Breast Pathology - 1

Question 1

Describe the ducts and lobules tree in a breast.

Answer 1

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.

Question 2

What does ‘triple assessment’ involve?

Answer 2

Breast examination
Mammogram/MRI/Sonogram
Cytopathology / histopathology

Question 3

Compare cytopathology and histopathology

Answer 3

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.

Question 4

What are histopathology samples fixed in? What are they stained in?

Answer 4

Fixed in formalin
Embedded in parrafin wax

Then thinly sliced

Then stained with H&E stain.

Question 5

What is the most common cause of nipple discharge?

Answer 5

Papilloma

Question 6

Describe papilloma

Answer 6

Papilloma is benign tumour of the surface epithelium. It is wart-like and can be either near the nipple or away from the nipple.

Question 7

Is papilloma benign or malignant? What increases the risk of malignancy?

Answer 7

Benign. But if bloody, or associated with a mass, higher risk of cancer.

Question 8

What are the features of a malignant cancer?

Answer 8

Poor differentiation
No encapsulation
Risk of metastasis
Abnormal mitosis

Question 9

What words re used to describe changes in cells? Compare these words.

Answer 9

Metaplasia =reversible change in cell type
Dysplasia = potentially cancerous change in cell

Question 10

How do we classify dysplasia?

Answer 10

High grade vs low grade

Question 11

What is the difference between high grade dysplasia vs low grade dysplasia?

Answer 11

High grade features:
- large nuclei
- increased nuclear-cytoplasmic ratio
- abnormal mitosis
- loss of architectural orientation

Low grade = same as above but fewer features

Question 12

Name the two types of benign epithelial tumours

Answer 12

Papilloma - surface epithelium
Adenoma - glandular epithelium

Question 13

What is a sarcoma?

Answer 13

Malignant tumour of connective tissue

Question 14

What is a carcinoma?

Answer 14

Malignant tumour of epithelial tissue

Question 15

What is a harmatoma?

Answer 15

Local overgrowth of tissue, but the cells are native to that organ. Usually in kids, but it resolves/stops growing as they grow older.

Question 16

Teratomas - in which population is it malignant?

Answer 16

Germ cell cancers.
Malignant in men, not in women.

Question 17

How do you classify cytology?

Answer 17

C1 - inadequate sample
C2 - benign
C3 - probably benign but some ATYPIA
C4 - likely malignant
C5 - malignant

Question 18

How do you classify histology?

Answer 18

B1 - inadequate or NORMAL
B2 - benign
B3 - uncertain malignant potential
B4 - suspicious of malignancy
B5 - malignant

Question 19

List some inflammatory breast diseases

Answer 19

Duct ectasia
Galactocele
Acute mastitis
Fat necrosis

Question 20

Duct ectasia - define

Answer 20

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

Question 21

What does cytology of duct ectasia nipple discharge show?

Answer 21

Proteinaceous material + inflammatory cells

Question 22

Signs of duct ectasia

Answer 22

Nipple discharge
Nipple retraction
Pain
Mass

Question 23

Acute mastitis - definition plus two causes

Answer 23

Lactational - staphyloccus
Non-lactational - due to keratinising squamous metaplasia blocking the ducts

Question 24

Sign/symptom of acute mastitis

Answer 24

Painful red breast

Question 25

Management of acute mastitis

Answer 25

Drainage and antibiotics

Question 26

What is seen on cytology in acute mastitis?

Answer 26

NEUTROPHILS

Question 27

Fat necrosis - definition, cause

Answer 27

Inflammation of breast fat after trauma/surgery/radiotherapy

Question 28

Sign of fat necrosis

Answer 28

Calcification (later stage)
PAINLESS breast mass

Question 29

What is seen on histology of fat necrosis?

Answer 29

Foamy macrophages
Multinucleated cells

Question 30

Galactocele - definition

Answer 30

Blockage of ducts in lactating women, leading to a build up of milk and dilation of the lobules/ducts.

Question 31

Sign of galactocele

Answer 31

Tender palable nodules
Fluctuant
Can become infected

Question 32

What can a galactocele become?

Answer 32

Acute mastitis/abscess if it gets infected