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4. Female GU System > Benign Breast Pathology > Flashcards

Benign Breast Pathology Flashcards

1
Q

What are the 7 types of benign breast pathology?

A
  1. Fibroadenoma
  2. Inflammation
  3. Traumatic fat necrosis
  4. Intraductal papilloma
  5. Adenosis
  6. Fibrocystic change
  7. Other
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2
Q

What are the 3 variants of fibroadenoma?

A

Juvenile fibroadenoma
Fibroadenomatoid lesions
Phyllodes tumour

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3
Q

What are the 4 variants of breast inflammation?

A

Duct ectasia
Periductal mastitis
Plasma cell mastitis
Granulomatous mastitis

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4
Q

What is the 1 subtype of intraductal papilloma?

A

Pseudo-angiomatous stromal hyperplasia (PASH)

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5
Q

What are the 3 variants of adenosis?

A

Sclerosing adenosis
Blunt duct adenosis
Microglandular adenosis

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6
Q

What is the 1 variant of fibrocystic change?

A

Radial scar

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7
Q

What are the 2 other types of benign breast pathology?

A

Diabetic mastopathy

Abscess

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8
Q

Describe the 4 connective tissue elements of normal breast anatomy.

A

Suspensory ligament of the breast

Retromammary space

Base (ribs 2-6, from sternum to mid-axillary line)

Axillary tail

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9
Q

When does normal cell proliferation in the breasts peak?

A

Luteal phase of menstrual cycle

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10
Q

What changes do the breasts undergo in puberty? (3)

A

Duct elongation
Stromal development
Lobulo-alveolar differentiation

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11
Q

What changes do the breasts undergo in pregnancy? (5)

A 
Lobular enlargement
Stromal depletion
Secretory change
Ducts filled with milk
Plasma cells in stroma (produce IgA)
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12
Q

List 7 types of developmental abnormalities of the breasts.

A

Functioning accessory breasts (polymastia)

Polythelia (supernumerary nipple)

Premature thelarche

Hypoplasia/amastia

Macromastia

Minor asymmetry

Major asymmetry

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13
Q

Which syndrome is associated with major breast asymmetry?

Define this syndrome.

A

Poland syndrome

“Rare birth defect characterised by underdevelopment or absence of the chest muscle (pectoralis) on one side, and usually also webbing of the fingers of the ipsilateral hand”

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14
Q

Describe the breast screening program.

Method?
Who?
Recall?
Detection of?

A

Method: 2 view mammography

Who: all women, age 50-70 years

Recall: every 3 years

Detection of:

  1. Lumps
  2. Asymmetry
  3. Distortion
  4. Calcification
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15
Q

Outline the triple assessment of breast symptoms.

A

Clinical examination

Imaging

  1. US for young women
  2. Mammography for older women
  3. MRI

Biopsy

  1. FNA
  2. Core biopsy
  3. Needle localisation (open) biopsy
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16
Q

Describe the rating of finds on:

a) Physical examination.
b) Fine needle aspiration.
c) Core biopsy.

A 
PHYSICAL EXAMINATION:
P1 - insufficient for diagnosis
P2 - benign
P3 - uncertain
P4 - suspicious
P5 - malignant
FINE NEEDLE ASPIRATION:
C1 - insufficient
C2 - benign
C3 - atypical: probably benign
C4 - atypical: probably malignant
C5 - malignant
CORE BIOPSY:
Same as FNA, except B1-B5
Also:
B5a - malignant but non-invasive
B5b - malignant and invasive
17
Q

What would a fibroadenoma feel like on physical examination? (5)

A 
Mobile ("breast mouse")
Firm, hard, rubbery
Smooth
Well-defined shape
Round
18
Q

Describe the 3 subtypes of fibroadenoma:

Juvenile fibroadenoma (2)

Fibroadenomatoid lesions (3)

Phyllodes tumour (2)

A

JUVENILE FIBROADENOMA:

  1. Fibroadenoma in a young person
  2. Very big

FIBROADENOMATOID LESIONS:

  1. Slightly more risky than fibroadenoma
  2. FNA: C2
  3. Core biopsy: B2 or B3

PHYLLODES TUMOUR:

  1. Acts aggressively - potential to turn malignant
  2. May be borderline
19
Q

What are the 6 features of a Phyllodes tumour?

A 
Well-defined margin
Increased cellularity
Pleomorphisms
Mitoses
Stromal overgrowth
Necrosis
20
Q

What is duct ectasia?

A

Dilation of ducts in breast tissue

Leading to chronic inflammation

21
Q

What are the features of:

  1. Periductal mastitis
  2. Plasma cell mastitis
  3. Granulomatous mastitis?
A

PERIDUCTAL:

  1. Acute inflammation
  2. Abscess formation
  3. Mammary duct fistula

PLASMA CELL:

  1. Same as periductal mastitis
  2. More plasma cells present
  3. Calcifications

GRANULOMATOUS:

  1. Granuloma presence
  2. Hyperprolactinaemia
22
Q

List some differential diagnoses for granulomatous mastitis.

A 
TB
Sarcoid
Fungal
Cat scratch disease
Vasculitis
Carcinomas
23
Q

What would you find on physical examination of a papillary lesion?

A

Central mass (just behind the nipple)

Single or multiple

24
Q

What are the 5 features of a papillary lesion?

A 
Nipple discharge (w/ blood)
Micro-calcifications
Fibrovascular cores
Epithelial and myoepithelial cells
Hyperplasia
25
Q

What would you find on physical examination of pseudo-angiomatous stromal hyperplasia (PASH)? (5)

A 
Hard lump
Well-circumscribed
Pseudo-encapsulated
Rapidly enlarging mass
Skin changes
26
Q

What are the 2 features of pseudo-angiomatous stromal hyperplasia (PASH)?

A
  1. Dense stroma
  2. Anastomosing channels lined by myofibroblasts

i.e. LIKE blood vessels - but contain myofibroblasts, therefore not (that’s why it’s called pseudo-angiomatous!)

27
Q

List 7 features of fibrocystic change.

A 
Cyclical variation
Fibrosis
Cysts
Apocrine metaplasia
Epithelial hyperplasia
Columnar cell change (typical/atypical)
Sclerosing adenosis
28
Q

Define sclerosing adenosis.

A

“Excessive growth or development of glands, involving hardening of the glandular tissue”

29
Q

List 4 features of sclerosing adenosis.

A

Micro-calcifications
Fibrosis
Increased number of acini in glands
Cyclical pain

30
Q

What are the 2 types of atypical proliferation in the breast?

A

Atypical ductal hyperplasia
1. Columnar cell change

Atypical lobular hyperplasia

31
Q

List 3 disadvantages of fine needle aspiration.

A

Does not show architecture (i.e. whether invasive or non-invasive carcinoma)

Requires trained cytologist

Increased rates of false positives/negatives

4. Female GU System (9 decks)

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