2: Breast Pathology I

Question 1

What is a triple assessment for suspected breast cancer?

Answer 1

Clinical - history and examination

Imaging - USS if < 40 (young women have denser breasts), mammogram if > 40

Biopsy - an FNA for cytology or a core biopsy for histology (more common)

Question 2

How do pathologists take breast biopsies for cytology?

Answer 2

FNA

Or discharge samples, nipple scrapings

Question 3

How do pathologists take breast biopsies for histology?

Answer 3

Core biopsy

Vacuum assisted biopsy

Skin biopsy

Incisional/Excisional biopsy

i.e all the ones involving cutting, core biopsy is the most important

Question 4

What is the difference between cytology and histology?

Answer 4

Cytology - individual cells

Histology - tissue

Question 5

The higher the grade number in a cytology or histology report, the more likely a tumour is ___.

Answer 5

malignant

Question 6

In terms of purpose, a breast biopsy can be ___ or ___.

Answer 6

diagnostic - only removes a small sample

therapeutic - aims to remove whole mass if there is one

Question 7

What ratings are used to describe tumours based on

a) cytology
b) histology?

Answer 7

a) C1-5

b) B1-5

higher numbers are bad

Question 8

What is the main advantage of histology over cytology for staging breast tumours?

Answer 8

Histology allows you to identify carcinomas-in-situ

Which are more sinister than abnormal hyperplasias (lower stage tumours)

Question 9

What are the developmental lines on which the mammary glands and nipples develop?

Answer 9

Milk lines

Question 10

What are some developmental problems which can occur with the breasts?

Answer 10

Growth problems - hyper or hypoplasia

Accessory breast tissue

Accessory nipple

Question 11

What is gynaecomastia?

Answer 11

Breast development in a male

Question 12

In gynaechomastia, which breast structures grow in a male?

Answer 12

Breast DUCTS

but not the lobules themselves

Question 13

Name two drug classes which cause gynaecomastia.

Answer 13

Oestrogen and oestrogen-like drugs

PPIs and H2 blockers

K-sparing diuretics i.e SPIRONOLACTONE

Question 14

Name a recreational drug which causes gynaecomastia.

Answer 14

Cannabis

Question 15

Problems with which organ can cause gynaecomastia?

Answer 15

Liver

Question 16

Why can liver disease cause gynaecomastia?

Answer 16

Liver produces carrier proteins like sex hormone binding globulin

So when it fails, levels of circulating oestrogen increase -> gynaecomastia

Question 17

Which menstrual abnormalities are risk factors for breast cancer?

Answer 17

Early menarche

Late menopause

The idea is that the more menstrual cycles a woman has, the greater the chances - so physiological amenorrhoea e.g post-natally is protective

Question 18

Which benign breast condition is associated with early menarche and late menopause?

Answer 18

Fibrocystic changes

Question 19

Which women tend to develop fibrocystic breast changes?

Answer 19

Perimenopausal women

40-50

Question 20

What do fibrocystic lesions look like?

Answer 20

Discrete breast lumps

Pale, blue dome

Question 21

What symptoms may women complain of which are caused by fibrocystic breast lumps?

Answer 21

Breast lump

Pain (sudden, constant or cyclical)

Question 22

How are benign fibrocystic lesions managed?

Answer 22

Reassure patient that it isn’t malignant

Excision if required

Question 23

What is a hamartoma?

Answer 23

Non-neoplastic cells but in an abnormal distribution or location

Question 24

What is a breast hamartoma?

Answer 24

Normal breast cells but in an abnormal number or location

Question 25

What is a common benign breast tumour typically found in women in their 30s?

Answer 25

Fibroadenoma

Question 26

Describe a fibroadenoma.

Answer 26

Well circumscribed

Rubbery in texture

Grey-white (not blue like fibrocystic lesions)

Question 27

Which imaging is used to view fibroadenomas?

Answer 27

USS

Because women tend to get them in their 30s (denser breasts)

Question 28

Fibroadenomas are (benign / malignant).

Answer 28

benign

Question 29

How are fibroadenomas managed?

Answer 29

Reassurance only

Very rarely excised only if causing discomfort

Question 30

Which benign breast lesion appears to have projections on USS and mimics malignancy?

Answer 30

Radial scar

Question 31

Which inflammatory breast condition is commonly caused by seatbelt injuries and warfarin?

Answer 31

Fat necrosis

Also dogs jumping up on people (true fact)

Question 32

Which inflammatory breast condition is associated with smoking and causes fistulas to open up around the nipple?

Answer 32

Duct ectasia

Question 33

Which inflammatory breast condition is caused by infection secondary to breastfeeding?

Answer 33

Acute mastitis

Question 34

Which samples can be used by a pathologist for cytopathology (looking at individual cells)?

Answer 34

FNA (fine needle aspirate)

Breast milk or nipple discharge

Nipple scrapings

Question 35

Why is ultrasound scanning superior to mammography (X-ray) for women under 40?

Answer 35

Younger women have denser breasts

Question 36

Are breast hamartomas benign or malignant?

Answer 36

Benign

May be mistaken for malignancy due to symptoms but they are normal cells, just growing in an abnormal place or shape

Question 37

What causes duct ectasia?

Answer 37

Blockage of ducts, causing inflammation –> pain and bloody/purulent discharge

Question 38

What occurs secondary to duct blockage in duct ectasia?

Answer 38

Inflammation > pain, discharge, nipple retraction

Fistulation

Question 39

Which lifestyle factor is duct ectasia associated with?

Answer 39

Smoking

Question 40

Which types of organism are responsible for duct ectasia?

Answer 40

Anaerobes

Question 41

Which specific organisms are commonly responsible for acute mastitis?

Answer 41

Staph aureus

Strep pyogenes

Question 42

What is a Phyllodes tumour?

Answer 42

Benign, slow growing breast tumour

Looks like a leaf on histology???

Cut it out