Breast Benign Pathology Flashcards

1
Q

What makes up the triple assessment of breast examination?

A

Clinical
Imaging
Pathology

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2
Q

What are the grades of breast FNA cytology?

A
C1 - unsatisfactory
C2 - Benign
C3 - Atypia, probably benign
C4 - Suspicious of malignancy
C5 - Malignant
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3
Q

What are the grades of breast needle core biopsy?

A
B1 - unsatisfactory/ normal 
B2 - Benign 
B3 - Atypia, probably benign
B4 - Suspicious of malignancy
B5 - Malignant
B5a - carcinoma in situ
B5b - invasive carcinoma
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4
Q

What are some benign developmental abnormalities of breast?

A

Hypoplasia
Juvenile hypertrophy
Accessory breast tissue
Accessory nipple

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5
Q

What are some non-neoplastic breast diseases?

A
Gynaecomastia
Fibrocystic change
Hamartoma
Fibroadenoma
Sclerosing lesions
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6
Q

What are inflammatory benign breast conditions?

A

Fat necrosis
Duct ectasia
Acute mastitis/ abscess

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7
Q

What are 2 benign tumours of the breast?

A

Phyllodes tumour

Intraduct papilloma

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8
Q

What is gynaecomastia?

A

Breast development in male

Ductal growth without lobular development

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9
Q

What are causes of gynaecomastia?

A
Stimulation of oestrogen
e.g. exogenous/ endogenous hormones
cannabis
prescription drugs
liver disease
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10
Q

Age group that get fibrocystic change?

A

Majority age 40-50

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11
Q

Presentation of fibrocystic change?

A

Smooth discrete lumps
Sudden pain (if cyst ruptures)
Cyclical pain
Lumpiness

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12
Q

What other benign condition might fibrocystic change be associated with?

A

Sclerosing adenosis

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13
Q

What is the management of fibrocystic change?

A

Exclude malignancy

Excise if necessary

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14
Q

What is a hamartoma?

A

Circumscribed lesion

Composed of tissue normally found in breast but in abnormal proportion or distribution

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15
Q

What ethnic group more commonly get fibroadenomas?

A

African women

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16
Q

What age group is the peak incidence of fibroadenomas?

A

3rd decade

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17
Q

What are the clinical features of fibroadenoma?

A

Painless, firm, discrete mobile mass

Breast mouse - moves away from examining fingers

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18
Q

What do fibroadenomas look like on ultrasound?

A

Solid

19
Q

Describe the pathology of a fibroadenoma

A

Circumscribed and rubbery
Grey-white colour
Biphasic (2 types of tissue) - epithelium and stroma

20
Q

Treatment of fibroadenoma?

A

Excise

21
Q

What is a sclerosing lesion?

A

Benign, disorderly proliferation of acini, stroma and myoepithelial cells

22
Q

What is the most common type of sclerosing lesion?

A

Sclerosing adenosis

23
Q

Describe the pathology of a radial scar?

A

Stellate architecture
Central puckering
Radiating fibrosis - proliferative epithelium

24
Q

Treatment of radial scar?

A

Excise or sample extensively by a vacuum biopsy

25
Q

What can cause fat necrosis?

A

Trauma

Warfarin

26
Q

What is fat necrosis?

A

Release of adipocytes due to damage and infiltration by acute inflammatory cells

27
Q

What role do macrophages have in fat necrosis?

A

Foamy macrophages ingest fat droplets leading to fibros

28
Q

Clinical features of duct ectasia?

A
Bloody/ purulent discharge
Fistulation
Nipple retraction 
Pain
Acute episodic inflammatory changes
29
Q

What part of the breast does duct ectasia affect?

A

Sub-areolar ducts

30
Q

What part of the social history is important in duct ectasia?

A

SMOKING

strong association

31
Q

Management of duct ectasia?

A

Treat acute infection
Exclude malignancy
Stop smoking
Excise ducts

32
Q

What are the 2 possible aetiologies of acute mastitis/ abscess?

A

Duct ectasia

Lactation

33
Q

What organisms cause acute mastitis to develop from duct ectasia?

A

Anaerobes

Mixed organisms

34
Q

Which antibiotic is sensitive for anaerobes?

A

Metrondiazole

35
Q

What organisms cause acute mastitis from lactation?

A

Staph aureus

Strep pyogenes

36
Q

What is the management of acute mastitis?

A

Antibiotics
Percutaneous drainage
Incise and drain
Treat underlying cause

37
Q

What is a phyllodes tumour?

A

Slow growing unilateral breast mass

38
Q

At what age do women get phyllodes tumour?

A

40-50years

39
Q

What are the classes of phyllodes tumour?

A

Benign
Borderline
Malignant (sarcomatous)

40
Q

What is the management of phyllodes tumour?

A

Excise

Prone to recurrence if not fully excised

41
Q

What are the 3 types of papillary lesions?

A

Encysted papillary carcinoma
Nipple adenoma
Intraduct papilloma

42
Q

What age of women get intraduct papillomas?

A

30 - 60 years

43
Q

What are the signs of intraduct papillomas?

A

Nipple discharge

Bleeding

44
Q

What do intraduct papillomas look like on pathology?

A

Papillary fronds

Fibrovascular core