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Repro > Breast Benign Pathology > Flashcards

Breast Benign Pathology Flashcards

-ANDI - aberrations in normal development and involution of the breast

1
Q

List components of Triple Assessment of patient with breast disease

A

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

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2
Q

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

A

FNA,
fluid assessments,
nipple discharge,
nipple scrape

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3
Q

What is FNA more commonly used for nowadays?

A

fluid collection of cysts, implant or post-surgical fluids

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4
Q

Breast FNA cytology classification C1-C5?

A 
C1 - unsatisfactory, 
C2 - benign, 
C3 - atypia, probs benign, 
C4 - suspicious of malignancy, 
C5 - malignant
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5
Q

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

A

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

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6
Q

3 types of therapeutic breast histopathology?

A

vacuum assisted excision,
excisions biopsy of mass,
resection

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7
Q

Breast needle core biopsy classification B1-B5a/b?

A 
B1 - unsatisfactory/normal,
B2 - benign, 
B3 - atypia, probs benign
B4 - suspicious of malignancy, 
B5 - malignant, 
B5a - in situ, 
B5b - invasive
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8
Q

Use of vacuum assisted biopsy over needle core biopsy?

A

vacuum for larger biopsy samples

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9
Q

Types of breast resection?

A

wide local excision,

mastectomy

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10
Q

Benign developmental anomalies? (4)

A

hypoplasia,
juvenile hypertrophy,
accessory breast tissue,
accessory nipple

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11
Q

Non-neoplastic breast disease types? (5)

A 
gyanecomastia, 
fibrocystic change, 
hamartoma, 
fibroadenoma, 
sclerosing lesions
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12
Q

Inflammatory breast diseases? (3)

A

fat necrosis,
duct ectasia,
acute mastitis/abscess

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13
Q

Benign types of tumours of breast? (2)

A

Phyllodes tumour,

intraduct papilloma

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14
Q

What is gynaecomastia?

A

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

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15
Q

Gynaecomastia causes? (4)

A

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

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16
Q

Fibrocystic change age group?

A

Women aged 20-50, mostly 40-50

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17
Q

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

A

True

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18
Q

Fibrocystic change is associated with what 3 processes?

A

menstrual abnormalities,
early menarche,
late menopause

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19
Q

Fibrocystic change presentation? (5)

A 
smooth discrete lumps, 
sudden pain, 
cyclical pain, 
lumpiness, 
incidental
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20
Q

Fibrocystic changes gross pathology? (4)

A 
small cysts (1mm-several cm), 
blue domed with pale fluid, multiple,
associated with other benign changes
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21
Q

Fibrocystic changes microscopic pathology?

A

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

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22
Q

Acoprine metaplasia?

A

Change from ductal epithelium to apocrine cells

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23
Q

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

A

False - benign!!

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24
Q

Management fibrocystic changes?

A

exclude malignancy,
reassure,
excise if necessary

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25
Q

Hamartoma is a ?

A

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

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26
Q

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

A

Usually solid,

most commonly found in black African/afro-caribbean women

27
Q

Peak fibroadenoma age?

A

20s

28
Q

Clinical appearance of fibroadenoma? (exam and USS)

A

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

29
Q

Fibroadenomas are circumscribed biphasic tumours. What does this mean?

A

demarcated lesions consisting of epithelial cells and stroma cells

30
Q

Fibroadenomas treatment?

A

reassure +/- excise

31
Q

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

A

sclerosing lesions

32
Q

What is a sclerosing lesion?

A

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

33
Q

Which non-neoplastic lesion can mimic carcinoma?

A

Sclerosing lesions esp. radial scar

34
Q

Presentation of sclerosing adenosis (symptoms & age range)

A

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

35
Q

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

A

fibrocystic changes

36
Q

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

A

True

37
Q

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

A

common,
wide age range,
incidental/mammographically detected

38
Q

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

A

radial scar - 1-9mm

complex sclerosing lesion - >10mm

39
Q

Pathology of radial scar? (3)

A

stellate architecture,
central puckering,
radiating fibrosis

40
Q

histology of radial scar? (4)

A

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

41
Q

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

A

Carcinoma in situ or invasive carcinoma may occur within these lesions

42
Q

Treatment radial scars?

A

excise or sample by vacuum biopsy

43
Q

Fat necrosis causes? (2)

A

local trauma e.g. seat belt or nothing,

warfarin

44
Q

Outline disease process of fat necrosis

A

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

45
Q

Fat necrosis management?

A

exclude malignancy

46
Q

Duct ectasia affects what ductS?

A

affects sub-areolar ducts

47
Q

Duct ectasia presentation? (5)

A 
pain, 
acute episodic inflammatory changes that worsen pain,
bloody +/ purulent discharge, 
fistulation, 
nipple retraction and distortion
48
Q

Duct ectasia is associated with what?

A

smoking

49
Q

Outline disease process of duct ectasia

A

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

50
Q

Duct ectasia management?

A

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

51
Q

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

A
  1. duct ectasia - mixed organisms & anaerobes,

2. lactation - staph aureus & strep pyogenies

52
Q

Acute mastitis/abscess management? (4)

A

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

53
Q

Phyllodes tumour is usually preceded by what?

A

biphasic fibroepithelial lesion like fibroadenoma

54
Q

Phyllodes tumour presentation? (age range, symptom)

A

age 40-50,

slow growing unilateral breast mass

55
Q

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

A

both biphasic but phyllodes has stromal overgrowth more than epithelium

56
Q

If phyllodes tumour is malignant it’s called?

A

sarcomatous

57
Q

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

A

false - prone to local recurrence if not adequately excised

58
Q

Papillary lesions types? (3)

A

intraduct papilloma,
nipple adenoma,
encapsulated papillary carcinoma

59
Q

Intraduct papilloma presentation? (age, symptoms)

A

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

60
Q

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

A

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

61
Q

intraduct papilloma and epithelial proliferation correlation?

A

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

62
Q

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

A

Benign IDP - vacuum,

IDP with ADH/IDP with DCIS - WLE

63
Q

ANDI?

A

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

Repro (49 decks)

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