Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

imed3003 > Benign Breast Diseases > Flashcards

Benign Breast Diseases Flashcards

1
Q

How does the breast develop embryologically?

A

Mammary ridges that run along ‘milk line’ which goes from axilla to the groin

Primary buds form initially which becomes more and more complex forming secondary buds and eventually forms a rudimentary duct system which stay the way it is until puberty.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What triggers development and differentiation of breast during pubery?

A

Hormonal influx triggers development of a terminal milk-producing lobule, the terminal duct lobular unit, TDLU

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the terminal duct lobular unit? What are the components of the TDLU?

A

The TDLU is the milk producing unit of the breast.

The TDLU has a basement membrane, a layer of myoepithelial cells, and a layer of epithelial cells.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What surrounds TDLU?

A

A cuff of loose intralobular stroma.

TDLUs are separated by interlobular stroma that are variably fibrofatty.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Where does milk move when going from TDLUs to the nipple?

A

TDLUs -> extralobular ducts -> Interlobular ducts -> Lactiferous ducts -> Lactiferous sinus -> orifice at the nipple

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Where does the breast lymphatic drainage drain the breasts?

A

Axillary lymph nodes -> Supraclavicular lymph nodes

Internal mammary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What does the nipple-areolar complex consist of?

A

Nipple - 5 - 9 duct openings

Areola surrounds the nipple (Sebaceous glands provide lubrication during lactation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How can breast development go wrong?

A

Ectopic breast tissue can develop anywhere along the milk line.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What happens to the breast during pregnancy / breast feeding?

A

TDLU undergoes terminal differentiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the significance of the ratio of parenchymal and stromal components?

A

It is unique to the individual and changes with age.

Cancer risk is affected

Has implications for screening (more stroma is harder to visualize)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How does breast disease present clinically?

A

16% of women present with breast condition over a 10 year period.

2 ways:

Screen detected (BreastScreen WA)

Symptomatic (Breast lump, pain, nipple discharge, skin changes, etc)

Most symptomatic and screen detected abnormalities are benign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What happens during breast screening?

A

Targets 50 - 74 year old asymptomatic women.

2 yearly mammograms; 5% are often recalled for assessment and the next tests are:

triple test: Clinical, additional radiological and pathological examination.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What percentage of screens find malignancy?

A

0.6% of screens and 10% of triple test assessments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How is mammography conducted?

A

Gentle compression of breast between digital X-ray detector plates.

Low dose X-ray which is converted to images and finds abnormalities using tissue densities.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What do MMG abnormalities look like?

A

Calcifications

Distortions

Densities/masses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the limitations of mammographies?

A

Small (and cumulative radiation risk)

Not all carcinomas are visible (small false negative rate)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How are abnormaliteis investigated using US?

A

High frequency sound used to show masses and cysts.

Not all carcinomas are visible and there is no radiation risk.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How do breast diseases present with symptoms?

A

The major clinical presentations of disease are:

Discrete mass (lump) / lumpiness

Pain

Nipple changes/discharge

Skin changes (tethering, peau d’orange, ulceration

Other (Metastases shows distant manifestations)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What does work-up of breast symptoms in clinical practice require?

A

Experience and judgement

A multidisciplinary approach with triple test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the risk factors for a palpable mass being malignant?

A

Age: 6% diagnosed in women under 40 are malignant. >70% diagnosed in women over 50 are malignant

Features of the mass: Soft, rubbery, mobile - low risk. Hard, fixed, axilla lump - high risk.

Benign lesions can cause malignancy (Fibroadenoma, FCC, cysts, fat necrosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What does pain tell us about a palpable breast mass?

A

Only 2% of women presenting with pain will have diagnosis of cancer (75% of these also have a mass)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How does pain present with benign breast conditions?

A

Cyclical/diffuse manner

No structural abnormality, cyclical mastalgia, infection/inflammation mastitis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What causes galactorrhoea from the nipple?

A

Often hormonal or drug related

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What can cause serous/bloody discharge from the nipple?

A

Cysts, intraduct papilloma, DCIS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What causes excoriation, crusting, and itching of the nipple?

A

Eczema

Dermatophytes

Pagets disease

Breast cancer invading skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the most important inflammatory breast diseases?

A

Acute mastitis (infection of static milk typically by staph species (rarely strep) which enter through cracks in nipple)

Subareolar abscess (squamous metaplasia of lactiferous ducts (SMOLD) resulting in obstruction, dilation and rupture with granulomatous reaction)

Mammary duct ectasia (Dilated subareolar ducts, uncertain aetiology)

Fat necrosis

Lymphocytic lobulitis

Granulomatous mastitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

How does acute mastitis present?

A

Almost always occurs during lactation.

Red, hot, swollen and painful breast/lump +/- generally unwell.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What does histology show in acute mastitis?

A

Inflammation with neutrophils +/- necrosis +/- abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How should acute mastitis be managed?

A

Breast feeding/pumping

Analgesia

Antibiotics

+/- surgery

30
Q

What is the clinical presentation of subareolar abscess?

A

90% are smokers

Red, hot, swollen, subareolar mass +/- draining fistula (to adjacent tissue)

31
Q

what does a subareolar abscess show on histology?

A

Ruptured squamous lined ducts with mixed inflammation, foreign body response +/- abscess

32
Q

How is a subareolar abscess managed?

A

Smoking cessation

Antibiotics

Surgery (in most cases necessary)

33
Q

How does mammary duct ectasia present clinically?

A

Postmenopausal parous women

Painful

Erythematous

Subareolar mass

+/- fistula

+/- discharge

34
Q

What does histology of mammary duct ectasia show?

A

Dilated ducts, periductal fibrosis and chronic inflammation

35
Q

How is mammary duct ectasia managed?

A

Conservative or surgery

36
Q

How does fat necrosis present clinically?

A

Necrotic fat and fibrous tissue

Hard mass, skin retraction, screen detected calcification

May stimulate cancer

Often site of prior injection

Can be caused by: Surgery, trauma, or radiation

37
Q

What does histology show with fat necrosis?

A

Necrotic adipose tissue

Foamy macrophages

Multinucleated giant cells

Chronic inflammation

Hemosiderin

Fibrosis

Calcification

38
Q

What is hemosidirin?

A

Hemosiderin or haemosiderin is an iron-storage complex. It is only found within cells (as opposed to circulating in blood) and appears to be a complex of ferritin, denatured ferritin and other material. The iron within deposits of hemosiderin is very poorly available to supply iron when needed

39
Q

What is lymphocytic lobulitis?

A

Diabetic mastopathy (attracts inflammatory tissue around it)

40
Q

What is fibrocystic change?

A

A non-neoplastic change in breast epithelium, particularly post-menopause.

Does not cause a significant risk of carcinoma

41
Q

What are the clinical symptoms of fibrocystic change?

A

Non-specific

Lump/lumpiness

Pain

Calcifications on screening

42
Q

What are the histopatholoigical features of fibrocystic change?

A

Cysts

Apocrine metaplasia

Fibrosis

43
Q

How is fibrocystic change managed?

A

Harmless condition so conservative measures taken (only assurance of diagnosis)

44
Q

What are the types of benign proliferative conditions of the breast?

A

Epithelial: Usually hyperplasia and columnar cell change (hyperplasia is only benign when there are no atypia)

Stroma: PseudoAngiomatous Stromal Hyperplasia (PASH)

Both elements:

Sclerosing adenosis

Complex sclerosing lesion/radial scar

Papilloma

Fibroadenoma

45
Q

What is epithelial hyperplasia of the breast?

A

Proliferation of epithelial cells within ducts and lobules

46
Q

How are epithelial hyperplasia and columnar cell change classified?

A

Presence or absence of atypia:

Atypia present = moderate risk of malignancy

No-atypia = mildly elevated risk of BC (compared to normal breast)

47
Q

What are the clinical symptoms of epithelial hyperplasia?

A

Asymptomatic

Comes up as calcifications on screening

48
Q

What are the histopathological features of epithelial hyperplasia?

A

Multilayering of small cells, rounded and oval, jumbled-up, irregular slits between cells, rare mitotic figures.

49
Q

How is mild, moderate, and florid hyperplasia distinguished?

A

Mild - 2 - 4 epithelial layers

Mod - 4 layers

Florid - Fills ducts

50
Q

How are epithelial hyperplasia and columnar change treated?

A

No atypia, nothing is done.

51
Q

What happens in columnar cell change?

A

Metaplastic proliferation of columnar cells (similar to hyperplasia of epithelium)

52
Q

What are the histological features of columnar cell change?

A

Columnar cells lining ducts and lobules

Apical snouts luminal secretions (+/- calcs)

Cellular multilayering

53
Q

What is sclerosing adenosis?

A

Increased glandular element and stromal formation

54
Q

What are the clinical symptoms of sclerosing adenosis?

A

Asymptomatic

Mass

Calcifications

Distortion on screening

55
Q

What is the risk of cancer like with sclerosing adenosis? How does this affect treatment?

A

No cancer risk no need for treatment.

56
Q

What are the histopathological features of sclerosing adenosis?

A

Lobular architecture

Increased glands

Compression by stroma

Myoepithelial layer/basement membrane maintained

Can mimic cancer

57
Q

What is a complex sclerosing lesion?

A

Increased glandular elements compressed by fibroelastotic stroma into a stellate arrangement.

58
Q

What kind of lesion is a complex sclerosing lesion/radial scar; benign or malignant?

A

It is benign but it is associated with another adjacent sinister lesion.

59
Q

What are the clinical features of a complex sclerosing lesion/radial scar?

A

Can be asymptomatic

Can form a mass

Calcifications or distortion on screening

60
Q

What are the histopathological features of a complex sclerosing lesion/radial scar?

A

Stellate architecture

Increased glands

Compression by stroma

Myoepithelial layer/basement membrane maintained

Can mimic cancer

61
Q

How is a complex sclerosing lesion/radial scar treated?

A

Conservative excision

62
Q

What causes an intraductal papilloma?

A

Intraductal proliferation of epithelial and myoepithelial cells overlying fibrovascular stalks.

63
Q

What kind of lesion is an intraductal papilloma; benign or malignant?

A

It is benign but, like complex sclerosing lesions, it is associated with adjacent sinister lesions.

If there is multiple or associated atypia it has moderate risk of malignancy.

64
Q

What are the clinical features of a intraductal papilloma?

A

Mass

Discharge

Incidental

Calcifications on screening

65
Q

How is an intraductal papilloma treated?

A

If there is one it is excised conservatively.

If there are multiple it is closely followed up.

66
Q

What are the clinical features of a fibroadenoma?

A

It is well circumscribed, rubbery, mobile

67
Q

What are the histopathological features of a fibroadenoma?

A

Circumscribed nodule of ducts and expanded stroma.

68
Q

How are fibroadenomas managed?

A

If its small - follow up and surgery if symptomatic.

If enlarging, symptomatic, provoking anxiety, and having atypical biopsy findings then it is treated with surgery

Must exclude phyllodes tumour.

69
Q

What is phyllodes tumour?

A

Tumour related to a fibroadenoma. Its behaviour ranges from benign to malignant.

70
Q

What is pseudoangiomatous stromal hyperplasia (PASH)?

A

A benign proliferation of stromal elements that form asymptomatic, occassionally mass forming, lesions.

imed3003 (48 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions