Breast Pathology - 1 Flashcards
Describe the ducts and lobules tree in a breast.
Lobules connect to extra-lobular terminal ducts (together this is called terminal ductal lobular unit).
These connect to SEGMENTAL ducts, which connect to COLLECTING ducts.
Collecting ducts connect and slightly widen to give LACTIFEROUS SINUS, which gives rise to the nipple.
What does ‘triple assessment’ involve?
Breast examination
Mammogram/MRI/Sonogram
Cytopathology / histopathology
Compare cytopathology and histopathology
Cytopathology - quick, analyses nipple discharge as well as cells from fine needle aspiration. However does not tell you about cell architecture as not that many cells are collected. Cells are examined on a slide.
Histopathology - fine needle biopsy - this examines more cells so you can tell cellular architecture in more detail, however this requires 24 hours to be processed.
What are histopathology samples fixed in? What are they stained in?
Fixed in formalin
Embedded in parrafin wax
Then thinly sliced
Then stained with H&E stain.
What is the most common cause of nipple discharge?
Papilloma
Describe papilloma
Papilloma is benign tumour of the surface epithelium. It is wart-like and can be either near the nipple or away from the nipple.
Is papilloma benign or malignant? What increases the risk of malignancy?
Benign. But if bloody, or associated with a mass, higher risk of cancer.
What are the features of a malignant cancer?
Poor differentiation
No encapsulation
Risk of metastasis
Abnormal mitosis
What words re used to describe changes in cells? Compare these words.
Metaplasia =reversible change in cell type
Dysplasia = potentially cancerous change in cell
How do we classify dysplasia?
High grade vs low grade
What is the difference between high grade dysplasia vs low grade dysplasia?
High grade features:
- large nuclei
- increased nuclear-cytoplasmic ratio
- abnormal mitosis
- loss of architectural orientation
Low grade = same as above but fewer features
Name the two types of benign epithelial tumours
Papilloma - surface epithelium
Adenoma - glandular epithelium
What is a sarcoma?
Malignant tumour of connective tissue
What is a carcinoma?
Malignant tumour of epithelial tissue
What is a harmatoma?
Local overgrowth of tissue, but the cells are native to that organ. Usually in kids, but it resolves/stops growing as they grow older.
Teratomas - in which population is it malignant?
Germ cell cancers.
Malignant in men, not in women.
How do you classify cytology?
C1 - inadequate sample
C2 - benign
C3 - probably benign but some ATYPIA
C4 - likely malignant
C5 - malignant
How do you classify histology?
B1 - inadequate or NORMAL
B2 - benign
B3 - uncertain malignant potential
B4 - suspicious of malignancy
B5 - malignant
List some inflammatory breast diseases
Duct ectasia
Galactocele
Acute mastitis
Fat necrosis
Duct ectasia - define
Dilation and inflammation of ducts
Ducts widen and the walls thicken after menopause. This can cause the duct to become clogged up and lead to milky discharge, nipple retraction resembling carcinoma and even abscess.
Usually in multiparous women in 5th or 6th decade of life
What does cytology of duct ectasia nipple discharge show?
Proteinaceous material + inflammatory cells
Signs of duct ectasia
Nipple discharge
Nipple retraction
Pain
Mass
Acute mastitis - definition plus two causes
Lactational - staphyloccus
Non-lactational - due to keratinising squamous metaplasia blocking the ducts
Sign/symptom of acute mastitis
Painful red breast
