Benign conditions of the breast Flashcards
Most breast lesions are _____.
_____ conditions of the breast include:
- d________ conditions - i________ conditions
- f_______ change
- s____-o__ changes
- b____ n______
Surgery is usually [[necessary / unnecessary]].
Most breast lesions are benign.
Benign conditions of the breast include:
- developmental conditions
- inflammatory conditions
- fibrocystic change
- stroma-only changes
- benign neoplasms.
Surgery is usually unnecessary.
Developmental abnormalities
- E____ breast tissue:
is the commonest congenital breast abnormality. It is most commonly on the ‘___ ___’ between axilla and groin.
May be a third nipple or just underlying glandular tissue or both.
Pic in folder.
Breast h______:
is associated with other syndromes, e.g. u____-m_____ syndrome (affects forearm and mammary gland development), T_____ syndrome ( X0 ) and c______ a_____ h_______.
S_____ overgrowth:
leading to excessive breast size (m_______). Can be at puberty (j_____ hypertrophy) or during pregnancy (g_______ hypertrophy).
Breast a_______:
mild only requires reassurance, severe may require surgery.
Nipple i_______:
is common and usually normal. A new i_______ though may be a sign of benign or malignant disease.
Developmental abnormalities
- Ectopic breast tissue:
is the commonest congenital breast abnormality. It is most commonly on the ‘milk line’ between axilla and groin.
May be a third nipple or just underlying glandular tissue or both.
Pic in folder.
Breast hypoplasia:
is associated with other syndromes, e.g. ulnar-mammary syndrome (affects forearm and mammary gland development), Turner’s syndrome ( X0 ) and congenital adrenal hyperplasia.
Stromal overgrowth:
leading to excessive breast size (macromastia). Can be at puberty (juvenile hypertrophy) or during pregnancy (gestational hypertrophy).
Breast asymmetry:
mild only requires reassurance, severe may require surgery.
Nipple inversion:
is common and usually normal. A new inversion though may be a sign of benign or malignant disease.
Inflammatory conditions
Can be infective or non-infective.
- A____ m_____:
is a c_____ (bacterial infection of skin) associated with breast feeding. Skin fissuring lets bacteria in and m___ s____ favours growth.
M_____ is breast tissue inflam. - G________ i________: can occur in systemic disease such as s______ (systemic g______) and infections such as TB.
NB - g________ i______ / g_______ are organised collections of m________. - I________ b____ c______
- I________ g_________ m_____:
is a lobule-located non-necrotising granulomatous inflam. May respond to steroids, but rule out infection first. - F______ b___ r______: around breast implants lead to capsular contractures (scar tissue forms around implant).
- R_______ s_______ a_______: associated with squamous metaplasia of ducts, mammary duct fistula and smoking.
- P_______ m_____ / d___ e_____: is dilation of ducts with chronic peri-ductal inflamm and scarring. Calcified luminal secretions can be seen on mammograms.
- F__ n______: following trauma (is benign but biopsy to rule out cancer)
..Inflammatory conditions
Can be infective or non-infective.
- Acute mastitis:
is a cellulits (bacterial infection of skin) associated with breast feeding. Skin fissuring lets bacteria in and milk stasis favours growth.
Mastitis is breast tissue inflam. - Granulomatous inflammation: can occur in systemic disease such as sarcoidosis (systemic granulomas) and infections such as TB.
NB - granulomatous inflammation / granulomas are organised collections of macrophages. - Inflammatory breast cancer
- Idiopathic granulomatous mastitis:
is a lobule-located non-necrotising granulomatous inflam. May respond to steroids, but rule out infection first. - Foreign body reaction: around breast implants lead to capsular contractures (scar tissue forms around implant).
- Recurrent subareolar abscesses: associated with squamous metaplasia of ducts, mammary duct fistula and smoking.
- Periductal mastitis / duct ectasia: is dilation of ducts with chronic peri-ductal inflamm and scarring. Calcified luminal secretions can be seen on mammograms. Ectasia means dilation.
- Fat necrosis: following trauma (is benign but biopsy to rule out cancer).
Fibrocystic change
- most frequent benign breast condition
- m_______ (arising from more than one source)
- b_______
- small or large cysts
- a______ (increased glandular tissue)
- increased f_____ s____
- epithelial h_______ usually of ‘usual type’ i.e. without atypia
- solitary p_______ (benign epithelial tumour growing outwards) and r____ s___ (star-like benign mass that can mimic malignancy) are both part of fibrocystic change
Fibrocystic change
- most frequent benign breast condition
- multifocal (arising from more than one source)
- bilateral
- small or large cysts
- adenosis (increased glandular tissue)
- increased fibrous stroma
- epithelial hyperplasia of ‘usual type’ i.e. without atypia
- solitary papillomas (benign epithelial tumour growing outwards) and radial scars (star-like benign mass that can mimic malignancy) are both part of fibrocystic change
Fibrocystic change and risk of breast cancer:
- ‘n__-p_______’ = no excess risk
- ‘p______ without a____’ = double risk
- ‘p______ with a____’ = x5 risk
Most woman with ‘proliferative with atypia’ (i.e. atypical epithelial hyperplasia) [[ will / will not ]] develop breast cancer.
Fibrocystic change and risk of breast cancer:
- ‘non-proliferative’ = no excess risk
- ‘proliferative without atypia’ = double risk
- ‘proliferative with atypia’ = x5 risk
Most woman with ‘proliferative with atypia’ (i.e. atypical epithelial hyperplasia) will not develop breast cancer.
More on fibrocystic change
- ‘______’ = increase in glandular breast tissue
- a specific type of this is ______ ____ which is a benign proliferation of distorted glandular tissue.
- therefore is proliferative variant of fibrocystic change
- ___________ can be observed on mammography
More on fibrocystic change
- ‘adenosis’ = increase in glandular breast tissue
- a specific type of this is sclerosing adenosis which is a benign proliferation of distorted glandular tissue.
- therefore is proliferative variant of fibrocystic change
- microcalcifications can be observed on mammography
More on fibrocystic change
- ______ ________ can be seen as large rounded epithelial cells with loads of granular cytoplasm and apical projections.
- very common fibrocystic change but no increased risk of cancer
apocrine metaplasia
Pic in folder.
More on fibrocystic change
E______ h______ is associated with increased cancer risk. There are ductal and lobular patterns.
Ductal h_______ of the ‘usual type’ there is usually a mixture of cell types.
‘Atypical ductal hyperplasia’ (ADH) is usually similar cell types. It has features in common with l__ g____ d_____ c_____ i_ s___ (DCIS).
It is associated with mircocalcifications.
Explain DCIS.
More on fibrocystic change
Epithelial hyperplasia is associated with increased cancer risk. There are ductal and lobular patterns.
Ductal hyperplasia of the ‘usual type’ there is usually a mixture of cell types.
‘Atypical ductal hyperplasia’ (ADH) is monotonous and has similar cell types with low grade ductal carcinoma in situ (DCIS).
It is associated with mircocalcifications.
DCIS is stage 0 of breast cancer, cells are cancerous but are confined in lobule / duct.
‘Lobular neoplasia’:
- ______ _____ _____ (ALH)
- _____ _____ __ ___ (LCIS)
only difference is the amount of cellular proliferation, LCIS worse.
‘Lobular neoplasia’:
- atypical lobular hyperplasia (ALH)
- lobular carcinoma in situ (LCIS)
only difference is the amount of cellular proliferation, LCIS worse.
‘_______ ___ _____’
- associated with microcalcifications
- can be cell change + hypertrophy with or without atypia
- atypia marker of risk
‘Columnar cell lesions’
- associated with microcalcifications
- can be cell change + hypertrophy with or without atypia
- atypia marker of risk
_____ ____
- Benign lesions with a fibrotic n elastic core
- trapped glands and a pseudo-infiltrative appearance
Radial scars
- Benign lesions with a fibrotic n elastic core
- trapped glands and a pseudo-infiltrative appearance
_______ ______
- Benign tumour of epithelium lining ducts
- solitary ______ are thought to be harmless if no epithelial atypia
Intraduct papilloma:
- Benign tumour of epithelium lining ducts
- solitary papillomas are thought to be harmless if no epithelial atypia
________
Multiple ______ are thought to be more associated with malignancy in breasts.
Papillamatosis
Multiple papillomas are thought to be more associated with malignancy in breasts.
Stromal-only changes / proliferations
- d_____ f_____ m______: stromal fibrosis with infiltrating lymphocytes.
- p____-a______ s____ h_______ (PASH): proliferation of myofibroblasts, cause is unknown
Stromal proliferations
- diabetic fibrous mastopathy: stromal fibrosis with infiltrating lymphocytes.
- pseudo-angiomatous stromal hyperplasia (PASH): proliferation of myofibroblasts, cause is unknown
Benign neoplasms
- overgrowth of epithelium and stroma can make a ________
- regress after menopause
- usually firm, non-tender, mobile
- stroma normal type
Pic in folder.
Benign neoplasms
- overgrowth of epithelium and stroma can make a fibroadenoma
- regress after menopause
- usually firm, non-tender, mobile
- stroma normal type
Pic in folder.
