Breast Benign Pathology

Question 1

List components of Triple Assessment of patient with breast disease

Answer 1

Clinical (history, exam),
Imaging (mammography, USS, MRI),
Pathology (cytopathology, histopathology)

Question 2

Breast cytopathology - rarely used now but what are 4 types?

Answer 2

FNA,
fluid assessments,
nipple discharge,
nipple scrape

Question 3

What is FNA more commonly used for nowadays?

Answer 3

fluid collection of cysts, implant or post-surgical fluids

Question 4

Breast FNA cytology classification C1-C5?

Answer 4

C1 - unsatisfactory, 
C2 - benign, 
C3 - atypia, probs benign, 
C4 - suspicious of malignancy, 
C5 - malignant

Question 5

4 types of diagnostic breast histopathology and which is most common?

Answer 5

needle core biopsy (most common),
vacuum assisted biopsy,
skin biopsy,
incisional biopsy of mass

Question 6

3 types of therapeutic breast histopathology?

Answer 6

vacuum assisted excision,
excisions biopsy of mass,
resection

Question 7

Breast needle core biopsy classification B1-B5a/b?

Answer 7

B1 - unsatisfactory/normal,
B2 - benign, 
B3 - atypia, probs benign
B4 - suspicious of malignancy, 
B5 - malignant, 
B5a - in situ, 
B5b - invasive

Question 8

Use of vacuum assisted biopsy over needle core biopsy?

Answer 8

vacuum for larger biopsy samples

Question 9

Types of breast resection?

Answer 9

wide local excision,

mastectomy

Question 10

Benign developmental anomalies? (4)

Answer 10

hypoplasia,
juvenile hypertrophy,
accessory breast tissue,
accessory nipple

Question 11

Non-neoplastic breast disease types? (5)

Answer 11

gyanecomastia, 
fibrocystic change, 
hamartoma, 
fibroadenoma, 
sclerosing lesions

Question 12

Inflammatory breast diseases? (3)

Answer 12

fat necrosis,
duct ectasia,
acute mastitis/abscess

Question 13

Benign types of tumours of breast? (2)

Answer 13

Phyllodes tumour,

intraduct papilloma

Question 14

What is gynaecomastia?

Answer 14

male boob growth - ductal growth but no lobular development unless if right stimulus

Question 15

Gynaecomastia causes? (4)

Answer 15

exogenous/endogenous hormones,
cannabis,
prescription drugs,
liver disease,

Question 16

Fibrocystic change age group?

Answer 16

Women aged 20-50, mostly 40-50

Question 17

Fibrocystic change is very common and tends to reduce after menopause. True/false?

Answer 17

True

Question 18

Fibrocystic change is associated with what 3 processes?

Answer 18

menstrual abnormalities,
early menarche,
late menopause

Question 19

Fibrocystic change presentation? (5)

Answer 19

smooth discrete lumps, 
sudden pain, 
cyclical pain, 
lumpiness, 
incidental

Question 20

Fibrocystic changes gross pathology? (4)

Answer 20

small cysts (1mm-several cm), 
blue domed with pale fluid, multiple,
associated with other benign changes

Question 21

Fibrocystic changes microscopic pathology?

Answer 21

cysts are thin walled but may be fibrotic, lined by apocrine epithelium,
intervening fibrosis

Question 22

Acoprine metaplasia?

Answer 22

Change from ductal epithelium to apocrine cells

Question 23

Apocrine metaplasia is malignant and a common sign of fibrocystic change? true/false

Answer 23

False - benign!!

Question 24

Management fibrocystic changes?

Answer 24

exclude malignancy,
reassure,
excise if necessary

Question 25

Hamartoma is a ?

Answer 25

circumscribed lesion composed of cells normal to be in breast but in an abnormal proportion or distribution

Question 26

Fibroadenomas are common. Are they usually solitary or multiple and what ethnic group most common in?

Answer 26

Usually solid, | most commonly found in black African/afro-caribbean women

Question 27

Peak fibroadenoma age?

Answer 27

20s

Question 28

Clinical appearance of fibroadenoma? (exam and USS)

Answer 28

painless, firm, discrete, mobile mass that is solid on USS

Question 29

Fibroadenomas are circumscribed biphasic tumours. What does this mean?

Answer 29

demarcated lesions consisting of epithelial cells and stroma cells

Question 30

Fibroadenomas treatment?

Answer 30

reassure +/- excise

Question 31

Sclerosing adenosis & radial scar/complex sclerosis lesion are both types of which non-neoplastic breast disease?

Answer 31

sclerosing lesions

Question 32

What is a sclerosing lesion?

Answer 32

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

Question 33

Which non-neoplastic lesion can mimic carcinoma?

Answer 33

Sclerosing lesions esp. radial scar

Question 34

Presentation of sclerosing adenosis (symptoms & age range)

Answer 34

symptoms: pain, tenderness, lumpiness/thickening, asymptomatic, Age range: 20-70

Question 35

Sclerosing adenosis can often be seen with what other kind of benign changes?

Answer 35

fibrocystic changes

Question 36

There is a negligible risk of subsequent carcinoma from sclerosing adenosis. True/false?

Answer 36

True

Question 37

Presentation of radial scar? (commonality, age range and symptoms)

Answer 37

common, wide age range, incidental/mammographically detected

Question 38

Radial scar is 1- ? mm and is a complex sclerosing lesion when >?mm

Answer 38

radial scar - 1-9mm | complex sclerosing lesion - >10mm

Question 39

Pathology of radial scar? (3)

Answer 39

stellate architecture, central puckering, radiating fibrosis

Question 40

histology of radial scar? (4)

Answer 40

fibroelastotic core, radiating fibrosis containing distorted ductules, fibrocystic change, epithelial proliferation

Question 41

Radial scars are probably not premalignant however why are they still very important to treat?

Answer 41

Carcinoma in situ or invasive carcinoma may occur within these lesions

Question 42

Treatment radial scars?

Answer 42

excise or sample by vacuum biopsy

Question 43

Fat necrosis causes? (2)

Answer 43

local trauma e.g. seat belt or nothing, | warfarin

Question 44

Outline disease process of fat necrosis

Answer 44

damage to adipocytes -> leakage of fat into tissue -> infiltration by acute inflammatory cells -> aggregation of foamy macrophages -> scarring

Question 45

Fat necrosis management?

Answer 45

exclude malignancy

Question 46

Duct ectasia affects what ductS?

Answer 46

affects sub-areolar ducts

Question 47

Duct ectasia presentation? (5)

Answer 47

``` pain, acute episodic inflammatory changes that worsen pain, bloody +/ purulent discharge, fistulation, nipple retraction and distortion ```

Question 48

Duct ectasia is associated with what?

Answer 48

smoking

Question 49

Outline disease process of duct ectasia

Answer 49

sub-areolar duct dilation -> periductal inflammation -> periductal fibrosis -> scarring

Question 50

Duct ectasia management?

Answer 50

treat acute infections, exclude malignancy, stop smoking, excise ducts

Question 51

Two main aetiologies of acute mastitis/abscess and their respective organisms?

Answer 51

1. duct ectasia - mixed organisms & anaerobes, | 2. lactation - staph aureus & strep pyogenies

Question 52

Acute mastitis/abscess management? (4)

Answer 52

antibiotics, percutaneous drainage, incision & drainage, treat underlying cause

Question 53

Phyllodes tumour is usually preceded by what?

Answer 53

biphasic fibroepithelial lesion like fibroadenoma

Question 54

Phyllodes tumour presentation? (age range, symptom)

Answer 54

age 40-50, | slow growing unilateral breast mass

Question 55

What is 1 similarity and 1 difference between fibroadenoma and phyllodes tumour?

Answer 55

both biphasic but phyllodes has stromal overgrowth more than epithelium

Question 56

If phyllodes tumour is malignant it's called?

Answer 56

sarcomatous

Question 57

Phyllodes tumours once excised rarely re-occur. True/false?

Answer 57

false - prone to local recurrence if not adequately excised

Question 58

Papillary lesions types? (3)

Answer 58

intraduct papilloma, nipple adenoma, encapsulated papillary carcinoma

Question 59

Intraduct papilloma presentation? (age, symptoms)

Answer 59

age 35-60, nipple discharge +/- blood, asymptomatic at screening - nodules/calcification

Question 60

Intraduct papillomas tend to be 2-20mm in diameter. Where do they occur and describe them?

Answer 60

sub-areolar ducts, papillary bits (fronds) withs fibrovascular core covered by my-epithelium and epithelium

Question 61

intraduct papilloma and epithelial proliferation correlation?

Answer 61

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

Question 62

Benign IDP treatment and IDP with ADH/IDP with DCIS treatment?

Answer 62

Benign IDP - vacuum, | IDP with ADH/IDP with DCIS - WLE

Question 63

ANDI?

Answer 63

aberrations in the normal development and involutions of the breast e.g. fibroadenoma, cysts, papilloma