII consists of only hair.
TREATMENT
It is recommended to completely remove the
accessory breast tissue.
CLINICAL
BREAST
CHANGES
BREAST LUMP
A breast lump is a localized swelling,
protuberance, bulge, or bump on the
breast that feels different from the
breast tissue around it or the tissue in
the same area of the other breast.
THERE ARE DIFFERENT REASONS WHY BREAST LUMPS
DEVELOP.
Causes include infection, trauma, fibro adenoma, cyst, fat
necrosis, or fibrocystic breasts.

Breast lumps may develop in both males and females but are
more common Trusted Source in females.

Some lumps are cancerous, but most are not.

TYPES AND SYMPTOMS
Breast lumps can develop for many reasons,
cancerous and noncancerous. The symptoms
may vary depending on the cause of the
lump.
NONCANCEROUS LUMPS
The size, feel, and texture of breast lumps can vary
considerably. The consistency may help a physician
diagnose what kind of a lump it is.

Examples:
Breast cysts
A breast cyst is a benign or noncancerous fluid-filled sac in
the breast. They commonly affect females aged 30–50
years Trusted Source and are rare after menopause.
IT MAY CAUSE NO SYMPTOMS, OR A
PERSON MAY NOTICE:

- a smooth and rubbery lump under the skin

- pain
- nipple discharge
CANCEROUS LUMPS

A breast cancer lump or tumor can appear in

the breast or underarm.
WARNING SIGNS INCLUDE

- nipple pain
- nipple inversion, or pulling inward of the nipple
- discharge, which may contain blood
- changes in the size or shape of the breast
BREAST RASH
Irritation, inflammation and changes in the
usual texture, appearance and color of your skin
are all signs of a skin rash.
COMMON SKIN RASHES
Dermatitis: this is a catch-all term to describe any type of
irritation, discoloration or inflammation on your skin.
Heat rash: occurs when sweat is trapped in the skin.
Psoriasis: a skin disease that causes a rash with itchy, scaly
patches.
TREATMENT
Treatment for a rash on your breast depends on the
cause.
INVASIVE LOBULAR CARCINOMA
INVASIVE LOBULAR CARCINOMA

Invasive lobular carcinoma is a type of breast cancer that begins

in the milk-producing glands (lobules) of the breast. Invasive
cancer means the cancer cells have broken out of the lobule
where they began and have the potential to spread to the
lymph nodes and other areas of the body. Invasive lobular
carcinoma makes up a small portion of all breast cancers.
The most common type of breast cancer begins in the breast
ducts.
 Symptoms
At its earliest stages, invasive lobular carcinoma may cause no signs and symptoms. As it grows
larger, invasive lobular carcinoma may cause:

● An area of thickening in part of the breast

● A new area of fullness or swelling in the breast
● A change in the texture or appearance of the skin
over the breast, such as dimpling or thickening
● A newly inverted nipple
What does it look like?
a new lump or thickening in your breast or armpit. a change in size,
shape or feel of your breast. skin changes in the breast such as
puckering, dimpling, a rash or redness of the skin. fluid leaking from
the nipple in a woman who isn't pregnant or breast feeding.
 Causes
It's not clear what causes invasive lobular carcinoma.
Doctors know that invasive lobular carcinoma begins when cells in one or more milk-
producing glands of the breast develop mutations in their DNA. The mutations lead to the
inability to control cell growth, which results in the cells dividing and growing rapidly.
Depending on the aggressiveness of the cancer type, the cancer cells can spread to other
parts of the body.
 Risk Factors
Being female- Women are more likely to develop breast cancer, but men also can
develop breast cancer.

Older age- Your risk of breast cancer increases as you age. Women with invasive
lobular carcinoma tend to be a few years older than women diagnosed with other
types of breast cancer.

Inherited genetic cancer syndromes- Women with a rare inherited condition called
hereditary diffuse gastric cancer syndrome have an increased risk of both stomach
(gastric) cancer and invasive lobular carcinoma.
 
 Treatment
Your treatment options for invasive lobular carcinoma depend on the aggressiveness of your
cancer, its stage, your overall health and your preferences. Treatment often consists of
surgery and additional (adjuvant) therapy, which may include chemotherapy, radiation and
hormone therapy.
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