3. First month Second Month First month Second Month Milk line remnant Milk line remnant Accessory axillary breast tissue Accessory axillary breast tissue Congenital nipple inversion Congenital nipple inversion

7. Life long breast changes

8. Cyclic hormonal effect

10. Breast abscess Breast abscess

11. Granulomatous mastitis

12. Periductal (recurrent )mastitis

13. Mammary ductectasia

14. Fat necrosis

15. Prolactinoma

18. Fibroademoma Fibroademoma

20. Phyllodes Tumor

22. Sarcoma Radiation induced angiosarcoma

23. Fibrocystic changes

33. Cribriform and solid in situ carcinoma

34. Comedo carcinoma

36. Paget’s disease

37. Infiltrating ductal carcinoma

38. Invasive ductal carcinoma

40. Grading Modified Bloom Richardson Grading System Modified Bloom Richardson Grading System

41. ER PR HER2 P53

43. Metastasis

44. Breast Carcinoma Metastasis

45. Risk Factors Age Age Genetics: BRCA1,BRCA2(first degree relatives) Genetics: BRCA1,BRCA2(first degree relatives) Carcinoma of contralateral breast Carcinoma of contralateral breast Endometrial carcinoma Endometrial carcinoma Reproductive life( early menarche, late menopause) Reproductive life( early menarche, late menopause) Parity( nulliparous > multiparous) Parity( nulliparous > multiparous) First live birth First live birth Race (Northern Europe) Race (Northern Europe) Geographic Influence (immigration) Geographic Influence (immigration) Radiation Exposure (therapeutic or environmental) Radiation Exposure (therapeutic or environmental)

46. Risk Factors Cont’ed Estrogen exposure Estrogen exposure Obesity( specially in postmenopausal state) Obesity( specially in postmenopausal state) Diet Diet Exercise Exercise Breast feeding Breast feeding Environmental toxins Environmental toxins Tobacco Tobacco

47. Prognostic and predictive factors Major: Invasive vs In situ Invasive vs In situ Distant Metastasis Distant Metastasis Lymph node metastasis Lymph node metastasis Locally advanced disease Locally advanced disease Inflammatory carcinoma Inflammatory carcinoma

48. Prognostic Factors cont’ed Minor: Histological type Histological type Tumor grade Tumor grade Estrogen and progesterone receptors Estrogen and progesterone receptors Lymphovascular invasion Lymphovascular invasion Proliferative rate Proliferative rate DNA content DNA content

49. Staging Stage 0: DCIS or LCIS ( 5 year survival 92%) Stage I : Invasive <2 cm, including in situ and microinvasive microinvasive Stage II: Invasive 5cm without nodal involvement involvement Stage III: Invasive>5 cm+ nodal involvement or any breast ca+ fixed L.N, or any breast ca+ fixed L.N, or inflammatory breast cancer inflammatory breast cancer Stage IV: Any form of breast Ca+ distant breast metastasis metastasis

50. Treatment option based on LN involvement 0: No systemic therapy depends on the main tumor tumor 1-3: some form of standard systemic treatment indicated ( hormonal or chemotherapy) indicated ( hormonal or chemotherapy) 4-9: high dose chemotherapy 10 or more: autologous bone marrow transplantation transplantation

52. Lobular Carcinoma

54. Colloid Carcinoma

55. Tubular Carcinoma

56. Medullary Carcinoma

57. Breast B. cell Lymphoma

58. Metastasis to the breast

60. Gynecomastia

61. Male breast Carcinoma