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Breast-nonmalignant
General
Pregnancy / lactation - breast
Reviewer: Hind Nassar, M.D. in January 2009 (see Authors page)
Revised: 24 September 2012, UPDATE IN PROGRESS
Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.
Physiology
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● Changes in breast usually begin at time of first missed menstrual period (gestational week 4)
● Changes are due to progesterone, estrogens, prolactin and placental lactogen secretion in third trimester
● Prolactin stimulates alveolar epithelium to produce and secrete casein, alpha-lactalbumin and lipids
Lactation:
● Begins 2-6 days after delivery
● Crying or suckling causes hypothalamus to produce oxytocin, causing contraction of myoepithelial cells, which expels milk
● When nursing stops, prolactin level drops, causing milk production to stop
● Lactation may cause macromastia - erythematous, edematous, painful breasts with variable ulceration of overlying skin; usually recurs with subsequent pregnancies
Terminology
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● See also lactating adenoma, pseudolactational hyperplasia
Clinical features
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● Enlargement of breast becomes apparent at month 5 of pregnancy
Case reports
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Clinical images
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Micro description (Histopathology)
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● Acinar proliferation with minimal intra- and interlobular connective tissue
● Intralobular ducts form buds that become secretory alveoli with grape-like clusters and scant stroma
● Epithelial cells accumulate cytoplasmic organelles to sustain postpartum lactation; glands have dilated lumina, contain lipid secretory vacuoles with large, apical nuclei resembling Arias-Stella reaction
● May have clear cell change in ductal or lobular epithelium; these changes may also occur without pregnancy or hormonal manipulation (see pseudolactational hyperplasia)
Lactation
● Increase in number of lobules and number of acini within each lobule; reduction in interlobular and intralobular stroma; myoepithelial cells are present but difficult to identify
● Luminal epithelial cells are secretory and have cytoplasmic vacuoles; after lactation ends, lobules involute over several months and are infiltrated by lymphocytes and plasma cells
● Post-lactational changes, present up to 5 years after cessation of lactation, include irregularly shaped lobules, angulated acini, flat epithelium, crenulated basement membrane, and lymphocytes and plasma cells within intralobular stroma (Histopathology 1989;15:415)
Micro images
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First trimester: slight acinar proliferation with minimal secretory change;
also involution of fibrofatty stroma
Third trimester 8th month Ectatic acinar lumens are lined by vacuolated
epithelium and contain secretion, typical of late
third trimester
Lactational change
Various images
Drawings
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Breast during lactation Breast lobules during lactation
Virtual Slides
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Hyperplasia of pregnancy
Lactating breast
Videos
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Hyperplasia of pregnancy #1; #2
Cytology description
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Cytology images
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Positive stains
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Negative stains
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Electron microscopy descriptions
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Electron microscopy images
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Molecular / cytogenetics description
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Molecular / cytogenetics images
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Differential Diagnosis
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● (link to topic)
Additional references
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End of Breast-nonmalignant > General > Pregnancy / lactation
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