Breast Benign Pathology Flashcards
-ANDI - aberrations in normal development and involution of the breast
List components of Triple Assessment of patient with breast disease
Clinical (history, exam),
Imaging (mammography, USS, MRI),
Pathology (cytopathology, histopathology)
Breast cytopathology - rarely used now but what are 4 types?
FNA,
fluid assessments,
nipple discharge,
nipple scrape
What is FNA more commonly used for nowadays?
fluid collection of cysts, implant or post-surgical fluids
Breast FNA cytology classification C1-C5?
C1 - unsatisfactory, C2 - benign, C3 - atypia, probs benign, C4 - suspicious of malignancy, C5 - malignant
4 types of diagnostic breast histopathology and which is most common?
needle core biopsy (most common),
vacuum assisted biopsy,
skin biopsy,
incisional biopsy of mass
3 types of therapeutic breast histopathology?
vacuum assisted excision,
excisions biopsy of mass,
resection
Breast needle core biopsy classification B1-B5a/b?
B1 - unsatisfactory/normal, B2 - benign, B3 - atypia, probs benign B4 - suspicious of malignancy, B5 - malignant, B5a - in situ, B5b - invasive
Use of vacuum assisted biopsy over needle core biopsy?
vacuum for larger biopsy samples
Types of breast resection?
wide local excision,
mastectomy
Benign developmental anomalies? (4)
hypoplasia,
juvenile hypertrophy,
accessory breast tissue,
accessory nipple
Non-neoplastic breast disease types? (5)
gyanecomastia, fibrocystic change, hamartoma, fibroadenoma, sclerosing lesions
Inflammatory breast diseases? (3)
fat necrosis,
duct ectasia,
acute mastitis/abscess
Benign types of tumours of breast? (2)
Phyllodes tumour,
intraduct papilloma
What is gynaecomastia?
male boob growth - ductal growth but no lobular development unless if right stimulus
Gynaecomastia causes? (4)
exogenous/endogenous hormones,
cannabis,
prescription drugs,
liver disease,
Fibrocystic change age group?
Women aged 20-50, mostly 40-50
Fibrocystic change is very common and tends to reduce after menopause. True/false?
True
Fibrocystic change is associated with what 3 processes?
menstrual abnormalities,
early menarche,
late menopause
Fibrocystic change presentation? (5)
smooth discrete lumps, sudden pain, cyclical pain, lumpiness, incidental
Fibrocystic changes gross pathology? (4)
small cysts (1mm-several cm), blue domed with pale fluid, multiple, associated with other benign changes
Fibrocystic changes microscopic pathology?
cysts are thin walled but may be fibrotic, lined by apocrine epithelium,
intervening fibrosis
Acoprine metaplasia?
Change from ductal epithelium to apocrine cells
Apocrine metaplasia is malignant and a common sign of fibrocystic change? true/false
False - benign!!
Management fibrocystic changes?
exclude malignancy,
reassure,
excise if necessary
Hamartoma is a ?
circumscribed lesion composed of cells normal to be in breast but in an abnormal proportion or distribution
Fibroadenomas are common. Are they usually solitary or multiple and what ethnic group most common in?
Usually solid,
most commonly found in black African/afro-caribbean women
Peak fibroadenoma age?
20s
Clinical appearance of fibroadenoma? (exam and USS)
painless, firm, discrete, mobile mass that is solid on USS
Fibroadenomas are circumscribed biphasic tumours. What does this mean?
demarcated lesions consisting of epithelial cells and stroma cells
Fibroadenomas treatment?
reassure +/- excise
Sclerosing adenosis & radial scar/complex sclerosis lesion are both types of which non-neoplastic breast disease?
sclerosing lesions
What is a sclerosing lesion?
benign, disorderly proliferation of acini and stroma causing a mass or calcification
Which non-neoplastic lesion can mimic carcinoma?
Sclerosing lesions esp. radial scar
Presentation of sclerosing adenosis (symptoms & age range)
symptoms: pain, tenderness, lumpiness/thickening, asymptomatic,
Age range: 20-70
Sclerosing adenosis can often be seen with what other kind of benign changes?
fibrocystic changes
There is a negligible risk of subsequent carcinoma from sclerosing adenosis. True/false?
True
Presentation of radial scar? (commonality, age range and symptoms)
common,
wide age range,
incidental/mammographically detected
Radial scar is 1- ? mm and is a complex sclerosing lesion when >?mm
radial scar - 1-9mm
complex sclerosing lesion - >10mm
Pathology of radial scar? (3)
stellate architecture,
central puckering,
radiating fibrosis
histology of radial scar? (4)
fibroelastotic core,
radiating fibrosis containing distorted ductules,
fibrocystic change,
epithelial proliferation
Radial scars are probably not premalignant however why are they still very important to treat?
Carcinoma in situ or invasive carcinoma may occur within these lesions
Treatment radial scars?
excise or sample by vacuum biopsy
Fat necrosis causes? (2)
local trauma e.g. seat belt or nothing,
warfarin
Outline disease process of fat necrosis
damage to adipocytes -> leakage of fat into tissue -> infiltration by acute inflammatory cells -> aggregation of foamy macrophages -> scarring
Fat necrosis management?
exclude malignancy
Duct ectasia affects what ductS?
affects sub-areolar ducts
Duct ectasia presentation? (5)
pain, acute episodic inflammatory changes that worsen pain, bloody +/ purulent discharge, fistulation, nipple retraction and distortion
Duct ectasia is associated with what?
smoking
Outline disease process of duct ectasia
sub-areolar duct dilation -> periductal inflammation -> periductal fibrosis -> scarring
Duct ectasia management?
treat acute infections,
exclude malignancy,
stop smoking,
excise ducts
Two main aetiologies of acute mastitis/abscess and their respective organisms?
- duct ectasia - mixed organisms & anaerobes,
2. lactation - staph aureus & strep pyogenies
Acute mastitis/abscess management? (4)
antibiotics,
percutaneous drainage,
incision & drainage,
treat underlying cause
Phyllodes tumour is usually preceded by what?
biphasic fibroepithelial lesion like fibroadenoma
Phyllodes tumour presentation? (age range, symptom)
age 40-50,
slow growing unilateral breast mass
What is 1 similarity and 1 difference between fibroadenoma and phyllodes tumour?
both biphasic but phyllodes has stromal overgrowth more than epithelium
If phyllodes tumour is malignant it’s called?
sarcomatous
Phyllodes tumours once excised rarely re-occur. True/false?
false - prone to local recurrence if not adequately excised
Papillary lesions types? (3)
intraduct papilloma,
nipple adenoma,
encapsulated papillary carcinoma
Intraduct papilloma presentation? (age, symptoms)
age 35-60,
nipple discharge +/- blood,
asymptomatic at screening - nodules/calcification
Intraduct papillomas tend to be 2-20mm in diameter. Where do they occur and describe them?
sub-areolar ducts, papillary bits (fronds) withs fibrovascular core covered by my-epithelium and epithelium
intraduct papilloma and epithelial proliferation correlation?
none = benign intraduct papilloma (IDP),
usual type hyperplasia = benign IDP,
atypical ductal hyperplasia (ADH) = IDP with ADH,
ductal carcinoma in situ = IDP with DCIS or papillary DCIS
Benign IDP treatment and IDP with ADH/IDP with DCIS treatment?
Benign IDP - vacuum,
IDP with ADH/IDP with DCIS - WLE
ANDI?
aberrations in the normal development and involutions of the breast e.g. fibroadenoma, cysts, papilloma
