Benign breast pathology Flashcards
what is triple examination
clinical
imaging
pathology
developmental abnormalities of the breast
hypoplasia
juvenile hypertrophy
accessory breast tissue
accessory nipple
non-neoplastic breast diseases
gynaecomastia fibrocystic change hamartoma fibroadenoma sclerosing lesions
what is gynaecomastia
breast development in the male - ductal growth but no lobular growth
causes of gynaecomastia
exogenous/endogenous hormones
cannabis
prescription drugs
liver disease
when do people get fibrocystic change
20-50 (usually 40-50)
if early menarche or late menopause
how does fibrocystic change present
smooth discrete lumps
sudden pain
cyclical
lumpy
pathology of fibrocystic change
cysts - blue domes with pale fluid, lined with apocrine epithelium
intervening fibrosis
definition of metaplasia
change from one fully differentiated cell type to another fully differentiated cell type
what is a hamartoma
developmental anomaly
circumscribed lesion of normal breast cells but in abnormal proportion/distribution - well differentiated lump
painless, firm mobile mass in a young patient
fibroadenoma (‘breast mouse’)
what does fibroadenoma look like on ultrasound
solid
macroscopic appearance of fibroadenoma
rubbery biphasic lesion (epithelium and stroma)
what are sclerosing lesions/sclerosing adenosis
benign disorderly proliferation of acini and stroma causing a mass or calcification
presentation of sclerosing adenosis
pain/tenderness
lumpy/thickening
asymptomatic
what is the only way to tell the difference between sclerosing adenosis and carcinoma
biopsy - look the same on US
radial scar pathology
stellate architecture
central puckering
radiating fibrosis containing distorted ductules
1mm-9mm
what does radial scar mimic on mammogram
carcinoma
history of local trauma (eg seat belt injury)
history of warfarin therapy
fat necrosis
pathology of fat necrosis
damage and disruption of adipocytes
infiltration by acute inflammatory cells (eg foamy macrophages)
subsequent fibrosis and scarring
presentation of fat necrosis
round and firm lump (may become hard and irregular)
pain in nipple (episodic)
bloody/purulent discharge
nipple retraction and distortion
duct ectasia
what is duct ectasia
inflammation of sub-areolar ducts
associations of duct ectasia
smoking
menopause
pathology of ductal ectasia
subareolar duct dilatation
periductal inflammation
periductal fibrosis
scarring and distortion
management for duct ectasia
treat acute infections
exclude malignancy
stop smoking
excise ducts
causes of mastitis/abscess
duct ectasia
lactation
bacteria in duct ectasia
mixed
anaerobes
bacteria in mastitis during lactation
staph aureus
strep pyogenes
presentation of abscess/mastitis
painful
red
swollen breast
management for mastitis/abscess
antibiotics percutaneous drainage incision and drainage treat underlying cause continue breastfeeding
investigation of choice to see radial scar
vacuum biopsy takes in larger amount of tissue to ensure no focal malignant lesions
what is there a negligible risk of in radial scars and sclerosing lesions
carcinoma
what is phyllodes tumour
biphasic tumour of stroma
phyllodes tumour is benign/malignant
benign
borderline
makignant (sacromatous)
what does the architecture of phyllodes tumour resemble
leaf
may contain lipoblasts
who gets phyllodes tumours
40-50 year olds
presentation of phyllodes tumour
slow growing mass
is phllodes tumour likely to metastasize
no
management for phyllodes tumour
excision
what happens if phyllodes tumour not adequately excised
likely to recur
age range for intraduct papilloma
35-60
presentation of intraduct papilloma
nipple discharge (possible blood) asymptomatic
what does intraduct papilloma look like on mammography
nodules
calcifications
what does intraduct papilloma affect
sub-areolar ducts
histology of intraduct papilloma
papillary fronds containing fibrovascular core
covered by myoepithelium and epithelium
what are the stages of IDP dependant on
presence and extent of epithelial proliferation
what are the stages of IDP
benign IDP - usual type hyperplasia
IDP with atypical ductal hyperplasia
ductal carcinoma in situ (doesn’t extend past basement membrane)
what can ductal carcinoma in situ become
invasive carcinoma
