CHAPTER 19
Female Reproductive System
387
Figure 19-16B.
Adenocarcinoma of the Breast (Breast Cancer).
H&E, left (
lower
)
3
44; right (
upper
)
3
71
In±
ltrating duct carcinoma
, or
invasive ductal carcinoma
, is the
most common
adenocarcinoma of the breast
(
breast cancer
); it
contains no features to further classify it into special types of breast
carcinoma, such as
lobular
,
tubular
, and
mucinous carcinomas
.
Risk factors for the development of breast cancer include female
gender, increasing age, family history, long reproductive life,
nul-
liparity
, and the presence of proliferative breast lesions or ductal
hyperplasia. Approximately 5% of breast cancers are related to
speciF c gene mutations, including BRCA1 and BRCA2. Common
signs and symptoms include a palpable breast mass, bloody dis-
charge from the nipple, change in size or shape of a breast, skin
dimpling, inverted nipple, peeling of the nipple skin, and redness or
pitting of the skin over the breast. Mammograms and breast exams
are used to screen for breast cancer. Biopsy is performed on suspi-
cious lesions to determine a tissue diagnosis. Histologically, breast
cancer varies from well-formed glandular structures to sheets of
poorly differentiated cells. Histologic grading of breast cancer is
based on tubule formation, nuclear
pleomorphism
, and the mitotic
rate. Treatment includes surgical removal of a tumor (
lumpec-
tomy
), removal of the entire breast (
mastectomy
) and lymph nodes,
radiation therapy, chemotherapy, and hormone therapy.
Figure 19-16A.
Nipple, mammary gland.
H&E,
3
11; left inset
3
146; right inset
3
136
The
nipple
is a small projection at the center of the breast. It
contains 15 to 25 openings of
lactiferous ducts
within its connec-
tive tissue and smooth muscle bundles. It is covered by thin skin and
surrounded by the
areola
(pigmented skin). The nipple has many
sensory nerve endings that receive stimulation during
suckling
. This
stimulation results in release of
oxytocin
from the pars nervosa of
the pituitary; the oxytocin stimulates contraction of the myoepithe-
lial cells in the mammary gland. The contraction of the myoepithelial
cells pushes milk out of the alveoli and ducts and through the lac-
tiferous ducts to the surface of the nipple. This process is called the
milk ejection refl ex
. The lactiferous ducts shown here are from the
proximal portion of the ducts near the lactiferous sinuses.
Lactiferous
Lactiferous
ducts
ducts
Lactiferous
ducts
Skin
Skin
Skin
stratified squamous
stratified squamous
epithelium
epithelium
stratified squamous
epithelium
Smooth
Smooth
muscle bundles
muscle bundles
Smooth
muscle bundles
Epithelium of
Epithelium of
lactiferous duct
lactiferous duct
Epithelium of
lactiferous duct
Connective
Connective
tissue
tissue
Connective
tissue
A
Infiltrating duct
carcinoma of the
breast
B
CLINICAL CORRELATION
SYNOPSIS 19-1
Clinical and Pathological Terms for the Female Reproductive System
Endophytic
: Term to describe an inward-growing process such as a neoplasm that grows on the interior of an organ
(±ig. 19-12B).
Exophytic
: Term to describe an outward-growing process such as a neoplasm that grows externally on an organ or within
the lumen of an organ (±ig. 19-12B).
Hemoperitoneum
: Blood within the peritoneal cavity because of a variety of causes including trauma, rupture of a tumor,
or rupture of an ectopic pregnancy (±ig. 19-7C).
Menorragia
: Refers to excessive or prolonged uterine bleeding at regular intervals during menstruation; some causes
include uterine leiomyomas, anovulation and ovarian dysfunction, hormonal imbalance, bleeding tendency, and malig-
nancy (±ig. 19-11B).
Metrorragia
: Refers to uterine bleeding at irregular intervals often at times between the expected menstrual periods;
causes may be similar to menorrhagia and include hormonal imbalance, malignancy, uterine polyps, and bleeding tendency
(±ig. 19-11B).
Nulliparity
: Term used to describe never having given birth to a child; by contrast, a woman who has given birth to two
or more children is termed
multiparous
(±ig. 19-16B).
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