Benign Breast Pathology Flashcards
What are the 7 types of benign breast pathology?
- Fibroadenoma
- Inflammation
- Traumatic fat necrosis
- Intraductal papilloma
- Adenosis
- Fibrocystic change
- Other
What are the 3 variants of fibroadenoma?
Juvenile fibroadenoma
Fibroadenomatoid lesions
Phyllodes tumour
What are the 4 variants of breast inflammation?
Duct ectasia
Periductal mastitis
Plasma cell mastitis
Granulomatous mastitis
What is the 1 subtype of intraductal papilloma?
Pseudo-angiomatous stromal hyperplasia (PASH)
What are the 3 variants of adenosis?
Sclerosing adenosis
Blunt duct adenosis
Microglandular adenosis
What is the 1 variant of fibrocystic change?
Radial scar
What are the 2 other types of benign breast pathology?
Diabetic mastopathy
Abscess
Describe the 4 connective tissue elements of normal breast anatomy.
Suspensory ligament of the breast
Retromammary space
Base (ribs 2-6, from sternum to mid-axillary line)
Axillary tail
When does normal cell proliferation in the breasts peak?
Luteal phase of menstrual cycle
What changes do the breasts undergo in puberty? (3)
Duct elongation
Stromal development
Lobulo-alveolar differentiation
What changes do the breasts undergo in pregnancy? (5)
Lobular enlargement Stromal depletion Secretory change Ducts filled with milk Plasma cells in stroma (produce IgA)
List 7 types of developmental abnormalities of the breasts.
Functioning accessory breasts (polymastia)
Polythelia (supernumerary nipple)
Premature thelarche
Hypoplasia/amastia
Macromastia
Minor asymmetry
Major asymmetry
Which syndrome is associated with major breast asymmetry?
Define this syndrome.
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”
Describe the breast screening program.
Method?
Who?
Recall?
Detection of?
Method: 2 view mammography
Who: all women, age 50-70 years
Recall: every 3 years
Detection of:
- Lumps
- Asymmetry
- Distortion
- Calcification
Outline the triple assessment of breast symptoms.
Clinical examination
Imaging
- US for young women
- Mammography for older women
- MRI
Biopsy
- FNA
- Core biopsy
- Needle localisation (open) biopsy
Describe the rating of finds on:
a) Physical examination.
b) Fine needle aspiration.
c) Core biopsy.
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
What would a fibroadenoma feel like on physical examination? (5)
Mobile ("breast mouse")
Firm, hard, rubbery
Smooth
Well-defined shape
RoundDescribe the 3 subtypes of fibroadenoma:
Juvenile fibroadenoma (2)
Fibroadenomatoid lesions (3)
Phyllodes tumour (2)
JUVENILE FIBROADENOMA:
- Fibroadenoma in a young person
- Very big
FIBROADENOMATOID LESIONS:
- Slightly more risky than fibroadenoma
- FNA: C2
- Core biopsy: B2 or B3
PHYLLODES TUMOUR:
- Acts aggressively - potential to turn malignant
- May be borderline
What are the 6 features of a Phyllodes tumour?
Well-defined margin Increased cellularity Pleomorphisms Mitoses Stromal overgrowth Necrosis
What is duct ectasia?
Dilation of ducts in breast tissue
Leading to chronic inflammation
What are the features of:
- Periductal mastitis
- Plasma cell mastitis
- Granulomatous mastitis?
PERIDUCTAL:
- Acute inflammation
- Abscess formation
- Mammary duct fistula
PLASMA CELL:
- Same as periductal mastitis
- More plasma cells present
- Calcifications
GRANULOMATOUS:
- Granuloma presence
- Hyperprolactinaemia
List some differential diagnoses for granulomatous mastitis.
TB Sarcoid Fungal Cat scratch disease Vasculitis Carcinomas
What would you find on physical examination of a papillary lesion?
Central mass (just behind the nipple)
Single or multiple
What are the 5 features of a papillary lesion?
Nipple discharge (w/ blood) Micro-calcifications Fibrovascular cores Epithelial and myoepithelial cells Hyperplasia
What would you find on physical examination of pseudo-angiomatous stromal hyperplasia (PASH)? (5)
Hard lump Well-circumscribed Pseudo-encapsulated Rapidly enlarging mass Skin changes
What are the 2 features of pseudo-angiomatous stromal hyperplasia (PASH)?
- Dense stroma
- Anastomosing channels lined by myofibroblasts
i.e. LIKE blood vessels - but contain myofibroblasts, therefore not (that’s why it’s called pseudo-angiomatous!)
List 7 features of fibrocystic change.
Cyclical variation Fibrosis Cysts Apocrine metaplasia Epithelial hyperplasia Columnar cell change (typical/atypical) Sclerosing adenosis
Define sclerosing adenosis.
“Excessive growth or development of glands, involving hardening of the glandular tissue”
List 4 features of sclerosing adenosis.
Micro-calcifications
Fibrosis
Increased number of acini in glands
Cyclical pain
What are the 2 types of atypical proliferation in the breast?
Atypical ductal hyperplasia
1. Columnar cell change
Atypical lobular hyperplasia
List 3 disadvantages of fine needle aspiration.
Does not show architecture (i.e. whether invasive or non-invasive carcinoma)
Requires trained cytologist
Increased rates of false positives/negatives
