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Reproduction & Sexual Health > Benign Breast Pathology > Flashcards

Benign Breast Pathology Flashcards

1
Q

How is breast disease assessed?

A

Triple Assessment

  • clinical
  • imaging
  • pathology
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2
Q

How can a sample of cytopathology be obtained?

A

Fine needle aspiration
Fluid
Nipple discharge/scrape

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3
Q

Describe the classification of cytopathology findings

A 
C1 - unsatisfactory 
C2 - benign 
C3 - atypia, probably benign 
C4 - suspicious of malignancy 
C5 - malignant
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4
Q

What are the two types of histopathology sampling?

A

Diagnostic

Therapeutic

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5
Q

Name the types of diagnostic histopathology sampling

A

Needle core biopsy
Vacuum assisted biopsy
Skin biopsy
Incisional biopsy of mass

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6
Q

How is a biopsy classified?

A 
B1 - unsatisfactory/normal
B2 - benign 
B3 - atypia
B4 - suspicious of malignancy 
B5a - in situ 
B5b - invasive
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7
Q

Name the therapeutic histopathology sampling

A

Vacuum assisted excision
Excision biopsy of mass
Resection of cancer with margin of clearance

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8
Q

Describe wide local excision

A

Conservation procedure with margin of clearance, sutures - short superior and long lateral for orientation

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9
Q

What is a mastectomy?

A

Full removal of all breast tissue

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10
Q

Name four breast developmental abnormalities

A

Hypoplasia
Juvenile hypertrophy
Accessory breast tissue
Accessory nipple

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11
Q

Name five non-neoplastic breast diseases

A 
Gynaecomastia 
Fibrocystic change 
Hamartoma 
Fibroadenoma 
Sclerosing lesions
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12
Q

What is gynaecomastia?

A

Breast development in male - ductal growth without lobular development

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13
Q

State the causes of gynaecomastia

A

Exogneous/endogenous hormones
Cannabis
Prescription drugs
Liver disease - reduced oestrogen metabolism

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14
Q

How do fibrocystic breast changes usually present?

A

Women aged 20-50 mainly perimenopausal - asymptomatic, smooth discrete lumps or sudden pain, cyclical pain, lumpiness that is ill defined

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15
Q

What is fibrocystic change associated with?

A

Menstrual abnormalities, early/late menarche

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16
Q

Describe the gross appearance of fibrocystic changes

A

Cysts with blue domed appearance and pale fluid, Usually multiple and can be associated with other benign changes

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17
Q

Describe the microscopic appearance of fibrocystic changes

A

Thin walled cysts may have fibrous wall. Lined by apocrine epithelium and can have intervening fibrosis

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18
Q

Define metaplasia

A

Change from one differentiated cell type to another

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19
Q

What metaplasia occurs in fibrocystic change?

A

Ductal - apocrine

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20
Q

How is fibrocystic change managed?

A

Exclude malignancy
Reassure
Excise if necessary

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21
Q

Define a hamartoma

A

Circumscribed lesion composed of cell types normal to the breast but present in an abnormal proportion or distribution

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22
Q

How does hamartoma present?

A

Pre or peri-menopausal women with a well defined mass

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23
Q

What is a fibroadenoma?

A

Benign proliferation of the epithelium and stroma of the duct lobules

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24
Q

How does a fibroadenoma usually present?

A

Solitary mobile mass, most common in afro-carribean women in 3rd decade. Detected via screening - painless firm discrete mobile mass solid on US

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25
Q

What will imaging of a fibroadenoma show?

A

Well circumscribed radio-opaque mass lesion with echo-genic area - sharply demarcated

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26
Q

What does a fibroadenoma look like pathologically?

A

Circumscribed, rubbery, grey-white, biphasic tumour with epithelium and surrounding stroma

27
Q

How is fibroadenoma treated?

A

Diagnose, reassure, excise if patient wishes

28
Q

Name two types of sclerosing lesion

A

Sclerosing adenomas

Radial scar/complex sclerosing lesion

29
Q

What are sclerosing lesions?

A

Benign disordered proliferation of the acini and stroma

30
Q

Describe a sclerosing adenosis

A

Pain, tenderness or lumpiness/thickening - can be asymptomatic often seen with surrounding breast changes

31
Q

Who most commonly gets sclerosing adenosis?

A

Women aged 20-70 years old

32
Q

What is preserved in sclerosing adenosis?

A

Myoepithelium

33
Q

How does a radial scar present?

A

Wide age range, often multi-centric and can be bilateral often detected incidentally or on mammogram

34
Q

What is the difference between a radial scar and complex sclerosing lesion?

A

1-9mm - radial scar

>10mm complex sclerosing lesion

35
Q

Describe the pathology of a radial scar

A

Stellate architecture, central puckering and radiating fibrosis

36
Q

Describe the histology of a radial scar

A

Fibroelastic core with radiating fibrosis containing distorted ductules, fibrocystic changes and epithelial proliferation

37
Q

What can occur within sclerosing lesions?

A

In situ or invasive carcinoma

38
Q

How are sclerosing lesions treated?

A

Excise or sample extensively by vacuum biopsy

39
Q

Name three types of inflammatory breast disease

A

Fat necrosis
Duct Ectasia
Mastitis

40
Q

What can cause fat necrosis?

A

Local trauma

Warfarin therapy

41
Q

Describe the pathogenesis behind fat necrosis

A

Damage and disruption of adipocytes causes leakage into the tissue - inflammation by macrophage attempting to phagocytose/remove fat leading to fibrosis scarring

42
Q

How is fat necrosis managed?

A

Exclude malignancy and reassure

43
Q

What is duct ectasia?

A

Dilatation and shortening of the sub-areolar ducts

44
Q

How does duct ectasia present?

A

Pain, acute episodic inflammation with nipple discharge (bloody or purulent), fistulation, retraction, cosmetic distortion

45
Q

What can duct ectasia cause?

A

Sub-areolar duct dilation, peri-ductal inflammation, peri-ductal fibrosis, scarring, distortion and mastitis

46
Q

What risk factor is duct ectasia strongly associated with ?

A

Smoking

47
Q

What will a biopsy of duct ectasia show?

A

Multiple plasma cells

48
Q

State the two main causes of mastitis

A

Duct ectasia - anaerobes/mixed organisms

Lactation - staph aureus, strep pyrogens

49
Q

What is mastitis?

A

Inflammation of breast tissue

50
Q

What does mastitis look like microscopically?

A

Granulation tissue with florid inflammation of mixed type

51
Q

How is mastitis managed?

A

Antibiotics
Percutanous drainage
Incision and drainage
Treat underlying cause

52
Q

How will mastitis present?

A

Pain, tenderness, erythema, warmth, inflammation, discharge and fever

53
Q

Name two benign tumours of breast

A

Phyllodes tumour

Papillary lesions

54
Q

What is Phyllodes tumour?

A

Fibroepithelial biphasic tumour

55
Q

How do phyllodes tumours present?

A

Age 40-50 with a slow unilateral mass

56
Q

What does a phyllodes tumour look like?

A

Lobulated white mass with cleated architecture

57
Q

Describe the histology of a phyllode tumour

A

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

58
Q

How is a phyllode tumour managed?

A

Local excision - prone to recurrence if not fully excised

59
Q

Name three papillary lesions

A
  • intraduct papilloma
  • nipple adenoma
  • encapsulated papillary carcinoma
60
Q

How will an intraduct papilloma present?

A

35-60 years old with discharge +/- blood or on screening (nodules or calcification)

61
Q

What do intraduct papilloma look like?

A

2-20mm diameter with papillary fronds and fibrovascular core covered by myoepithelium and epithelium which may show proliferative activity

62
Q

What are the types of hyperplasia?

A

None - benign
Usual type - benign
Atypical ductal hyperplasia - IDP with ADH
Ductal carcinoma in situ - IDP with DCIS or papillary DCIS

63
Q

What does DCIS stand for?

A

Ductal carcinoma in situ

64
Q

How are papillary lesions treated?

A

Benign intraductal papilloma - excised by vacuum biopsy without margins
Atypia/in situ - excision with margins

Reproduction & Sexual Health (36 decks)

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