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![Page 1: Mama](https://reader033.fdocuments.es/reader033/viewer/2022052910/559a106d1a28abfa548b456f/html5/thumbnails/1.jpg)
GLANDULA MAMARIA
CARLOS EVELIO GRISALES GUTIERREZ
MEDICO PATOLOGO
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• Cada conducto terminal y sus conductillosconstituyen la unidad lobulillar ductal terminal
• Solo con el comienzo del embarazo la mama asumesu maduración morfológica y su actividad funcionalcompleta
• Después del tercer decenio de la vida, los conductosy lobulillos se atrofian progresivamente condisminución del volumen del estroma intralobulillar einterlobulillar
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TRANSTORNOS DEL DESARROLLO
• Pezones o mamas supernumerarias
• Tejido mamario axilar accesorio• Inversión congénita de los
pezones• Macromastia
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Ms supernumeraria
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Pezon invertido
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PROCESOS INFLAMATORIOS
• MASTITIS AGUDA: Por lactancia yeccema, estafilococos,estreptococos.
• MASTITIS PERIDUCTAL: Porpenetración del epitelio planoqueratinizado en conductos delpezón.
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Mastitis aguda
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PROCESOS INFLAMATORIOS
• ECTASIA DE CONDUCTOS MAMARIOS: Dilatación de conductos con espesamiento de secreciones.
• NECROSIS ADIPOSA: Por traumas. Cirugías o radiaciones.
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Ectasia de conductos mamarios
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Ectasia ductal
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PROCESOS INFLAMATORIOS
• MASTITIS GRANULOMATOSA
Granulomatosis de Wegener
Sarcoidosis
Mico bacterias
Hongos
. IMPLANTES MAMARIOS DE SILICONA
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Ms granulomatosa
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Implantes mamarios
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ALTERACIONES FIBROQUISTICAS
• Entre los 20 y 40 años, raro después de la menopausia.
• Por aumento de estrógenos o disminución de progesterona
• Alteraciones en el metabolismo hormonal
• Tres patrones histológicos: Formación de quistes, fibrosis y adenosis
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Enfermedad fibroquistica
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ENFERMEDADES PROLIFERATIVAS MAMARIAS
•HIPERPLASIA EPITELIAL
•ADENOSIS ESCLEROSANTE
•PAPILOMAS DE CONDUCTOS PEQUEÑOS
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Adenosis esclerosante
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HIPERPLASIA EPITELIAL
• HIPERPLASIA ATIPICA
• HIPERPLASIA DUCTAL ATIPICA
• HIPERPLASIA LOBULILLAR ATIPICA
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TUMORES EPITELIALES
• PAPILOMA INTRADUCTAL O DE CONDUCTOS GRANDES.
Crecen en el interior de conductos o senos galactóforos. Secreción serosa o hemorrágica por pezón, unilaterales.
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Papiloma de conductos
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Significado clínico de la enfermedad proliferativa
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TUMORES DEL ESTROMA
FIBROADENOMA: Constituido portejido fibroso y glandular, alrededorde los 30 años
TUMOR FILODES: Alrededor de los60 años, de bajo y alto grado.
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SARCOMAS
• ANGIOSARCOMAS: Por radioterapia
• RABDOMIOSARCOMAS
• LIPOSARCOMAS
• LEIOMIOSARCOMAS
• CONDROSARCOMAS
• OSTEOSARCOMAS
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angiosarcoma
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CARCINOMA DE MAMA
• EN ESTADOS UNIDOS UNA DE CADA9 MUJERES DESARROLLA ESTAENFERMEDAD, LA TERCERA PARTEDE ELLAS FALLECEN POR ESTAPATOLOGIA, LO QUE REPRESENTA44.000 MUERTES AL AÑO
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PREDISPOSION GENETICA
• LOS ANTECEDENTES FAMILIARESREPRESENTAN UN FACTOR DERIESGO PARA LA APARICION DE CADE MAMA Y ENTRE 5 Y 10% SONATRIBUIBLES A LA HERENCIA DE UNGEN AUTOSOMICO DOMINANTE
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PREDISPOSICION GENETICA
DOS GENES, BRCA1 Y BRCA2ESTAN RELACIONADOS CON LAMAYORIA DE CANCER MAMARIOHEREDITARIO
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CARCINOMA DUCTAL IN SITUY ENFERMEDAD DE PAGET
CLASIFICACION
• COMEDOCARCINOMA• SOLIDO• CRIBIFORME• PAPILAR• MICROPAPILAR
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CARCINOMA LOBULILLAR INSITU
• POCO FRECUENTE, 1 A 6% DE LOS TUMORES
• BILATERAL EN 50 A 70%
• MAYORES DE 20 AÑOS PUEDEN DESARROLLAR CA INFILTRANTE EN 25 A 35%
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CARCINOMA DUCTAL INFILTRANTE
• NODULOS DUROS DE 1-2 CMS A 4-5 CMS
• FIJOS A PARED TORACICA Y RETRACION DEL PEZON Y PIEL
• HISTOLOGIA: CORDONES, SOLIDO, TUBULOS.
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CARCINOMA LOBULILLAR INFILTRANTE
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Carcinoma lobulillar infiltrante
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CARCINOMA MEDULAR
• MASAS DE 2 A 3 CMS LA MAYORIA
• MASAS CARNOSAS
• MEJOR PRONOSTICO QUE EL INFILTRANTE CONVENCIONAL
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Carcinoma medular
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CARCINOMA COLOIDE O MUCINOSO
• EDAD AVANZADA Y CRECIMIENTO LENTO
• MASA BLANDA BIEL DELIMITADA, BLANDA, ASPECTO GELATINOSO GRIS AZULADO
• METASTASIS A GANGLIOS LINFATICOS EN MENOS DEL 20% DE LAS PACIENTES
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Carcinoma mucinoso
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Carcinoma mucinoso
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CARCINOMA TUBULAR
• MASA IRREGULAR Y ESPICULADA EN LA MAMOGRAFIA
• EDAD CERCA A LOS 50 AÑOS
• MULTIFOCALES EN LA MISMA MAMA EN EL 10 A 56 %
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CARCINOMA TUBULAR
•BILATERALES EN EL 9 A 38%
•BIEN DIFERENCIADOS
•PRONOSTICO EXCELENTE EN ESTADIO I
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Carcinoma tubular
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CARACTERISTICAS MAMOGRAFICAS
CARACTERISTICAS A RX:
• ZONAS DE DENSIDAD AUMENTADA
• DISTORSION DE LA ARQUICTETURA
• CALCIFICACIONES
• MODIFICACIONES EN EL TRANSCURSO DEL TIEMPO
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CARACTERISTICAS COMUNES
• SE EXTIENDEN EN TODAS LAS DIRECCIONES
• SE FIJAN A LA FASCIA PROFUNDA DE LA PARED TORACICA
• BLOQUEAN LOS LINFATICOS CON LINFEDEMA Y ENGROSAMIENTO DE LA PIEL (DE NARANJA)
• CARCINOMA INFLAMATORIO
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CARACTERISTICAS COMUNES
• DISEMINACION LINFATICA ESPECIALMENTE AGANGLIOS AXILARES SI LA MASA ESTA ENCUADRANTE EXTERNO
• DISEMINACION HEMATICA A PULMON,HUESOS, HIGADO SUPRARRENALES, CEREBROY MENINGES
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Diseminación linfática
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Linfadenectomia axilar
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ESTADIOS
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En cuba
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metastasis
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GINECOMASTIA
• DESEQUILIBRIOS DE ESTROGENOS
• PUBERTAD O EDAD AVANZADA
• TUMORES TESTICULARES
• ALCOHOL, MARIHUANA, HEROÍNA, ESTEROIDES ANABOLIZANTES
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ginecomastia
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ginecomastia
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ginecomastia
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CARCINOMA MASCULINO
• MUY INFRECUENTE 1:1000
• VIVIR EN PAISES OCCIDENTALES
• ANTECEDENTES FAMILIARES
• EDAD AVANZADA, INFERTILIDAD
• EXPOSICION A ESTROGENOS EXOGENOS
• INFILTRA PIEL Y PARED TORACICA, SE ULCERA
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