Breast Benign Pathology Flashcards
What makes up the triple assessment of breast examination?
Clinical
Imaging
Pathology
What are the grades of breast FNA cytology?
C1 - unsatisfactory C2 - Benign C3 - Atypia, probably benign C4 - Suspicious of malignancy C5 - Malignant
What are the grades of breast needle core biopsy?
B1 - unsatisfactory/ normal B2 - Benign B3 - Atypia, probably benign B4 - Suspicious of malignancy B5 - Malignant B5a - carcinoma in situ B5b - invasive carcinoma
What are some benign developmental abnormalities of breast?
Hypoplasia
Juvenile hypertrophy
Accessory breast tissue
Accessory nipple
What are some non-neoplastic breast diseases?
Gynaecomastia Fibrocystic change Hamartoma Fibroadenoma Sclerosing lesions
What are inflammatory benign breast conditions?
Fat necrosis
Duct ectasia
Acute mastitis/ abscess
What are 2 benign tumours of the breast?
Phyllodes tumour
Intraduct papilloma
What is gynaecomastia?
Breast development in male
Ductal growth without lobular development
What are causes of gynaecomastia?
Stimulation of oestrogen e.g. exogenous/ endogenous hormones cannabis prescription drugs liver disease
Age group that get fibrocystic change?
Majority age 40-50
Presentation of fibrocystic change?
Smooth discrete lumps
Sudden pain (if cyst ruptures)
Cyclical pain
Lumpiness
What other benign condition might fibrocystic change be associated with?
Sclerosing adenosis
What is the management of fibrocystic change?
Exclude malignancy
Excise if necessary
What is a hamartoma?
Circumscribed lesion
Composed of tissue normally found in breast but in abnormal proportion or distribution
What ethnic group more commonly get fibroadenomas?
African women
What age group is the peak incidence of fibroadenomas?
3rd decade
What are the clinical features of fibroadenoma?
Painless, firm, discrete mobile mass
Breast mouse - moves away from examining fingers
What do fibroadenomas look like on ultrasound?
Solid
Describe the pathology of a fibroadenoma
Circumscribed and rubbery
Grey-white colour
Biphasic (2 types of tissue) - epithelium and stroma
Treatment of fibroadenoma?
Excise
What is a sclerosing lesion?
Benign, disorderly proliferation of acini, stroma and myoepithelial cells
What is the most common type of sclerosing lesion?
Sclerosing adenosis
Describe the pathology of a radial scar?
Stellate architecture
Central puckering
Radiating fibrosis - proliferative epithelium
Treatment of radial scar?
Excise or sample extensively by a vacuum biopsy
What can cause fat necrosis?
Trauma
Warfarin
What is fat necrosis?
Release of adipocytes due to damage and infiltration by acute inflammatory cells
What role do macrophages have in fat necrosis?
Foamy macrophages ingest fat droplets leading to fibros
Clinical features of duct ectasia?
Bloody/ purulent discharge Fistulation Nipple retraction Pain Acute episodic inflammatory changes
What part of the breast does duct ectasia affect?
Sub-areolar ducts
What part of the social history is important in duct ectasia?
SMOKING
strong association
Management of duct ectasia?
Treat acute infection
Exclude malignancy
Stop smoking
Excise ducts
What are the 2 possible aetiologies of acute mastitis/ abscess?
Duct ectasia
Lactation
What organisms cause acute mastitis to develop from duct ectasia?
Anaerobes
Mixed organisms
Which antibiotic is sensitive for anaerobes?
Metrondiazole
What organisms cause acute mastitis from lactation?
Staph aureus
Strep pyogenes
What is the management of acute mastitis?
Antibiotics
Percutaneous drainage
Incise and drain
Treat underlying cause
What is a phyllodes tumour?
Slow growing unilateral breast mass
At what age do women get phyllodes tumour?
40-50years
What are the classes of phyllodes tumour?
Benign
Borderline
Malignant (sarcomatous)
What is the management of phyllodes tumour?
Excise
Prone to recurrence if not fully excised
What are the 3 types of papillary lesions?
Encysted papillary carcinoma
Nipple adenoma
Intraduct papilloma
What age of women get intraduct papillomas?
30 - 60 years
What are the signs of intraduct papillomas?
Nipple discharge
Bleeding
What do intraduct papillomas look like on pathology?
Papillary fronds
Fibrovascular core
