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This image shows the growth pattern of cancer cells confined to the ductal system. Like a cross section of many "soda straws," the blue areas represent ducts that contain tumor cells. Ductal carcinoma in situ means that malignant cells exist in the tubules, but haven't invaded beyond the tubules or ducts. The reason there are round, blue nodules is that tubules have been cut in cross section. Since there is no invasion, the spaces between the blue tubules are filled with fat or fibrous tissue. The black dots are placed around the periphery of this tumor for measurement purposes. </div> <div> <IMG SRC="074f4c90.jpg" border=0 width="500" height="457" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> <IMG SRC="075f44d0.jpg" border=0 width="500" height="333" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> <IMG SRC="076f48d0.jpg" border=0 width="500" height="397" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> The "comedo" part of its name comes from the actual tissue features. When this type of carcinoma is cross cut with a knife, the central necrotic debris can be expressed out, tooth-paste-fashion, like a comedo or black head on your skin. </div> <div> ductal carcinoma in situ</div> <div> <IMG SRC="0bae7470.gif" border=0 width="487" height="327" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="0bce7470.jpg" border=0 width="487" height="327" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> <IMG SRC="0bef8520.jpg" border=0 width="504" height="338" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><FONT SIZE="1" COLOR="#000000" FACE="Arial" >Fig 2A-C. — Low-grade DCIS, noncomedocarcinoma. </FONT></div> <div> (A) Cribriform growth pattern with a uniform cell population forming rounded lumens.</div> <div> (B) Predominantly solid growth pattern,</div> <div> (C) Micropapillary pattern </div> <div> <IMG SRC="0c0f3500.jpg" border=0 width="499" height="336" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> Intermediate-grade DCIS. Multiple ducts with cribriform and micropapillary forms showing central necrosis, microcalcifications, and mild cytologic atypia. </div> <bR> <bR> <div> <IMG SRC="05aaf9b0.jpg" border=0 width="175" height="155" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="05baf9b0.jpg" border=0 width="175" height="155" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="05caf9b0.jpg" border=0 width="175" height="155" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="05daf9b0.jpg" border=0 width="175" height="155" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="05eaf9b0.jpg" border=0 width="175" height="155" ALIGN="BOTTOM" HSPACE="0" VSPACE="0">breast transplant<IMG SRC="05f06b80.jpg" border=0 width="262" height="184" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="06006b80.jpg" border=0 width="262" height="184" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="06106b80.jpg" border=0 width="262" height="184" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <bR> <bR> <bR> <bR> <div> <B><U>fibroadenoma</U></B></div> <div> <IMG SRC="06796650.jpg" border=0 width="150" height="101" ALIGN="BOTTOM" HSPACE="0" VSPACE="0">fibroadenoma<IMG SRC="069e8c40.jpg" border=0 width="232" height="196" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> abundant pink fibrous tissue, which is nearly everywhere, and surrounds slit-like spaces lined by compressed ductal epithelium. Toward the center some of splits open up a bit, and form very small cysts-like areas. The slits and small cysts give the fibroadenoma its finely granular and nodular appearance noted when viewed by the naked eye. </div> <div> <IMG SRC="06af4a10.jpg" border=0 width="500" height="417" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> fibroadenoma with large calcifications present. The typical composition of this lesion is evident: slit-like spaces lined by thin or attenuated epithelium, and abundant pink fibrous stroma surrounding these slits. These microcalcifications are very large, and would show as large white objects on mammograms. </div> <bR> <div> <IMG SRC="06bf4cc0.jpg" border=0 width="500" height="460" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <bR> <div> <B><U>papilloma</U></B></div> <div> This is a whole mount of an intraductal papilloma. Usually, but not always, these lesions are not large enough to photograph as a gross specimen, something you would easily see with the naked eye. This papilloma resides in a dilated or cystic duct. You can see how large the duct is by comparing it to other nearby ducts which are more normal in size. There are different portions of this papilloma, some are larger, while others are quite small. </div> <div> When looking at microscopic images, some pieces of tissue inside the duct do not appear connected to each other. This is because the tissue on the slide is only two dimensional. The actual tissue is three dimensional, and the connections are not visible because they are not included in the plane of section. </div> <bR> <div> <B><U><IMG SRC="06cf44a0.jpg" border=0 width="500" height="330" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></U></B></div> <div> <B><U><IMG SRC="06df44d0.jpg" border=0 width="500" height="333" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></U></B></div> <div> the finger-like, papillary nature of this growth</div> <div> <B><U><IMG SRC="06ef44d0.jpg" border=0 width="500" height="333" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></U></B></div> <bR> <div> <B><U>fibrocystic change</U></B></div> <div> <B><U><IMG SRC="06ff4880.jpg" border=0 width="500" height="392" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></U></B></div> <div> There are areas of white fibrous tissue toward the top. Below, bright yellow fatty tissue is the dominant component. In the upper half of the image, cystic spaces are present. These contain usually watery fluid. The bluish areas are the so called "blue dome cysts," and under the microscope show apocrine metaplasia. These later areas have features of sweat glands, hence the name "apocrine."</div> <bR> <div> This whole mount shows an overall view of changes in the breast which include: 1. dense and hardening of the supportive, fibrous tissue (broad pink areas), 2. cystic changes (white, clear areas) which will enlarge with accumulations of fluid. Larger cysts on mammograms often look like masses but with ultrasound examination of the breast, the difference between cysts and masses (tumors) is easier to distinguish. Small collections of glands represent early adenosis</div> <bR> <div> <B><U><IMG SRC="070f4e10.jpg" border=0 width="500" height="481" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></U></B></div> <bR> <div> <B><U><IMG SRC="071f4f00.jpg" border=0 width="500" height="496" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></U></B></div> <bR> <div> <B><U><IMG SRC="072f4c00.jpg" border=0 width="500" height="448" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></U></B></div> <bR> <div> shows intraductal hyperplasia to be present in the lower half of the duct. Notice the complex network of interconnecting cells in this area. These microcalcifications formed in association with the hyperplasia can be easily identified. The broad pink areas toward the top of this image represents fibrosis within the hyperplasia. It should be noted that calcifications may also be seen with carcinoma, both intraductal and invasive. </div> <bR> <div> <B><U><IMG SRC="073f4940.jpg" border=0 width="500" height="404" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></U></B></div> <bR> <div> <B><U>Medullary Carcinoma </U></B></div> <div> <B>big bulky and soft</B></div> <div> <B>a lot of lymphocytes</B></div> <div> <B>HLA-DR?</B></div> <div> <B>MUTATED BRCA1 SYNDROME</B></div> <bR> <div> H&E stained slide showing a large undifferentiated breast cancer. The interstitium is filled with inflammatory cells. The structure of the cells is undifferentiated, "syncitial". This is a medullary carcinoma</div> <bR> <div> <B><IMG SRC="0ca81d20.jpg" border=0 width="641" height="466" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B><IMG SRC="0cfb0440.gif" border=0 width="432" height="324" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B><B>Papillary Carcinoma of Breast (Low Power) </B></div> <div> <B>•</B> This low power view shows one massively dilated and several smaller ducts filled with papillary proliferations </div> <div> <B>•</B> The papillae are covered with columnar epithelium </div> <div> <B>•</B> The cores of the papillae contain fibrovascular connective tissue </div> <div> <B>General Gross Description</B></div> <bR> <div> <B>•</B> Usually 2-3 cms in size </div> <div> <B>•</B> Approximately 1/2 located beneath the nipple (associated with bloody nipple discharge) </div> <div> <B>•</B> Well-circumscribed </div> <div> <B>•</B> Cystic lesions contain brown mixture of blood clot and neoplastic tissue</div> <bR> <bR> <div> <B>Tubular Carcinoma of Breast </B></div> <div> <B>•</B> The arrows point to small ductular structures composed of a single layer of cells </div> <div> <B>•</B> The malignant ducts frequently exhibit angular cross sections. </div> <div> <B>•</B> The cells have round to oval nuclei and nucleoli. </div> <div> <B>•</B> The stroma is fairly delicate</div> <div> <B><IMG SRC="0d0b1440.gif" border=0 width="433" height="324" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B><B>General Gross Description</B></div> <bR> <div> <B>•</B> Usually small (<2 cms), firm to hard lesions </div> <div> <B>•</B> Stellate</div> <div> •Examples: <B>General Microscopic Description</B></div> <bR> <div> <B>•</B> Small duct-like structures lined by a single cell layer often with an angular profile on cut section </div> <div> <B>•</B> Embedded in stroma with increased cellularity and/or collagen and elastin </div> <div> <B>•</B> Nuclei are generally very bland and closely resemble normal breast duct epithelium </div> <div> <B>•</B> May be difficult to separate from sclerosing adenosis or radial scar but generally spread outside the confines of enlarged lobules</div> <bR> <div> <B>Medullary Carcinoma of Breast (Low Power) </B></div> <div> <B>•</B> This low power view shows ill defined nests of neoplastic cells </div> <div> <B>•</B> The cells do not make ducts </div> <div> <B>•</B> The stroma contains numerous lymphocytes surrounding the large neoplastic cells </div> <div> <B><IMG SRC="0d259c30.gif" border=0 width="601" height="451" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <bR> <div> <B>Lobular Carcinoma In Situ of Breast (High Power) </B></div> <div> <B>•</B> This close up of the lobule shows acini distended by a relatively monomorphic populations of cells. </div> <div> <B>•</B> The nuclei are round and regular </div> <div> <B>•</B> The cytoplasm is eosinophilic </div> <div> <B>•</B> The intervening stroma is unremarkable </div> <div> <B><IMG SRC="0d466cb0.gif" border=0 width="614" height="459" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <bR> <bR> <div> <B>Intraductal Papilloma of Breast (10X) </B></div> <div> <B>•</B> This low power view demonstrates an intracystic proliferation. </div> <div> <B>•</B> There is a proliferation of finger-like processes into the lumen. </div> <div> <B>•</B> The fingers contain a fibrovascular stroma. </div> <div> <B>•</B> The lining epithelium contains duct epithelium and myoepithelial cells. </div> <div> <B><IMG SRC="0d620970.gif" border=0 width="544" height="407" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <bR> <div> <B>Infiltrating Duct Carcinoma (High Power) </B></div> <div> <B>•</B> The blue arrows surround a nest of neoplastic cells in an infiltrating ductal carcinoma. </div> <div> <B>•</B> Although no central lumens are identifiable in this picture the cells are not infiltrating as single cells "indian filing". </div> <div> <B>•</B> The green arrowheads point to intervening stroma. </div> <div> <B>•</B> Mitotic figures are seen. </div> <div> <B><IMG SRC="0d8bc0d0.gif" border=0 width="700" height="525" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <bR> <div> <B>Infiltrating Duct Carcinoma (Low Power) </B></div> <div> <B>•</B> This low power photomicrograph is completely involved by invasive duct carcinoma. </div> <div> <B>•</B> The blue arrows surround a neoplastic duct with a central lumen. </div> <div> <B>•</B> The yellow arrows point to the intervening desmoplastic stroma. </div> <div> <B><IMG SRC="0da3bac0.gif" border=0 width="571" height="428" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>Infiltrating Duct Carcinoma (Low Power) </B></div> <div> <B>•</B> This a low power view showing predominantly invasive or infiltrating carcinoma (blue arrows). The photograph is too low power to see what type of invasive disease it is. </div> <div> <B>•</B> There is also intraductal carcinoma (white arrows); it is the large size of the ducts completely filled with cells that supports the diagnosis of intraductal carcinoma at this power. </div> <div> <B>•</B> In light of the presence of intraductal carcinoma it is most likely that the invasive disease is invasive ductal carcinoma</div> <bR> <div> <B><IMG SRC="0dc6ed30.gif" border=0 width="622" height="467" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <bR> <bR> <div> <B>Ductal Carcinoma in Lymphatic (High Power) </B></div> <div> <B>•</B> This close up view of a lymphatic tumor embolus allows the identification of lymphatic endothelial cells (arrows). </div> <div> <B>•</B> The neoplastic cell cluster completely distends the lymphatic vessel.</div> <div> <B><IMG SRC="0de88e60.gif" border=0 width="648" height="486" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <bR> <div> <B>Ductal Carcinoma in Lymphatic (Medium Pow) </B></div> <div> <B>•</B> The arrows point to a thrombus of tumor cells lodged in a lymphatic. </div> <div> <B>•</B> It is not possible to see the lymphatic endothelial cell lining at this power. </div> <div> <B>•</B> Note the dramatic difference in nuclear and overall cell size between the neoplastic cells and the normal (N) cells</div> <div> <B><IMG SRC="0e0b0040.gif" border=0 width="688" height="516" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <bR> <div> <B>Infiltrating Duct Carcinoma </B></div> <div> <B>•</B> This is the view of a mastectomy specimen with the nipple to the right. </div> <div> <B>•</B> The arrows point to a mass which has grown through the skin and ulcerated. </div> <div> <B><IMG SRC="0e277d90.gif" border=0 width="631" height="473" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>Infiltrating Duct Carcinoma </B></div> <div> <B>•</B>The specimen consists of the skin of the breast (black arrows) with underlying breast tissue. </div> <div> <B>•</B>The blue arrows point to a poorly circumscribed yellow white mass which is the neoplasm</div> <bR> <div> <B><IMG SRC="0e48ce90.gif" border=0 width="652" height="489" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>Infiltrating Duct Carcinoma (Closer View) </B></div> <div> <B>•</B> This is a close view of a right mastectomy specimen with axillary tail (AX). </div> <div> <B>•</B> The extremely large carcinoma has destroyed the entire central portion of the breast including the nipple. </div> <div> <B>•</B> Although most breast carcinomas are identified earlier in their course some patients do not reach medical attention until very late in the progression of local disease.</div> <div> <B><IMG SRC="0e5b0450.gif" border=0 width="432" height="325" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>Lobular Carcinoma of Breast (High Power) </B></div> <div> <B>•</B> The blue arrows identify the neoplastic cells. </div> <div> <B>•</B> The cells are notable for eccentric nuclei set into mucin rich cytoplasm. </div> <div> <B>•</B> The nuclei are hyperchromatic and round to oval. </div> <div> <B>•</B> No pleomorphism or mitoses are seen. </div> <div> <B>•</B> The stroma is very dense with acellular collagen. </div> <div> <B><IMG SRC="0e6b0440.gif" border=0 width="432" height="324" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>Infiltrating Lobular Carcinoma of Breast (High Power) </B></div> <div> <B>•</B> This high power view shows the cytologic features of lobular carcinoma. </div> <div> <B>•</B> The cells have oval to round nuclei and may be "signet ring" (arrows) with a vacuole of mucin forming the hole in the center of a ring and the nucleus bulgin to form the seal or stone in the ring. </div> <div> <B>•</B> The linear pattern of infiltration is also known as "indian filing". </div> <div> <B><IMG SRC="0e874d70.gif" border=0 width="628" height="471" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <bR> <bR> <bR> <bR> <bR> <bR> <bR> <bR> <div> <B><IMG SRC="0eaf84c0.jpg" border=0 width="504" height="332" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="504" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 53 WIDTH="500"><div> This is atypical ductal epithelial hyperplasia of the breast. A significantly increased risk (5 times normal) for breast carcinoma occurs with cytologically atypical epithelial hyperplasia.</div> </tD> </tR> </TABLE></div> <bR> <div> <B><IMG SRC="0ebf84b0.jpg" border=0 width="504" height="331" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> The classic cribriform pattern of intraductal carcinoma of the breast is shown here. The neoplastic epithelial cells within the duct show minimal hyperchromatism and pleomorphism, but they have holes with sharp margins as though punched out by a cookie cutter</div> <div> <B><IMG SRC="1dcfafb0.jpg" border=0 width="250" height="251" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B>This is a picture of a cancer cell being attaked by your immune system killer T-Cells. Scanning electron microscope shows killer t-cells attacking the cancer cell. Notice the tenticles of the cancer cell</div> <div> <B><IMG SRC="1ddfa880.jpg" border=0 width="250" height="392" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="1df96e00.jpg" border=0 width="150" height="224" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="1e02cb40.jpg" border=0 width="300" height="180" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="1e21a2c0.jpg" border=0 width="282" height="300" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B><IMG SRC="1e9a8800.jpg" border=0 width="168" height="128" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="1eab0890.jpg" border=0 width="176" height="137" ALIGN="BOTTOM" HSPACE="0" VSPACE="0">pagets disease</B></div> <div> <B><IMG SRC="1eb0ac80.jpg" border=0 width="266" height="200" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="1ec15c80.jpg" border=0 width="277" height="200" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B>Breast cancer cells tolerate overabundant proenkephalin (stained green) in the nucleus when p53 is non-functional (left); when p53 function is restored, the cells die and fragment into proenkephalin-laden apoptotic bodies </div> <div> <B><IMG SRC="1ee6be00.jpg" border=0 width="363" height="480" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="1efb3ec0.jpg" border=0 width="179" height="236" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="1f0e1950.jpg" border=0 width="225" height="149" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="1f1e19c0.jpg" border=0 width="225" height="156" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="1f2ba120.jpg" border=0 width="186" height="274" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="1f3fa4d0.jpg" border=0 width="250" height="333" ALIGN="BOTTOM" HSPACE="0" VSPACE="0">peau d'orange</B></div> <div> <B><IMG SRC="1f4fabc0.jpg" border=0 width="250" height="188" ALIGN="BOTTOM" HSPACE="0" VSPACE="0">extra nipple<IMG SRC="1f5e1a90.jpg" border=0 width="225" height="169" ALIGN="BOTTOM" HSPACE="0" VSPACE="0">cool<IMG SRC="1f6e1bc0.jpg" border=0 width="225" height="188" ALIGN="BOTTOM" HSPACE="0" VSPACE="0">nipple inversion</B></div> <bR> <div> <B><IMG SRC="1f7e1a10.jpg" border=0 width="225" height="161" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="1f8e1970.jpg" border=0 width="225" height="151" ALIGN="BOTTOM" HSPACE="0" VSPACE="0">nipple retraction</B></div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="227" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 96 WIDTH="223"><div> Xeroradiograph that demonstrates a cancer behind the nipple pulling the nipple in. Xeroradiography has been replaced by mammography.</div> </tD> </tR> </TABLE></div> <bR> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="227" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 38 WIDTH="223"><div> Inverted nipple (the discoloration is due to a needle biopsy.)</div> </tD> </tR> </TABLE></div> <div> <IMG SRC="1f9f8af0.jpg" border=0 width="248" height="175" ALIGN="BOTTOM" HSPACE="0" VSPACE="0">nipple discharge<IMG SRC="1fa04b20.jpg" border=0 width="260" height="178" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="1fb0ab10.jpg" border=0 width="266" height="177" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="1fccc7f0.jpg" border=0 width="204" height="127" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="1fde1990.jpg" border=0 width="225" height="153" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="209" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 153 WIDTH="205"><div> Bloody discharge here represented a benign intraductal papilloma- - a type of fibrocystic condition. Surgery was performed to remove the benign tumor. This is a dilated duct with the papilloma in the duct.</div> </tD> </tR> </TABLE></div> <bR> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="231" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 57 WIDTH="227"><div> The papilloma or benign growth in the enlarged duct under the microscope.</div> </tD> </tR> </TABLE></div> <div> <IMG SRC="1fee1a90.jpg" border=0 width="225" height="169" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="1ffe1a90.jpg" border=0 width="225" height="169" ALIGN="BOTTOM" HSPACE="0" VSPACE="0">in men</div> <bR> <div> <IMG SRC="200e1980.jpg" border=0 width="225" height="152" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="201e1980.jpg" border=0 width="225" height="152" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><B>Ulceration of breast skin</B></FONT></div> <bR> <div> <IMG SRC="202e1950.jpg" border=0 width="225" height="149" ALIGN="BOTTOM" HSPACE="0" VSPACE="0">skin nodule</div> <div> <B><IMG SRC="203e1b20.jpg" border=0 width="225" height="178" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="204e1980.jpg" border=0 width="225" height="152" ALIGN="BOTTOM" HSPACE="0" VSPACE="0">nipple ulceration</B></div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="229" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 134 WIDTH="225"><div> This represents Paget's disease which is cancer of the nipple. You can see there is ulceration of the nipple and bloody fluid. This is not a true discharge but nonetheless some fluid was noted</div> </tD> </tR> </TABLE></div> <bR> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="227" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 153 WIDTH="223"><div> Neglected Paget's disease where the cancer now involves not only the nipple but the areola area as well - - the darker breast skin which surrounds the nipple. Paget's disease is typically an early breast cancer with a very good outcome.</div> </tD> </tR> </TABLE></div> <bR> <div> <B><IMG SRC="205b20b0.jpg" border=0 width="178" height="267" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="206fcb20.jpg" border=0 width="252" height="178" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="207e1960.jpg" border=0 width="225" height="150" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B><IMG SRC="20880a20.jpg" border=0 width="384" height="162" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <I>a. fine (thin) needle</I></div> <div> <I>b. core (thicker) needle</I></div> <div> <I>c. surgical biopsy</I></div> <div> fluid is not obtained then a biopsy should be performed to assure the mass is benign. There are essentially 3 types of biopsies that can be performed: a thin needle biopsy which retrieves only cells (a), a thicker or core biopsy which retrieves tissue and therefore the architecture can be evaluated (b) or a surgical biopsy to remove the mass (c).</div> <div> <B><IMG SRC="209e1b40.jpg" border=0 width="225" height="180" ALIGN="BOTTOM" HSPACE="0" VSPACE="0">normal breast cells</B></div> <div> <B><IMG SRC="20ae1b20.jpg" border=0 width="225" height="178" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B><FONT SIZE="3" COLOR="#0000FF" FACE="Arial" >Abnormal breast cells on a thin needle aspirate both pictures</FONT></div> <bR> <div> <IMG SRC="20bfa930.jpg" border=0 width="250" height="147" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="159" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 57 WIDTH="155"><div> Breast asymmetry seconday to surgery and radiation therapy.</div> </tD> </tR> </TABLE></div> <DIV ALIGN="LEFT"></DIV> <div> <IMG SRC="20c07b20.jpg" border=0 width="263" height="178" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><B>Breast Hair</B></FONT></div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="177" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 57 WIDTH="173"><div> This is not abnormal. In fact years ago it was called Barber's nipples.</div> </tD> </tR> </TABLE></div> <bR> <div> <IMG SRC="20de1910.jpg" border=0 width="225" height="145" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="20ee1910.jpg" border=0 width="225" height="145" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"> Breast Redness</div> <div> Breast infection secondary to breast feeding called mastitis. This woman needed antibiotics.</div> <div>  </div> <div>  Progressive breast infection secondary to breast feeding -- this was an abscess and needed to be drained.</div> <div>  </div> <div>  </div> <div>  <IMG SRC="20fb3d90.jpg" border=0 width="179" height="217" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="210e1970.jpg" border=0 width="225" height="151" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="1efb3ec0.jpg" border=0 width="179" height="236" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <bR> <bR> <bR> </td> </tr></table></body>