Documente Academic
Documente Profesional
Documente Cultură
BY
DR H. JOKO S. LUKITO,SpPA
Mammary Glands
Parenchyma
essential parts of
an organ that are Stroma
concerned with its
function
Stroma
framework/support
ing tissue of an
organ;
contains
connective tissue&
blood vessels
Parenchyma
opposite of
parenchyma
Terminology
Exocrine Gland
a gland whose secretion
reaches an epithelial
surface Capillaries
Duct cell
Secretory cell
Endocrine Gland
a gland that secretes
directly into the bloodstream
Anatomy of the Breast
Interlobular duct
Terminal duct
Duct cells
Lobules
Alveolar
Secretory
cells gland
Tubular gland
Ductal / Tubular
Architecture
Nipple
Lactiferous duct
Lactiferous sinus
Lactiferous duct
Interlobular duct
Tubular duct
Alveolar gland
Development of the Breast
Birth
rudimentary branching
ducts fan out in the region
of the nipple and areola
Prepuberty
very slow but progressive
growth & branching of
mammary ducts
growth ceases at this stage
in the male
Development of the Breast
Premenstruation
growth rate increases; branching of
ducts proliferation interductal stroma
stimulated by oestrogen
ducts end blindly (terminal ducts)
Menarche
terminal ducts proliferate, giving rise
to 30 epithelium-lined ductules acini
each terminal duct & ductules form
lobule
Pregnancy
Morphologic maturation & functional
development
influenced by oestrogen,progesterone &
prolactin
oestrogen & progesterone suppress
the milk-producing effects of prolactin
Reversal of usual stromal-glandular
relationship
composed almost entirely of glands,
separated by relatively scant amount of
stroma
Cuboidal epithelium lines the secretory
glands
secretory vacuoles of lipid material appear
Lactation
GALACTOCELE
Cystic dilatation of terminal ducts
during lactation.
FIBROCYSTIC CHANGE
= Mammary dysplasia fibrocystic
disease.
Hormonal imbalance.
Short menstruation cycle(21-24days)
Estrogen >> Hyperestrism.
50% breast surgery cases in reproductive
period.
Premenstrual pain+lumpy breast.
Stromal and terminal ducts epithelial
proliferation.
FIBROCYSTIC CHANGE
NON PROLIFERATIVE
SCLEROSING
ADENOSIS
proliferation of
small ducts &
myoepithelial cells
in terminal duct
lobular unit.
FIBROSIS
Elastic, mobile.
White
homogenous.
30-35 years.
Stromal collagen
>>
Fibrosis.
Gland atrophy.
CYSTIC
Cyst 3-5 cm.
Serrous blue brown
fluid.
45-55 years.
Stromal >>.
Fibrosis.
Gland & epithelial
proliferation.
Dilated duct
cyst.
ADENOSIS
Sclerosing
adenosis.
Duct hyperplasia.
35-45 years.
Firm.
Blurred borders.
Duct hyperplasia.
Intraduct
papilloma.
Gland & stromal
proliferation.
BREAST TUMORS
BENIGN :
- FIBROADENOMA
- FIBROMA
- INTRADUCTAL PAPILLOMA
- CHONDROMA
MALIGNANY:
- CARCINOMA
- SARCOMA
FIBROADENOMA MAMMA
Benign neoplasm of the breast and is
composed of epithelial and stromal
elements that originate from the terminal
duct lobular unit.
Ages : 20-30 years.
Sign : round, rubbery tumor, soliter /
multiple, sharply demarcated, freely
moveable, upper lateral quadrant >>
Macros : encapsulated, gray white.
Micros : proliferation of glands and fibrous
stroma.
FIBROADENOMA MAMMA
PERICANALICUL
AR ROUND
GLANDS
DISPERSED
WITHIN FIBROUS
STROMA.
FIBROADENOMA MAMMA
INTRACANALICU
LARE FIBROUS
TISSUE FORM
TUMORCOMPRES
S PROLIFERATED
DUCTS
CURVILINEAR
SLITS.
SOME JUVENILE FIBROADENOMAS
ATTAIN GREAT SIZE
GIANT FIBROADENOMA.
MAMMOGRAM
4
Hematogenous
metastasis
Lymphatogenou
s metastasis
Mechanism of metastasis
Modified
from AJCC STAGING OF BREAST CANCER ( TMN )
1992
PRIMARY TUMOR (T) REGIONAL LYMPH NODES (N)
T0 No evidence of primary tumor N0 No regional lymph nodes
N1 Metastasis to moveable ipsilateral
Tis Carcinoma in situ nodes
N2 Metastasis to matted or fixed
T1 Tumor 2 cm ipsilateral nodes
N3 Metastasis to ipsilateral internal
T2 Tumor >2 cm but 5 cm mammary nodes
T3 Tumor >5 cm
DISTANT METASTASIS (M)
M0 No distant metastasis
T4 Extent to chest wall,
M1 Distant metastasis (includes spread
inflammation, satellite lesions,
ulcerations to ipsilateral supraclavicular nodes)
TUMOR MAMMA
ASPIRASI
BIOPSI
DIAGNOSA
EKSISI
GANAS JINAK
Kel.Ro Paru
Rontgen Paru
STADIUM KLINIK EKSTIRPASI
Scanning Tulang
Scanning Hati
Fungsi Hati
THERAPI
Breast Self-Examination
The American Cancer Society recommends that
women perform a breast self-examination once
a month.
Bending forward
POSITIONS FOR PALPATION
Flat position
If you can use only one hand, use that for checking both breasts,
and examine the breast on that side as well as you can.
PALPATION WITH PADS OF FINGERS
Use the pads of three fingers to examine every inch of your
breast tissue.Move your fingers in circles about the
size of a dime.