Benign breast pathology

Question 1

what is triple examination

Answer 1

clinical
imaging
pathology

Question 2

developmental abnormalities of the breast

Answer 2

hypoplasia
juvenile hypertrophy
accessory breast tissue
accessory nipple

Question 3

non-neoplastic breast diseases

Answer 3

gynaecomastia 
fibrocystic change 
hamartoma 
fibroadenoma 
sclerosing lesions

Question 4

what is gynaecomastia

Answer 4

breast development in the male - ductal growth but no lobular growth

Question 5

causes of gynaecomastia

Answer 5

exogenous/endogenous hormones
cannabis
prescription drugs
liver disease

Question 6

when do people get fibrocystic change

Answer 6

20-50 (usually 40-50)

if early menarche or late menopause

Question 7

how does fibrocystic change present

Answer 7

smooth discrete lumps
sudden pain
cyclical
lumpy

Question 8

pathology of fibrocystic change

Answer 8

cysts - blue domes with pale fluid, lined with apocrine epithelium
intervening fibrosis

Question 9

definition of metaplasia

Answer 9

change from one fully differentiated cell type to another fully differentiated cell type

Question 10

what is a hamartoma

Answer 10

developmental anomaly

circumscribed lesion of normal breast cells but in abnormal proportion/distribution - well differentiated lump

Question 11

painless, firm mobile mass in a young patient

Answer 11

fibroadenoma (‘breast mouse’)

Question 12

what does fibroadenoma look like on ultrasound

Answer 12

solid

Question 13

macroscopic appearance of fibroadenoma

Answer 13

rubbery biphasic lesion (epithelium and stroma)

Question 14

what are sclerosing lesions/sclerosing adenosis

Answer 14

benign disorderly proliferation of acini and stroma causing a mass or calcification

Question 15

presentation of sclerosing adenosis

Answer 15

pain/tenderness
lumpy/thickening
asymptomatic

Question 16

what is the only way to tell the difference between sclerosing adenosis and carcinoma

Answer 16

biopsy - look the same on US

Question 17

radial scar pathology

Answer 17

stellate architecture
central puckering
radiating fibrosis containing distorted ductules
1mm-9mm

Question 18

what does radial scar mimic on mammogram

Answer 18

carcinoma

Question 19

history of local trauma (eg seat belt injury)

history of warfarin therapy

Answer 19

fat necrosis

Question 20

pathology of fat necrosis

Answer 20

damage and disruption of adipocytes
infiltration by acute inflammatory cells (eg foamy macrophages)
subsequent fibrosis and scarring

Question 21

presentation of fat necrosis

Answer 21

round and firm lump (may become hard and irregular)

Question 22

pain in nipple (episodic)
bloody/purulent discharge
nipple retraction and distortion

Answer 22

duct ectasia

Question 23

what is duct ectasia

Answer 23

inflammation of sub-areolar ducts

Question 24

associations of duct ectasia

Answer 24

smoking

menopause

Question 25

pathology of ductal ectasia

Answer 25

subareolar duct dilatation
periductal inflammation
periductal fibrosis
scarring and distortion

Question 26

management for duct ectasia

Answer 26

treat acute infections
exclude malignancy
stop smoking
excise ducts

Question 27

causes of mastitis/abscess

Answer 27

duct ectasia

lactation

Question 28

bacteria in duct ectasia

Answer 28

mixed

anaerobes

Question 29

bacteria in mastitis during lactation

Answer 29

staph aureus

strep pyogenes

Question 30

presentation of abscess/mastitis

Answer 30

painful
red
swollen breast

Question 31

management for mastitis/abscess

Answer 31

antibiotics 
percutaneous drainage 
incision and drainage 
treat underlying cause 
continue breastfeeding

Question 32

investigation of choice to see radial scar

Answer 32

vacuum biopsy takes in larger amount of tissue to ensure no focal malignant lesions

Question 33

what is there a negligible risk of in radial scars and sclerosing lesions

Answer 33

carcinoma

Question 34

what is phyllodes tumour

Answer 34

biphasic tumour of stroma

Question 35

phyllodes tumour is benign/malignant

Answer 35

benign
borderline
makignant (sacromatous)

Question 36

what does the architecture of phyllodes tumour resemble

Answer 36

leaf

may contain lipoblasts

Question 37

who gets phyllodes tumours

Answer 37

40-50 year olds

Question 38

presentation of phyllodes tumour

Answer 38

slow growing mass

Question 39

is phllodes tumour likely to metastasize

Answer 39

no

Question 40

management for phyllodes tumour

Answer 40

excision

Question 41

what happens if phyllodes tumour not adequately excised

Answer 41

likely to recur

Question 42

age range for intraduct papilloma

Answer 42

35-60

Question 43

presentation of intraduct papilloma

Answer 43

nipple discharge (possible blood)
asymptomatic

Question 44

what does intraduct papilloma look like on mammography

Answer 44

nodules

calcifications

Question 45

what does intraduct papilloma affect

Answer 45

sub-areolar ducts

Question 46

histology of intraduct papilloma

Answer 46

papillary fronds containing fibrovascular core

covered by myoepithelium and epithelium

Question 47

what are the stages of IDP dependant on

Answer 47

presence and extent of epithelial proliferation

Question 48

what are the stages of IDP

Answer 48

benign IDP - usual type hyperplasia
IDP with atypical ductal hyperplasia
ductal carcinoma in situ (doesn’t extend past basement membrane)

Question 49

what can ductal carcinoma in situ become

Answer 49

invasive carcinoma