Benign Breast Pathology Flashcards
How is breast disease assessed?
Triple Assessment
- clinical
- imaging
- pathology
How can a sample of cytopathology be obtained?
Fine needle aspiration
Fluid
Nipple discharge/scrape
Describe the classification of cytopathology findings
C1 - unsatisfactory C2 - benign C3 - atypia, probably benign C4 - suspicious of malignancy C5 - malignant
What are the two types of histopathology sampling?
Diagnostic
Therapeutic
Name the types of diagnostic histopathology sampling
Needle core biopsy
Vacuum assisted biopsy
Skin biopsy
Incisional biopsy of mass
How is a biopsy classified?
B1 - unsatisfactory/normal B2 - benign B3 - atypia B4 - suspicious of malignancy B5a - in situ B5b - invasive
Name the therapeutic histopathology sampling
Vacuum assisted excision
Excision biopsy of mass
Resection of cancer with margin of clearance
Describe wide local excision
Conservation procedure with margin of clearance, sutures - short superior and long lateral for orientation
What is a mastectomy?
Full removal of all breast tissue
Name four breast developmental abnormalities
Hypoplasia
Juvenile hypertrophy
Accessory breast tissue
Accessory nipple
Name five non-neoplastic breast diseases
Gynaecomastia Fibrocystic change Hamartoma Fibroadenoma Sclerosing lesions
What is gynaecomastia?
Breast development in male - ductal growth without lobular development
State the causes of gynaecomastia
Exogneous/endogenous hormones
Cannabis
Prescription drugs
Liver disease - reduced oestrogen metabolism
How do fibrocystic breast changes usually present?
Women aged 20-50 mainly perimenopausal - asymptomatic, smooth discrete lumps or sudden pain, cyclical pain, lumpiness that is ill defined
What is fibrocystic change associated with?
Menstrual abnormalities, early/late menarche
Describe the gross appearance of fibrocystic changes
Cysts with blue domed appearance and pale fluid, Usually multiple and can be associated with other benign changes
Describe the microscopic appearance of fibrocystic changes
Thin walled cysts may have fibrous wall. Lined by apocrine epithelium and can have intervening fibrosis
Define metaplasia
Change from one differentiated cell type to another
What metaplasia occurs in fibrocystic change?
Ductal - apocrine
How is fibrocystic change managed?
Exclude malignancy
Reassure
Excise if necessary
Define a hamartoma
Circumscribed lesion composed of cell types normal to the breast but present in an abnormal proportion or distribution
How does hamartoma present?
Pre or peri-menopausal women with a well defined mass
What is a fibroadenoma?
Benign proliferation of the epithelium and stroma of the duct lobules
How does a fibroadenoma usually present?
Solitary mobile mass, most common in afro-carribean women in 3rd decade. Detected via screening - painless firm discrete mobile mass solid on US
What will imaging of a fibroadenoma show?
Well circumscribed radio-opaque mass lesion with echo-genic area - sharply demarcated
What does a fibroadenoma look like pathologically?
Circumscribed, rubbery, grey-white, biphasic tumour with epithelium and surrounding stroma
How is fibroadenoma treated?
Diagnose, reassure, excise if patient wishes
Name two types of sclerosing lesion
Sclerosing adenomas
Radial scar/complex sclerosing lesion
What are sclerosing lesions?
Benign disordered proliferation of the acini and stroma
Describe a sclerosing adenosis
Pain, tenderness or lumpiness/thickening - can be asymptomatic often seen with surrounding breast changes
Who most commonly gets sclerosing adenosis?
Women aged 20-70 years old
What is preserved in sclerosing adenosis?
Myoepithelium
How does a radial scar present?
Wide age range, often multi-centric and can be bilateral often detected incidentally or on mammogram
What is the difference between a radial scar and complex sclerosing lesion?
1-9mm - radial scar
>10mm complex sclerosing lesion
Describe the pathology of a radial scar
Stellate architecture, central puckering and radiating fibrosis
Describe the histology of a radial scar
Fibroelastic core with radiating fibrosis containing distorted ductules, fibrocystic changes and epithelial proliferation
What can occur within sclerosing lesions?
In situ or invasive carcinoma
How are sclerosing lesions treated?
Excise or sample extensively by vacuum biopsy
Name three types of inflammatory breast disease
Fat necrosis
Duct Ectasia
Mastitis
What can cause fat necrosis?
Local trauma
Warfarin therapy
Describe the pathogenesis behind fat necrosis
Damage and disruption of adipocytes causes leakage into the tissue - inflammation by macrophage attempting to phagocytose/remove fat leading to fibrosis scarring
How is fat necrosis managed?
Exclude malignancy and reassure
What is duct ectasia?
Dilatation and shortening of the sub-areolar ducts
How does duct ectasia present?
Pain, acute episodic inflammation with nipple discharge (bloody or purulent), fistulation, retraction, cosmetic distortion
What can duct ectasia cause?
Sub-areolar duct dilation, peri-ductal inflammation, peri-ductal fibrosis, scarring, distortion and mastitis
What risk factor is duct ectasia strongly associated with ?
Smoking
What will a biopsy of duct ectasia show?
Multiple plasma cells
State the two main causes of mastitis
Duct ectasia - anaerobes/mixed organisms
Lactation - staph aureus, strep pyrogens
What is mastitis?
Inflammation of breast tissue
What does mastitis look like microscopically?
Granulation tissue with florid inflammation of mixed type
How is mastitis managed?
Antibiotics
Percutanous drainage
Incision and drainage
Treat underlying cause
How will mastitis present?
Pain, tenderness, erythema, warmth, inflammation, discharge and fever
Name two benign tumours of breast
Phyllodes tumour
Papillary lesions
What is Phyllodes tumour?
Fibroepithelial biphasic tumour
How do phyllodes tumours present?
Age 40-50 with a slow unilateral mass
What does a phyllodes tumour look like?
Lobulated white mass with cleated architecture
Describe the histology of a phyllode tumour
Leaf like structure distorting ductal system. Condensation of cells around epithelial cells. Stromal atypia and loss of circumscription.
Different types of sarcoma may be present too
How is a phyllode tumour managed?
Local excision - prone to recurrence if not fully excised
Name three papillary lesions
- intraduct papilloma
- nipple adenoma
- encapsulated papillary carcinoma
How will an intraduct papilloma present?
35-60 years old with discharge +/- blood or on screening (nodules or calcification)
What do intraduct papilloma look like?
2-20mm diameter with papillary fronds and fibrovascular core covered by myoepithelium and epithelium which may show proliferative activity
What are the types of hyperplasia?
None - benign
Usual type - benign
Atypical ductal hyperplasia - IDP with ADH
Ductal carcinoma in situ - IDP with DCIS or papillary DCIS
What does DCIS stand for?
Ductal carcinoma in situ
How are papillary lesions treated?
Benign intraductal papilloma - excised by vacuum biopsy without margins
Atypia/in situ - excision with margins
