breast Flashcards
normal features in breast
2 main structures
* Large ducts
* TDLU (Terminal ductal lobular unit)
2 types of epithelial cells
* Luminal cells
* Myoepithelial cells
2 types of stroma,
* Interlobular stroma
* Intralobular stroma - within the lobules
structure of breast
- breast has 15-25 lobes
- Each lobe has 30 lobules
- lubules are made of acini/ductules
- Each lobe drains through a main duct – lactiferous duct into the nipple.
Successive branching of the lactiferous ducts distally -> the terminal duct
-> which proliferates further -> ductules / acini (lobules)
The TDLU are the functional unit of the breast.
histological features of the breast
what is this tissue section from and what are the cells
breast
what is the presentation of breast disease
lump
pain
abnormal screening
nipple discharge
causes of breast lumps
what is the approach to Ix for breast disease
triple assessment:
* physical examination
* imaging - sonography, mammorgraphy, MRI
* pathology - cytopathology and/or histopathology (FNAC)
most common cause of nipple discharge
papilloma
* it is benign
* weak association with cancer - increased if discharge is bloody or associated with mass
causes of nipple discharge
physiological - bilateral and multiple ducts
pathological - unilateral, single duct, spontaenous, persistent, bloody
* papilloma - benign
* duct ectasia - benign
pros and cons of FNAC
Pros:
* safe
* reliable
* accurate
* fast
* cost saving
* complication free
* good cellular detail
* quick to prepare
cons
* no architecture
* cant differentiate atypical ductal hyperplasia from low grade cancer or high grade in situ ca from invasive ca
* ancillary testing not always possible
FNAC technique
Small needle - trained radiologist under US or stereotactic guidance
Direct smear onto glass slide
Air dryu preparation/fixed in alcohol
2 stains
Preservated – send lab – optyimal smear – and choose best smear to process specimen
scoring of cytology from FNAC
C1 = inadequate
C2 = benign
C3 = atypia, probably benign
C4 = suspicious of malignancy
C5 = malignant
biopsy technique
Core biospsy
Vacuumassisted – get bigger tissue. US guided or stereotactic guided – get more visualisation
under USS, MRI, mammogram (stereotactic) guidance
how do you get histopathology sample and pros/cons
Intact tissue removed, fixed in formalin, embedded in paraffin wax, thinly sliced, stained with H&E.
Biopsies, surgical excisions.
Takes 24 hours to process. – not as quick as cytology
Architectural & cellular detail.
score from biopsy
- B1:normal tissue / inadequate sample
- B2:benign lesion
- B3:uncertain malignant potential – eg not seeing edge of lesion/ not enough of the lesion – cant say how it behaves - includes: radial scar, some papillary lesions, ADH, lobular neoplasia
- B4:suspicious of malignancy
- B5:malignant
summarise duct ectasia
- 5th -6th decade, multiparous women
- Inflammation and dilation of large breast ducts.
- Aetiology unclear.
- Usually presents with nipple discharge.
- Sometimes causes breast pain, breast mass and nipple retraction. – similar to cancer signs
- Cytology of nipple discharge shows proteinaceous material and inflammatory cells only.
- Benign condition with no increased risk of malignancy.
summarise acute mastitis
Acute inflammation in the breast.
Often seen in lactating women due to cracked skin and stasis of milk.
May also complicate duct ectasia.
Staphylococci the usual organism.
Presents with a painful red breast.
Drainage & antibiotics usually curative.
summarise fat necrosis
An **inflammatory reaction to damaged adipose tissue**
Caused by **trauma, surgery, radiotherapy**.
Presents with a
* breast **mass**,
* late stages may show **focal calcification** – might simulate cancer and lead to further Ix but it is **benign**!
summarise galactocele
Cystic dilation of a duct during lactation
Usually multiple ducts
Tender palpable nodules
Secondary infection may convert these to acute mastitis or abscess
what are the inflammatory breast diseases
mastatitis
duct ectasia
galactocele
fat necrosis
what is fibrocystic disease
A group of alterations in the breast which reflect normal, albeit exaggerated, responses to hormonal influences.
Very common.
Presents with breast lumpiness.
No increased risk for subsequent breast carcinoma.
Fibro – loose stroma is replaced by compressed fibrous tissue containing
Cysts lined by flattened (larger cysts) to low cuboidal epithelium (smaller cysts)
adenosis – increased number of acini
summarise fibroadenoma
A benign neoplasm composed of fibrous and glandular tissue.
Common.
Presents as a circumscribed mobile breast lump
aged 20-30.
Simple “**shelling out” curative. – enucleation **
cytology of fibroadenoma
Cytology - biphasic population composed of abundant spindle stromal cells and naked nuclei, epithelium arranged in antler horn clusters or fenestrated honeycomb sheets
Delicate fibroblastic stroma enclosing intact round to oval glands lined by single or multiple layers of cells (pericanalicular type)
Active proliferation of connective tissue stroma with compression of the glands into slit like irregular clefts, strands or cords ( intracanalicular type)
Both patterns may coexist in the same tumour
In background small nuclei – lost their cytoplasm. Myoepithelial cells
summarise phyllodes tumours
A group of potentially aggressive fibroepithelial neoplasms of the breast.
Uncommon tumours.
Present as enlarging masses in women aged over 50.
Some may arise within pre-existing fibroadenomas.
Vast majority behave in a benign fashion, but a small proportion can behave more aggressively.
