Fig. 1.22
Fig. 1.23
The lobules may exhibit a deviated morphology as compared with that described previously. This phenomenon is called Aberration of Normal Development and Involution (ANDI). Some examples of ANDI:
– Apocrine metaplasia (Fig. 1.25) with large cells having granulated eosinophilic cytoplasm (as compared with normal epithelium, Fig. 1.24)
– Clear-cell change (Fig. 1.26)
– Eosinophilic change (Fig. 1.27), appearance of cells with eosinophilic cytoplasm among the cells of the usual type
– Lactational change (Fig. 1.28), milk-producing lobules in the breast of nonpregnant, nonlactating women
– Fibroadenomatoid change (Fig. 1.29) with proliferation of the intralobular stroma and distortion of the acini
– Microcystic involution (Fig. 1.30, galactography image; Fig. 1.31, thick-section image; and Fig. 1.32) if involution of the lobules (diminished number of acini) is associated with dilatation of the acini
A common type of ANDI is adenosis, which is described in detail in Chapter 6.
Fig. 1.24
Fig. 1.25
Fig. 1.26
Fig. 1.27
Fig. 1.28
Fig. 1.29
Fig. 1.30
Fig. 1.31
Fig. 1.32
Some ANDIs represent changes predominantly of the phenotype of the epithelial cells and may lead to accumulation of secretion in the lobule, which in turn may calcify. Other forms of ANDIs represent architectural changes within the lobules, leading to marked enlargement of the TDLUs. The calcifications or the enlarged TDLUs may be mammographically or clinically detected, causing anxiety for the patient and differential diagnostic problems for the radiologist.
Fig. 1.33
Fig. 1.34
The histologically “normal” breast tissue may show numerous aberrations, many of which cannot be detected by clinical or radiologic examination. If these lesions are sufficiently large to be radiologically or clinically detected and, especially when symptomatic, they are more appropriately called “fibrocystic change,” which is still a variation of normal breast morphology.
The difference between ANDIs and fibrocystic change is more quantitative than qualitative. It is impossible to draw a sharp line between microcystic involution and cysts (Figs. 1.33 and 1.34) or between fibroadenomatoid change and fibroadenoma (Figs. 1.35 and 1.36).
Fig. 1.35
Fig. 1.36
The distinction between “normal” or “pathologic” depends on the method of examination. Histology is an extremely sensitive method and may detect many clinically and prognostically unimportant details, which are best characterized as variations and aberrations of the normal breast morphology.
The normal breast tissue contains lobules typical of both the proliferative and secretory and menstrual phases of the menstrual cycle, different combinations of involutional changes, and different ANDIs all at the same time. Consequently, normal breast tissue offers the interested examiner a variable and fascinating picture under the microscope (Figs. 1.37-1.41; Fig. 1.40, thick-section image).
Fig. 1.37
Fig. 1.38
Fig. 1.39
Fig. 1.40
Fig. 1.41
Fig. 1.42
Fig. 1.43
The mammogram represents a black-and-white summation of the morphologic details of the breast. The lobules are visible on a high-quality mammogram as l-to-2-mm nodular densities.
