5.

8 PATHOLOGY OF THE BREAST

Save the BREAST for last
DR. JANELYN DYLEDESMA, DPSP

NORMAL GROSS ANATOMY AND HISTOLOGY

OF THE BREAST
The breast is composed of epithelial and stromal components.

EPITHELIAL COMPONENT
1.
2.

3.

Lobe: A breast of a young female is composed of 10

lobes. Each lobe is composed of lobules.
Lobules: Depending on age and status of hormones
in the body, they can be as low as 20 lobules per
breast or up to 200. Each lobule is composed of acini
or ductal cells.
Acini:
o AKA Terminal duct lobular unit
o Lined by two types of cells:
a. Cuboidal cells: innermost layer,seen
towards the lumen and produces
secretion
b. Myoepithelial cells: outermost layer,
seen at the periphery

JANUARY 24, 2013

detects radio dense masses. Since the breast of a young female

is also dense, so theres no difference in lucency on the
mammogram, so its very easy to miss any type of lesion. The
use of ultrasound is recommended.
Picture B: The density of a young woman's breast is due to the
predominance of fibrous interlobular stroma and scanty
adipose tissue.
Picture C. In a woman who is breastfeeding, the breast will go
under lactational changes. The lobule becomes enlarged and
the acini become dilated because it starts producing milk.
During lactation, progesterone is increased which give rise to
hyperplasia of lobules while prolactin will produce the breast
milk secretion.

STROMAL COMPONENT
1.

2.

Interlobular: found in between lobules

Intralobular: around each acini

Figure 3. Picture D: In the elderly female, atrophic and

degenerative changes are seen. Theres atrophy and decreased
in number of lobules and acini, lobules are far apart, fibrous
tissue in between lobules is decreased and theres an increase
in the adipose tissue.
Picture E: In elderly female (40-50y/o), due to increased
adipose tissue in the breast, mammograms become more
radiolucent which can detect non palpable lesions and
calcifications.

DISORDERS OF DEVELOPMENT
Figure 1. Epithelial components of the breast: lobe, lobule and
acini.Yellow arrow: myoepithelial cells

CHANGES IN THE FEMALE BREAST

Appearance of the breast both on mammogram and

on histology depends on the age and status of
hormones.

*Important to remember is you should be able to distinguish these

disorders of development from carcinoma.

CONGENITAL NIPPLE INVERSION

Figure 2. Changes in Female Breast

Failure of the nipple to evert during development

(congenital) and may be unilateral
A cosmetic deformity, non pathologic
Can sometimes impede lactation
Can correct spontaneously during lactation due to
hyperplasia wherein breast becomes full and it
pushes the nipple out, everting it
In acquired nipple inversion (e.g. nipple piercing), it
indicates malignancy (this is the main difference between
congenital nipple inversion. One must be able to obtain
history from patient if nipple is inverted since birth)

Figure 4. Nipple inversion

Picture A: In younger woman who presents with palpable

lesion on breast, mammogram is not indicated because it only
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UERM 2015B

Page 1 of 8

MILKLINE REMNANTS

Supernumerary nipples result from the persistence of

epidermal thickenings along the milk line, which
extends from the axilla to the perineum.
Commonly located at the chest

Figure 7. Acute mastitis: erythematous and swollen breast

PERIDUCTAL MASTITIS

Figure 5. Left: Supernumerary nipple. Right: Milk line where nipple

can arise from the axilla to the perineal area

ACCESSORY AXILLARY BREAST TISSUE

Normally, the breast tissue extends to the axilla or

the axillary tail of Spence
It is only considered an accessory breast tissue when
it forms a lump
Since the accessory breast tissue is similar to the
breast proper, it can also undergo hormonal changes.
It can be tender or enlarged during menstruation and
can develop a carcinoma.

AKA Reccurent Subareolar Abscess, Squamous

Metaplasia of lactiferous ducts, Zuska Disease

Can arise in both male or female breast

High incidence in smokers

Associated with inverted nipple

Normally, the nipple is lined by keratin producing

squamous epithilium while the ducts are lined by
cuboidal epithelium

In periductal mastitis, the ducts undergoes squamous

metaplasia where it produces keratin, keratin
flakes fill up the ducts the ducts rupture leading to
inflammation (abscess formation, secondary bacterial
infection)
Note: Acute and Periductal Mastitis are mainly an inflammatory
process

MAMMARY DUCT ECTASIA

Figure 6. Accessory Axillary Breast Tissue. Slight protuberance at

axillary region

MORPHOLOGY

INFLAMMATORY DISORDERS
1.
2.
3.
4.
5.
6.
7.
8.

Acute Mastitis
Periductal Mastitis
Mammary Duct Ectasia
Fat Necrosis
Lymphocytic Mastopathy
Lobulitis
Granulomatous Mastitis
Inflammatory Carcinoma
Pagets Disease of the Breast

(Sclerosing

Lymphocitic

Number 1,2: obviously seen as inflammatory with the patient

presenting fever, erythematous swollen breast, and tender to
touch. These are completely benign, can be treated with antibiotics
and should not be confused with malignancy (no palpable masses).
Number 3,4, 5 ,6: classified as benign and inflammatory but often
mistaken for carcinoma due to presence of an irregular palpable
masses with occasional nipple discharge
Number7, 8: both are TRUE MALIGNANT process but they were
included in this section since they present as an inflammatory
process (erythematous swollen breast with occasional nipple
discharge). They dont have a palpable mass.

FAT NECROSIS

Caused by lactation/breastfeeding
Seen on the first month of breastfeeding wherein
nipple becomes cracked, dry and develops fissures
Staphylococcus aureus invades the fissures and
cracks inducing acute mastitis

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Dilation of ducts, filled with granular debris and lipid

laden macrophages
Periductal and interductal tissue contains dense
infiltrates of lymphocytes and macrophages, and
variable numbers of plasma cells
Fibrosis may eventually produce skin and nipple
retraction (fibrous tissue pulls on the underlying skin
producing a puckering/depression which can be
mistaken for a sign of breast cancer)

Figure 8. Mammary duct ectasia. In the later part of the disease, it

produces intense fibrosis secondary to inflammation compressing the
duct forming a slit-like space. The ducts are filled by granular debris
that contains numerous lipid-laden macrophages.

ACUTE MASTITIS

Occurs in 50-60 years old

Benign inflammatory disease
Present with a poorly defined palpable periareolar
mass that is often associated with thick, white nipple
secretions and sometimes with skin retraction
On mammogram, appears as radio dense image with
irregular borders

UERM 2015B

Associated with history of breast trauma and surgery

Can present as a painless palpable mass, skin
thickening or retraction, or chunky white lesions in
the breast
A mammographic density, or mammographic
calcifications.
Microscopically, fat necrosis will be seen
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Page 2 of 8

LYMPHOCYTIC MASTOPHATHY
(SCLEROSING LYMPHOCYTIC LOBULITIS)

Prognosis depends on underlying features of

invasive carcinoma

Seen in woman with Type 1 Diabetes Mellitus and

other autoimmune thyroid diseases
Presents as small single or multiple hard palpable
masses.
Microscopically, it shows a collagenized stroma
surrounding atrophic ducts and lobules. The
epithelial basement membrane is often thickened. A
prominent lymphocytic infiltrate surrounds the
epithelium and small blood vessels.

GRANULOMATOUS MASTITIS

Can be secondary to tuberculosis, Wegener

granulomatosis or sarcoidosis which produces a
granulomatous inflammation
Associated with presence of foreign bodies (leaked
silicone implants) and immunocompromised women
The granulomatous inflammation is confined to the
lobules, suggesting that it is caused by a
hypersensitivity reaction to antigens expressed by
lobular epithelium during lactation.

INFLAMMATORY CARCINOMA

A TRUE malignant tumor

Rarely presents as a mass
Breast appears erythematous, swollen with nipple
discharge and peau dorange (orange peel skin)
Doesnt produce a mass because the tumor cells is
found within the dermal lymphatics which is not big
enough to produce a palpable lesion
Cannot be observed in mammogram (it is too small)
Very poor prognosis due to the involvement of
lymphatics and can easily metastasize
Tumor is negative for hormone receptors
Surgery, chemotherapy and hormone therapy are not
beneficial

Figure 10. Top Left: Scaly nipple lesion. Top Right: DCIS arising
within the ductal system of the breast can extend up the lactiferous
ducts and into the skin of the nipple without crossing the basement
membrane. The malignant cells disrupt the normally tight squamous
epithelial cell barrier, allowing extracellular fluid to seep out and form
an oozing scaly crust. Bottom: Poorly differentiated, doesnt form any
tubules

BENIGN EPITHELIAL LESIONS

NONPROLIFERATIVE BREAST CHANGES
FIBROCYSTIC CHANGES

Figure 9. Inflammatory Carcinoma. Left: Breast is swollen and

erythematous Middle: peau dorange. Right: lymphatic invasion

PAGETS DISEASE OF THE BREAST

Rare manifestation of breast cancer

Palpable mass is present in 50% to 60%
Almost all have an underlying invasive carcinoma
Women who dont have palpable masses have Ductal
Carcinoma In Situ (DCIS)
Eczematous, scaly, pruritic lesion in the nipple
In the skin biopsy of the nipple, the Paget cells are
present in the lining epithelium of the nipple and
areolar complex
Presents as calcification on mammogram
Negative for Estrogen Receptor (ER)
Positive for HER2/neu, a receptor that has been used
to determine if a patient responds to Trastuzumab
Trastuzumab (Herceptin) :
a target therapy
antagonizing the HER2/neu receptor; very expensive
If positive for HER2/NEU, patient cant be given
Tamoxifen (estrogen antagonist) because it will not
work on the tumor

Rivero | Robledo |Sales| Santiago L | Santiago S | Santos JR

Lumpy bumpy, rubbery, movable

30-40 y/o
Cancer risk = 3%
CYSTS
Formed by dilation and
unfolding of lobules
May coalesce to form
bigger cysts
Lined
by
flattened
atrophic epithelium or by
metaplastic apocrine cells
Metaplastic apocrine cells
Abundant granular,
eosinophilic cytoplasm,
round nuclei
Resembles
normal
apocrine epithelium
of sweat glands
Calcification common
Alarming when solitary
and firm!
FIBROSIS
Ruptured cyst release
material to stroma
chronic inflammation and
fibrosis

ADENOSIS

UERM 2015B

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Increase in number of
acini per lobule
Normal: pregnancy
Nonpregnant: focal change
Acini are enlarged (bluntduct adenosis) but NOT
distorted
Lined by columnar cells
which may look benign or
have atypical features (flat
epithelial atypia)

Page 3 of 8

PROLIFERATIVE BREAST DISEASE WITHOUT

ATYPIA

PAPILLOMAS

Proliferation of ductal epithelium and/or stroma

WITHOUT cytologic or architectural features
suggesting carcinoma in situ (CIS).
Myoepithelial cells are PRESENT
Cancer risk = 5-7%

Figure 11. Normal acini lined by 2 cell types: myoepithelial and

luminal cell

EPITHELIAL HYPERPLASIA

Lined by >2 cell

layers (may be both
luminal
and
myoepithelial)
Irregular
lumens
(slitlike fenestrations)
at the periphery
Usually incidental

PROLIFERATIVE BREAST DISEASE WITH ATYPIA

Resemble CIS but lack enough features for diagnosis

Features of atypia: loss of stroma between acini,
cellular
pleomorphism,
hyperchromasia,
increased/abnormal mitoses

Cancer risk= 13-17%

ATYPICAL DUCTAL
Same
as
ductal
HYPERPLASIA
carcinoma in situ (DCIS)
but has limited extent
and partially
filling
ducts
(+) myoepithelial cells
More rigid cells
Breast Ca risk

The duct is dilated and filled with

cells. There is hyperplasia of ductal
cells

SCLEROSING ADENOSIS

The lobular unit is enlarged, acini

are compressed and distorted by
dense stroma. Calcifications are
present within some of the lumens.
Unlike carcinomas, the acini are
arranged in a swirling pattern, and
the
outer
border
is
wellcircumscribed.

COMPLEX SCLEROSING
ADENOSIS (Radial scar)

Grossly solid and has irregular

borders, but not as firm as an
invasice CA. Glands are compressed
and distorted.

> 2x number of acini

per terminal duct
Normal
lobular
arrangement
maintained
Acini compressed &
distorted
CENTRALLY
but
dilated
PERIPHERALLY
Prominent
myoepithelial cells
May
completely
compress lumens to
look like solid cords
which may mimic
invasive carcinoma

Only benign lesion to

form irregular mass
and mimic invasive
carcinoma
Has a central nidus
or entrapped glands
in
a
hyalinized
stroma
with
projections
containing
epithelium
with
varying degrees of
cyst formation and
hyperplasia
NOT associated with
previous trauma or
surgery

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Composed
of
multiple branching
fibrovascular cores
with
connective
tissue axis lined by
luminal
and
myoepithelial cells
Growth occurs in a
dilated duct
(+)
epithelial
hyperplasia
and
apocrine metaplasia
Large
duct
papilloma- solitary;
in lactiferous sinus of
nipple;
BLOODY
NIPPLE
DISCHARGE
Small papilloma
multiple;
located
deeper;
NO
DISCHARGE

ATYPICAL LOBULAR
HYPERPLASIA

Same
as
lobular
carcinoma in situ (LCIS)
Cells fill < 50% of acini
May involve contiguous
ducts
via
pagetoid
spread
->
atypical
lobular cells lie between
ductal
casement
membrane
and
overlying normal ductal
epithelial cells.
May stay there for a
long time

CARCINOMA OF THE BREAST

INCIDENCE AND RISK FACTORS

It is the most common non-skin malignancy in

women

RISK FACTORS INCLUDE

1.
2.
3.
4.
5.
6.
UERM 2015B

Age increases with age (70% occur in women >50

years of age
Age at Menarche those who reach menarche <11
years old have 20% chance
First live birth those with a first full-term
pregnancy at <20 years old
First-degree relatives with breast cancer
Breast biopsies
Race high among white Caucasians
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Page 4 of 8

ADDITIONAL RISK FACTORS

Estrogen exposure hormonal replacement therapy
1.2 to 1.7 increase risk
2. Radiation exposure
3. Carcinoma of the contralateral breast or endometrium
4. Geographic influence high in US and Europe
5. Diet alcohol, fat, postmenopausal obesity
6. Obesity
7. Environmental toxins pesticides
8. Tobacco
9. Exercise lower risk
10. Breastfeeding lower risk

PAPPILARY

Grows into spaces

and
lines
fibrovascular cores
typically lacking the
normal
myoepithelial layer

MICROPAPPILARY

Bulbous protrusions
without
a
fibrovascular core,
often
forming
intraductal patters

SOLID

Completely fills the

involved spaces

1.

ETIOLOGY AND PATHOGENESIS

1.

2.

Hereditary cases about 25% of familial cancers can

be attributed to mutations in BRCA1 and BRCA2; p53
mutation in women with Li-Fraumeni syndrome

BRCA1
Poorly differentiated (poor prognosis)
Negative estrogen, progesterone, HER2

BRCA2
Poorly differentiated
More often ER positive
Sporadic cases related to hormone exposure:
gender, age at menarche and menopause,
reproductive history, breastfeeding and exogenous
estrogens.

CLASSIFICATION OF BREAST CARCINOMA

CARCINOMA IN SITU
I.

DUCTAL
CARCINOMA
IN SITU
(DCIS,
INTRADUCTAL CARCINOMA)

Also known as Intraductal Carcinoma (tumors

are confined within ducts)

Malignant population of cells limited to ducts

and lobules by the basement membrane

Often detected through mammography

Myoepithelial cells are preserved but may be

diminished

This is a clonal proliferation and usually involves

a single ductal system

CLINGING FLAT

CRIBRIFORM

A. TYPES
1. Comedocarcinoma (High-grade DCIS)
o Solid sheets of pleomorphic cells with
high grade nuclei and central necrosis
and calcification
o A paste like substance oozes out of the
nipple
o Necrosis in a hyperplastic duct is DCIS

Cells forming round,

regular
(cookie
cutter)
spaces;
lumens are filled
with
calcifying
secretory material

II. LOBULAR CARCINOMA IN SITU (LCIS)

Not associated with calcifications or a stromal

reaction

Bilateral in 50-70%

Involves young women

Figure 12. B: ducts filled with punctuate areas of necrosis. C: DCIS

with large central zones of necrosis and calcifications fills several
adjacent ducts

2.

Non-Comedo
o Monomorphic population of cells within
nuclear grades ranging from low to high
o Solid without necrosis

Rivero | Robledo |Sales| Santiago L | Santiago S | Santos JR

Figure 13. A: monomorphic population of small, rounded loosely

cohesive cells fills and expands the acini of a lobule. B: E-cadherin
positive normal luminal cells that have been undermined by Ecadherin-negative LCIS cells spreading along the basement membrane.

UERM 2015B

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o
o

INVASIVE INFILTRATING CARCINOMA

A. INVASIVE DUCTAL CARCINOMA: NO SPECIAL
TYPE (NST)

Breast cancer

Originates from ducts with invasion into stroma

Firm and hard, irregular border

At the center are small pinpoint foci or streaks of

chalky white elastotic stroma and sometimes
calcifications

There is a characteristic grating sound when cut

or scraped

Frequent mitotic figures

Moderate
to
marked
lymphoplasmacytic
infiltrate
surrounding and within the tumor
Have better prognosis

Figure 16. The tumor is soft, fleshy and well circumscribed.

D. MUCINOUS (COLLOID) CARCINOMA

Figure 14. On gross examination, the tumor is firm to hard and have
an irregular border

MOLECULAR CLASSIFICATION OF INVASIVE DUCTAL

CARCINOMA, NST
1. LUMINAL A
o 40-55% of NST of cancers, post menopausal
o ER +, Her2neu
o Well or moderately differentiated
o Slow growing, responds well to hormonal
treatment
2. LUMINAL B
o 15-20% of NST
o Higher grade, often overexpress Her2neu
o More likely to have nodal metastasis
3. BASAL-LIKE
o Triple negative (-ER, PR, Her2neu)
o Includes
medullary
and
metaplastic
carcinoma
o BRCA1
o Higher grade and proliferation rate
o Poorer prognosis

Figure 17. has the consistency and appearance of pale-gray-blue

gelatin. The borders are pushing or circumscribed. The tumor cells are
arranged in clusters and small islands of cells within large lakes of
mucin.

E. TUBULAR CARCINOMA

B. INVASIVE LOBULAR CARCINOMA

Occur in older women (median age 71)

Tend to grow slowly
The tumor is soft and rubbery
Overall prognosis is slightly better than NST
carcinomas

Bilateral palpable mass

Her 2 Neu overexpression is rare
Metastasize to peritoneum, retroperitoneum,
GIT, leptomeninges, ovaries and uterus

Small irregular mammographic densities in

women in their late 40s.
Uncommon but constitute up to 10% of tumors
that are smaller than 1 cm in size.
It can be confused with sclerosing adenoma
Has excellent prognosis
More than 95% of all tubular carcinomas are
diploid, ER positive and Her2neu negative

Figure 15. Hallmark is the presence dyscohesive infiltrating tumor

cells, often arranged in single file indian file or in loose clusters or
sheets. Tubule formation is absent. The cytologic appearance is
identical to the cells of atypical lobular hyperplasia and LCIS.

C. MEDULLARY CARCINOMA
Usually occurring in the 60s and presents as a

Figure 18. The tumor is composed of well-formed angulated tubules

lined by a single layer of cells with small uniform nuclei.

well circumscribed mass

Histologically, the carcinoma is characterized by
o Solid, syncytium-like sheets of large
cells with vesicular, pleomorphic nuclei,
and prominent nucleoli, which compass
more than 75% of the tumor mass

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F. INVASIVE PAPILLARY CARCINOMA

UERM 2015B

Rare
Invasive pappilary carcinomas are usually ER
positive and have a favorable prognosis

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Page 6 of 8

7.

Micropapillary variant is ER negative and has a

poorer prognosis

8.

Response to neoadjuvant therapy patient is treated

with chemotherapy before surgery
Gene expression profiling predict survival and
recurrence-free interval and identifies patients who
are most likely to benefit from a particular type of
chemotherapy. Proliferation index how fast tumor
replicates itself.
AJCC STAGING FOR BREAST CANCER

STAGE
Figure 19. Micropapillary variant with node metastasis

DCIS or LICS
Invasive
carcinoma
</= to 2cm
Invasive
carcinoma > 2
cm
Invasive
carcinoma <5
cm
Invasive
carcinoma > 5
cm

G. METAPLASTIC CARCINOMA

Rare types of breast cancer

They are ER-PR-HER2 neu triple negative
often express myoepithelial proteins and appear
to be related to the basal like carcinomas.
Rare lymph node metastasis, but poor prognosis

PRIMARY
CANCER (T)

II

Any size
invasive
carcinoma
Figure 20. Metaplastic CA variants

III

PROGNOSTIC AND PREDICTIVE FACTORS

Prognosis is determined by the pathologic examination of the
primary carcinoma and the axillary lymph nodes

MAJOR PROGNOSTIC FACTORS

1.

2.
3.

4.
5.

6.

Invasive carcinoma versus in situ disease in situ ca

are confined to the ductal system and cannot
metastasize
Distant metastases one it occur, cure is unlikely
Lymph node metastases axillary lymph node status
is the most important (1sT) prognostic factor for
invasive carcinoma in the absence of distant
metastases. Used in STAGING
Tumor size 2nd most important prognostic factor
Locally advanced disease carcinomas invading into
skin or skeletal muscle are usually large and may be
difficult to treat surgically
Inflammatory carcinomas breast cancers presenting
with breast swelling and skin thickening d/t dermal
lymphatic involvement have poor prognosis

MINOR
PROGNOSTIC
FACTORS
1.
2.

3.

4.
5.

6.

AND

IV

Invasive
carcinoma
with skin or
chest wall
involvement
or
inflammatory
carcinoma
Any size
invasive
carcinoma

LYMPH
NODES
(LNs)
None

METASTASIS
(M)

5 YEAR
SURVIVAL

Absent

92

None

Absent

87

None

Absent

13
positive
LNs
13
positive
LNS
>or = to
4
positive
LNS

75
Absent

Absent

Absent
46

0 to > 10
LNs

Absent

(-) or (+)
LNs

Present

13

BENIGN STROMAL TUMORS

FIBROADENOMA

Most common benign tumor of the female breast

Occur in younger women 20s to 30s
Epithelium is hormonally responsive
Can calcify with age

PREDICTIVE

Histologic subtype
Histologic grade GRADING. Most commonly used
grading system is Nottingham Histologic Score
(Scarff-Bloom-Richardson), which combines nuclear
grade, tubule formation and mitotic rate to classify
invasive carcinomas
Estrogen and progesterone receptors 80% of
carcinomas that are ER and PR positive respond to
hormonal manipulation
HER2/neu Her2/neu overexpression is associated
with poorer survival
Lymphovascular invasion tumor cells are present
within vascular spaces in about half of all invasive
carcinomas
Proliferative rate high proliferation rates means
poorer prognosis but respond better to chemotherapy

Rivero | Robledo |Sales| Santiago L | Santiago S | Santos JR

A: The radiogram shows a characteristically wellcircumscribed mass. B: Grossly, a rubbery white, well
circumscribed mass is clearly demarcated from the
surrounding yellow adipose tissue. C: Proliferation of
intralobular stroma surrounds, pushes and distorts the
associated epithelium

PHYLLODES TUMOR

UERM 2015B

AKA Cystosarcoma phylloides most common in

elderly women
Distinguished from fibroadenomas by cellularity,
mitotic rate, nuclear pleomorphism, stromal growth

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Page 7 of 8

CARCINOMA

and infiltrative borders

Tumors must be excised with wide margins to
prevent recurrences

Rare occurrence only 1%

There is a palpable subareolar mass usually 2-3 cm in
size
3-8% is associated with Klinefelters syndrome
The risk factors are similar with women
The histologic subtype is the same, the papillary is
more common
Nipple discharged is a common symptom
The carcinoma is situated close to the overlying skin
and underlying thoracic wall, and even small
carcinomas can invade these structures and ulcerate
through the skin

Phyllodes tumor (leaflike). Compared to fibroadenoma, there

is increased stromal cellularity, cytologic atypia, and stromal
overgrowth giving rise to typical leaflike structures

BENIGN STROMAL LESIONS

Tumors of the interlobular stroma of the breast are

composed of stromal cells w/o an accompanying
epithelial components

Angiosarcoma can be sporadic or arise as a

complication of radiotherapy.
Sporadic occur in young women mean age is 35,
poorer prognosis
Angiosarcoma from radiation exposure arises after
10-15 years
Can also arise in the skin of an arm rendered
chronically lymphedematous by prior mastectomy
and lymph node dissection (Stewart-Treves
Syndrome)
Metastasis to the lung via hematogenous route

MALIGNANT STROMAL TUMORS

Figure 22. Male Breast CA. remember that Gynecomastia here is NOT
a risk factor.

THE MALE BREAST

GYNECOMASTIA

I see my body as an instrument,

rather than an ornament Alanis
Morissette

Enlargement of the male breast

May be unilateral or bilateral
May occur as a result of hormonal imbalance between
estrogen which stimulates breast tissue and
androgens which counteract these effects
Encountered also in liver cirrhosis
Drugs such as alcohol, marijuana, heroin,
antiretroviral therapy, anabolic steroids have also
been associated

Figure 21. Gynecomastia. Terminal ducts WITHOUT lobule formation

are lined by a multilayered epithelium with small papillary tufts.
There is typically surrounding periductal hyalinization and fibrosis.

REFERENCE
Robbins and Dra. Ledesmas Lecture

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UERM 2015B

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