7.1.1 Breast Disease Pathology Flashcards
What is the normal histological appearance of breast tissue?
Modified sweat glands
Lobules and lactiferous ducts
Lobules contain acini and intralobular stroma
Describe the acini ducts in breast tissue
Cuboidal epithelia lining the lumen
Myoepithelial cells act as basement membrane on outside of the lumen
What physiological changes occur in breast tissue in these phases?
- Prepubertal
- Menarche
Prepubertal
Few lobules- identical to male breasts
Mencharce
Increase in number of lubules
Increased volume of interlobular stroma
What physiological changes occur in breast tissue during pregnancy?
- Increase in size and number of lobules
- Decrease in stroma
- Secretory changes
- Cessation of lactation, atrophy of lobules but not back to former levls
What physiological changes occur during the menstrual cycle?
Follicular phase lobules quiescent
After ovulation proliferation and stromal oedema
Menstruation leads to decrease in lobules
What physiological changes occur to breast tissue as women age?
Terminal duct lobular units decrease in number and size
Stroma replaced with adipose tissue
What does breast tissue look like in pregnancy?
Loss of stroma
Glands produce milk so are filled with colostrum initially, then milk - large dilated white filled acini
Stop producing milk when baby feeding stops
How can breast conditions present?
Pain
Palpable mass
Nipple discharge
Mammographic abnormalities
Skin changes
Lumpiness
What breast conditions cause pain?
May be cyclical and diffuse
Non-cyclical and focal- ruptured cysts, injury, inflammation
Breast cancer (sometimes)
What breast conditions cause a palpable mass?
Normal nodularity
Invasive carcinomas
Fibroadenomas
Cysts
Worrying if hard, craggy and fixed
What breast conditions cause mammographic abnormalities?
Densities
Invasive carcinomas
Fibroadenomas
Cysts
Calcifications
Ductal carcinoma in situ (DCIS)
Benign changes
What age group are invited to mammographic screening ?
Women between 47-73 years old every 3 years
Easier to detect lesions in breasts of older women
What is the most common benign tumour of the breasts?
Fibroadenoma
How common is breast cancer?
Most common non-skin malignancy in women
What does mammographic screening increase detection of?
Small invasive tumours and in situ carcinomas
What are some issues with detecting ductal carcinoma in situ using mammograms?
May never develop into harmful cancer
May put people through unnecessary testing
What are fibroadenomas?
Benign, firm, well-rounded, non-tender, mobile breast lumps
Arises from breast lobules
Most likely between 20-24
Why is a phyllodes tumour?
Rare
Breast tumour arising from stroma (connective tissue) of the breast
Benign or malignant
Mostly in 60<
How do we classify pathological conditions of the breast?
- Development disorders
- Inflammatory conditions
- Benign epithelial lesions
- Stromal tumours
- Gynaecomastia
- Breast carcinoma
What inflammatory breast conditions can be seen?
Acute mastitis
Fat necrosis
What is acute mastitis?
- Almost always during lactation
- Staphylococcus aureus infection from nipple cracks and fissures
- Erythematous painful breast
- Pyrexia
- Breast abscesses
How is acute mastitis treated?
Keep expressing milk as caused by blocked milk duct
Flucloxacillin
What is fat necrosis of the breast?
Presents as a mass, skin changes or mammographic abnormality
Hx of trauma or surgery
Can mimic carcinoma clinically and mammographyically
Fat cells break down and surrounded by macrophages and inflammatory cells
What are examples of benign epithelial changes of breast?
Fibrocytic change
May disappear when fine needle biopsied as you drain the liquid out
What is fibrocystic change?
- Commonest breast lesion
- Can present as a mass or mammographic abnormality
- Histology- cyst formation, fibrosis and apocrine metaplasia
- Can mimic carcinoma clinically and mammographically
What stromal tumours can be seen?
Fibroadenoma
Phyllodes tumours
Lipoma
Leiomyoma
Hamartoma
What is the histology of fibroadenomas?
Composed of a mixture of stromal and epithelial elements
What is gynaecomastia?
Enlargement of male breast
Unilateral or bilateral
Often seen in puberty and elderly
Can mimic male breast cancer especially if unilateral
What causes gynaecomastia?
Occurs in neonates due to circulating maternal and placental oestrogens and progesterone
Oestrogen production peaks earlier than testosterone in puberty
Reduced androgens in elderly
Klinefelter’s syndrome
Liver cirrhosis- oestrogen not metabolised effectively
Drug related- spironolactone
