Breast pathology 1

Question 1

Clinical assessments for patient with breast disease?

Answer 1

Clinical history and examination

Question 2

Imaging techniques for patients with breast disease?

Answer 2

Mammography
MRI
Ultrasound

Question 3

Assessment of cellular pathology in breast disease?

Answer 3

Cytopathology
Histopathology

Question 4

What is histopathology for breast conditions?

Answer 4

Histopathological examination is the gold standard for examination of breast cancer grading.

Histopathological examination is a microscopic examination of the organism’s tissues.

Question 5

What is cytopathology for breast conditions?

Answer 5

Focuses mainly on morphology and recognising benign lesions and the main features of malignancy.

Question 6

Examples for breast cytopathology?

Answer 6

Fine Needle Aspiration (FNA).
Fluid.
Nipple discharge.
Nipple scrape.

Question 7

What are the two main types of histopathological breast procedures?

Answer 7

Diagnostic and therapeutic (treatment) procedures

Question 8

Diagnostic breast histopathology procedure examples?

Answer 8

(Needle) core biopsy.

Vacuum assisted biopsy (large volume).

Skin biopsy.

Incisional biopsy of mass.

Question 9

Therapeutic breast histopathology procedure examples?

Answer 9

Vacuum assisted excision.

Excisional biopsy of mass.

Resection of cancer.
- Wide local excision.
- Mastectomy.

Question 10

Breast cytopathology classifications?

Answer 10

C1 – Unsatisfactory.
C2 – Benign.
C3 – Atypia, probably benign
(equivocal).
C4 – Atypia, suspicious of malignancy.
C5 – Malignant.

Question 11

How many grades are there for breast cytopathology?

Answer 11

C1-C5

Question 12

Grading for diagnostic (needle) core biopsy?

Answer 12

B1 – Normal tissue or inadequate.
B2 – Benign.
B3 – Lesion of uncertain malignant potential (+/- epithelial atypia if appropriate)
B4 – Suspicious of malignancy.
B5 – Malignant:
~B5a – Unequivocally carcinoma in situ (only specific subtypes).
~B5b – Unequivocally invasive carcinoma.
~B5c – Rarely used, malignant unable to specify nature.

Question 13

What is fibrocystic disease of the breast?

Answer 13

Most common benign breast disorder characterised presence of fibrous tissues and cysts in the breasts.

Question 14

Who is most commonly affected by fibrocystic breast disease?

Answer 14

Affects woman between ages of 20 to 50, most commonly between ages 40-50

Question 15

What is fibrocystic disease of the breast associated with?

Answer 15

Menstrual abnormalities, early menarche and late menopause

Question 16

Main pathophysiology of fibrocystic breast disease?

Answer 16

Long term build up of progesterone and oestrogen leading to breast tissue changes, this includes multiple small cysts and intervening fibrosis

Question 17

Clinical features of fibrocystic breast disease?

Answer 17

Bilateral “lumpy” breasts , most commonly in upper outer quadrant. Cysts usually 1mm to several cm. Blue domed with pale fluid

Breast pain

May be asymptomatic-incidental finding particularly on screening.

Symptoms that worsen with menstrual cycle, typically peaking 1 week before menstruation

Question 18

Investigations for fibrocystic breast disease?

Answer 18

Physical examination and mammogram /ultrasound/biopsy in order to exclude any malignancy

Question 19

Management of fibrocystic breast disease?

Answer 19

Often resolves or diminishes after menopause - reassurance often enough

Analgesia for pain relief

Excise if necessary (unusual)

Question 20

What is a hamartoma?

Answer 20

AKA fibroadenolipomas

Circumscribed lesion composed of cell types normal to the breast but presents in an abnormal proportion or distribution

Question 21

What is the most common benign growth in the breast?

Answer 21

Fibroadenoma

Question 22

At what age and ethnicity is fibroadenoma most common in?

Answer 22

More common in Afro-Caribbean women.

Usually occurs in women of reproductive age with peak incidence in 3rd decade but can occur in any age

Question 23

Features of fibroadenoma?

Answer 23

Peak incidence in 3rd decade.

Screening.

Painless, firm, discrete, mobile mass.

“Breast mouse”. Known as this due to their high mobility

Solid on ultrasound.

Question 24

Pathological features of fibroadenoma?

Answer 24

Circumscribed.
Rubbery.
Grey-white colour.
Biphasic tumour/lesion:
- Epithelium.
- Stroma.

Question 25

Management of fibroadenoma?

Answer 25

Diagnose

Reassure

Excise

Question 26

What are sclerosing lesions?

Answer 26

Benign, disorderly proliferation of acini (small saclike cavity in a gland, surrounded by secretory cells) and stroma

Can cause a mass or calcification

Question 27

Clinical features of sclerosing adenosis?

Answer 27

Pain, tenderness or lumpiness/
thickening.

Asymptomatic.

Age 20-70.

Question 28

What is a radial scar of the breast?

Answer 28

A radial scar is a growth that looks like a scar when the tissue is viewed under a microscope.

Question 29

Age range for radial scar of breast?

Answer 29

Wide age range of 20-70 years

Question 30

How is a radial scar detected?

Answer 30

Incidental finding.

Mammographically detected.

Question 31

Classical features of radial scar?

Answer 31

Fibro-elastotic core.

Radiating fibrosis containing distorted
ductules.

Fibrocystic change.

Epithelial proliferation.

Question 32

Summary of radial scar?

Answer 32

Mimic carcinoma radiologically.

Probably not premalignant.

Often show epithelial proliferation.

In situ or invasive carcinoma may occur within these lesions.

Treatment.
Excise or sample extensively by vacuum
biopsy/excision (no atypia).

Question 33

What are phyllodes tumour?

Answer 33

Rare fibroepithelial tumours which most commonly affects women aged 40-50 years

Appears as a slow growing unilateral breast mass

Question 34

What is stroma?

Answer 34

Stroma (tissue), the connective, functionally supportive framework of a biological cell, tissue, or organ

Question 35

What are pathological features of phyllodes tumours?

Answer 35

Tumour border.
Stromal cellularity.
Stromal atypia.
Mitotic activity.
Stromal ‘overgrowth’.
Malignant heterologous elements.

Question 36

Typical pattern of behaviour for phyllodes tumour?

Answer 36

Pathology helps to predict.

Prone to local recurrence if not.
adequately excised.

Rarely metastasise.

Question 37

Clinical features of papillary lesions?

Answer 37

Age 35-60.
Nipple discharge +/- blood.
Asymptomatic at screening.
Nodules.
Calcification.

Question 38

Pathological features of papillary lesions?

Answer 38

Sub-areolar ducts.
2-20 mm diameter.
Papillary fronds containing a fibrovascular core.
Covered by myoepithelium and epithelium.
Epithelium may show proliferative activity.

Question 39

General management of benign breast lumps?

Answer 39

• With benign breast lumps that have been confirmed, in most cases/subtypes reassurance and routine check up appointments are sufficient.
• However, if breast lump cannot be confirmed to be benign or has malignant potential with atypical cells, may be excised after triple assessment - open lumpectomy or percutaneous vacuum assisted core-biopsy

Question 40

For some women, benign breast lumps may cause symptoms, such as pain or discomfort if they grow, what should be done for this?

Answer 40

If they grow, excision may be the best option

Question 41

What is the triple assessment for breast screening?

Answer 41

Triple assessment, as the name indicates, includes three modalities, physical examination, imaging (mammography and/or ultrasound), and biopsy (FNA and core biopsy).