Benign breast pathology

Question 1

Imaging modalities in assessment of breast disease (3)

Answer 1

Mammogram; US; MRI

Question 2

Developmental anomalies in breast tissue (3)

Answer 2

Hypoplasia
Juvenile hypertrophy
Accessory breast tissue/nipple

Question 3

Breast development in the male

Answer 3

Gynaecomastia

Question 4

Which part of the breast tissue is hypertrophic in gynaecomastia?

Answer 4

The ducts- no lobular involvement

Question 5

Causes of gynaecomastia (4)

Answer 5

Exogenous/endogenous hormones
Cannabis
Liver cirrhosis
Prescription drugs

Question 6

Most common breast lesion

Answer 6

Fibrocystic change

Question 7

Peak incidence of fibrocystic change

Answer 7

Pre-menopausal

Question 8

Presentation of fibrocystic change (3)

Answer 8

Smooth discrete lumps, sometimes with pain; incidental on screening

Question 9

Macroscopic appearance of fibrocystic change

Answer 9

Multiple thin-walled cysts, often appearing “blue-domed”

Question 10

How should fibrocystic change be managed? (3)

Answer 10

Exclude malignancy, reassure, excise if necessary

Question 11

Circumscribed lesion composed of cell types normal to the breast but present in abnormal proportion/presentation

Answer 11

Hamartoma

Question 12

Peak incidence of fibroadenoma

Answer 12

3rd decade

Question 13

Presentation of fibroadenoma

Answer 13

Painless, firm, discrete, fixed mass

Question 14

Microscopic pathology of fibroadenoma

Answer 14

Localised hyperplasia of the intralobular stroma, with “tufts” of epithelium

Question 15

Two main types of sclerosing lesions

Answer 15

Sclerosing adenosis

Radial scar

Question 16

Most commonly presents as mammographic calcifications

Answer 16

Sclerosis adenosis

Question 17

Radiating “stellate” connective tissue with a fibrovascular core

Answer 17

Radial scar

Question 18

Cause of fat necrosis

Answer 18

Trauma to adipose tissue

Question 19

Why does fat necrosis present as a lump?

Answer 19

Infiltration of acute inflammatory cells, leading to subsequent fibrosis and scarring

Question 20

Underlying pathology of duct ectasia (3)

Answer 20

Duct dilatation, inflammation, fibrosis

Question 21

How does duct ectasia usually present?

Answer 21

Nipple discharge

Question 22

Two main aetiologies of acute mastitis

Answer 22

Duct ectasia, lactation/breastfeeding

Question 23

Large lobulated mass with a gross “leaf-like” structure

Answer 23

Phyllodes tumour

Question 24

Benign epithelium over a dense fibro-vascular core

Answer 24

Papillary breast lesions

Question 25

How do papillary breast lesions present?

Answer 25

Discharge +/- blood