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Aberration of normal development and involution (andi) of thebreast

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ANDI
ABERRATION OF NORMAL DEVELOPMENT
AND INVOLUTION (ANDI) OF THEBREAST

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Normal three phases of physiology of breast—
(1)Lobular development;
(2) Cyclical hormonal modifications;
(3) Involution.

First coined by LE Hughes at Cardiff breast clinic in
1987
ANDI includes variety of benign breast disorders
occurring at different periods of reproductive periods
in females—early, matured and involution phase of
reproductive age group.

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Early reproductive age group (15-25 years)
Normal lobule formation may cause aberration as
fibroadenoma.
>5 cm - Giant fibroadenoma as a diseased status. It
is AND of alobule.
Normal stroma may develop juvenile hypertrophy
as aberration and multiple fibroadenoma as
diseased status.

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Mature reproductive age group (25-40 years):
Normal cyclical hormonal effects on glands and
stroma get exaggerated by aberration causing
generalised enlargement.
Its disease is cyclical mastalgia with nodularity also
called as fibrocystadenosis.

7.

Involution age group (40-55 years):
Lobular involution with microcysts, fibrosis, adenosis,
apocrine metaplasia and eventual aberrations as
macrocysts and cystic disease of breast. Macrocyst is
an aberration of normal involution (ANI). Sclerosing
adenosis is also a type of aberration.

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Ductal involution
Aberration - ductal dilatation and nipple discharge.
Later Disease status develops with
Periductal mastitis,
Nonlactational breast abscess and
Mammary duct fistula.
Periductal fibrosis - partial nipple retraction.
Epithelial changes leads into epithelial hyperplasia
and atypia.

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FIBROADENOMA
Hyperplasia of a single lobule of the breast (AND).
Most common benign tumour of the breast.
Encapsulated tumour common in young females.
Bilateral in 20% of cases. 20% are multiple.

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Progression
30% of fibroadenomas may disappear or reduce in size
in 2-4 years.
10 -15% will increase in size progressively.
It does not occur after menopause unless women are
on hormones.

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Fibroadenoma Variants
1. Juvenile fibroadenoma
Occurs in adolescent girls.
Even though it shows rapid growth with stromal and
epithelial hyperplasia, it does not show any alteration in
stromal epithelial balance or cellular atypia or periductal
cellular concentration.
Mimic phyllodes tumour.

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2. Complex fibroadenoma
It occurs in older age group.
Having typical fibroadenoma with fibrocystic changes
like apocrine metaplasia, cyst formation, sclerosing
adenosis.
15% of proven fibroadenomas are complex.
Occasionally it may turn into malignancy unlike usual
fibroadenomas.

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Pathological Types
1. Intracanalicular: large and soft—mainly cellular.
Stroma with distorted duct.
2. Pericanalicular : small and hard—mainly fibrous.
Stroma with normal duct

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Clinical Features
Painless swelling
Smooth, firm, nontender, well-localised and
Moves freely within the breast tissue (mouse in the
breast).

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Investigations
Mammography (well-localised smooth regular
shadow).
FNAC.
Ultrasound (to confirm solid nature).

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Treatment
Fibroadenoma which is small (< 3 cm)/single/age < 30
years can be left alone with regular follow-up with
USG at 6 monthly interval.
Indications for surgery are:
Size > 3 cm.
Multiple.
Giant type.
Recurrence.
Cosmesis.
Complex type.

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Early Reproductive Period(1525yrs)
NORMAL
PROCESS
• LOBULE
FORMATION
• STROMA
FORMATION
ABERRATION
DISEASE STATE
• FIBROADENOMA
• GIANT
FIBROADENOMA
• JUVENILE
HYPERTROPHY
• MULTIPLE
FIBROADENOMA

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PHYLLOIDES TUMOR
Aka Cystosarcoma Phylloides Or Serocystic Disease Of
Brodie
This Is A Giant Fibroadenoma Which Shows A Wide
Spectrum Of Activity From A Benign Condition (85%)
To Locally Aggressive To Metastatic Tumor (15%)

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Gross : Large, Capsulated, Cystic Changes
Cut Curface: Soft, Cystic Spaces
Microscopy: Cystic Spaces With Leaf Like Projections
Hence Called “Phylloides”

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CLINICAL FEATURES
30-50yrs
Unilateral
Grows rapidly to attain large size
Bosselated surface with necrosis of skin
Swelling is warm, not fixed to skin or chest wall

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INVESTIGATIONS
ULTRASOUND
FNAC
CHEST XRAY

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TREATME
Excision
NT
Total Mastectomy If Malignant

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Mature Reproductive Period (2540yrs)
NORMAL
• CYCLICAL
HORMONE
EFFECTS ON
GLANDULAR
TISSUE AND
STROMA
ABERRATION
DISEASED STATE
• EXAGGERATED
CYCLICAL
EFFECTS
• CYCLICAL
MASTALGIA
AND
NODULARITY

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Cyclical Mastalgia With Nodularity
Aka Fibrocystadenosis / Fibrocystic Disease Of Breast/
Mammary Dysplasia
Estrogen Dependant

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BLUEDOME CYST OF
BLOODGOOD
One Of The Cyst May Get Enlarged And Become
Clinically Palpable
Non Tender, Fluctuant, Transilluminant With Thin
Bluish Capsule

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Initially Aspirated
Surgical Excision Done If Recurs/ Persists/ Blood
Stained/ Residual Lump Remains
Multiple Small Cysts – Schimmelbusch’s Disease

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FIBROCYSTADENOSIS

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CLINICAL FEATURES
B/L, Diffuse, Painful, Granular Swelling Better Felt
With Palpating Fingers
Pain And Tenderness More Just Prior To
Menstruatuion
Subsides During Pregnancy/ Lactation/After
Menopause

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INVESTIGATIONS
FNAC- EPITHELIOSIS (PREMALIGNANT)
USG
MAMMOGRAPHY

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TREATMENT
(A) CONSERVATIVE
Reassurance
Oil Of Evening Primrose: Gamolenic Acid
NSAIDS
Vit E And B6
Bromocriptine- Prolactin Inhibitor
Tamoxifen- Estrogen Antagonist
Danozol- Antigonadotrohin Agent

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SURGERY
Excision Of Cyst/ Diseased Tissue
D/D: Tietze’s Disease Costochondritis Of Second
Costal Cartilage

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Involution (35-55 yrs)
NORMAL
• LOBULAR
INVOLUTION
• DUCTAL
INVOLUTION
• EPITHELIAL
TURNOVER
ABERRATION
DISEASED STATE
• MACROCYST,
SCLEROSING
ADENOSIS
• DUCT
DILATATION,
PERIDUCTAL
FIBROSIS
• MILD
EPITHELIAL
HYPERPLASIA
• CYSTIC DIAEASE
• PERIDUCTAL
MASTITIS, NON
LACTATIONAL
BREASTABSCESS
• EPITHELIAL
HYPERPLASIA
WITH ATYPIA