Breast pathology 1 Flashcards
Clinical assessments for patient with breast disease?
Clinical history and examination
Imaging techniques for patients with breast disease?
Mammography
MRI
Ultrasound
Assessment of cellular pathology in breast disease?
Cytopathology
Histopathology
What is histopathology for breast conditions?
Histopathological examination is the gold standard for examination of breast cancer grading.
Histopathological examination is a microscopic examination of the organism’s tissues.
What is cytopathology for breast conditions?
Focuses mainly on morphology and recognising benign lesions and the main features of malignancy.
Examples for breast cytopathology?
Fine Needle Aspiration (FNA).
Fluid.
Nipple discharge.
Nipple scrape.
What are the two main types of histopathological breast procedures?
Diagnostic and therapeutic (treatment) procedures
Diagnostic breast histopathology procedure examples?
(Needle) core biopsy.
Vacuum assisted biopsy (large volume).
Skin biopsy.
Incisional biopsy of mass.
Therapeutic breast histopathology procedure examples?
Vacuum assisted excision.
Excisional biopsy of mass.
Resection of cancer.
- Wide local excision.
- Mastectomy.
Breast cytopathology classifications?
C1 – Unsatisfactory.
C2 – Benign.
C3 – Atypia, probably benign
(equivocal).
C4 – Atypia, suspicious of malignancy.
C5 – Malignant.
How many grades are there for breast cytopathology?
C1-C5
Grading for diagnostic (needle) core biopsy?
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.
What is fibrocystic disease of the breast?
Most common benign breast disorder characterised presence of fibrous tissues and cysts in the breasts.
Who is most commonly affected by fibrocystic breast disease?
Affects woman between ages of 20 to 50, most commonly between ages 40-50
What is fibrocystic disease of the breast associated with?
Menstrual abnormalities, early menarche and late menopause
Main pathophysiology of fibrocystic breast disease?
Long term build up of progesterone and oestrogen leading to breast tissue changes, this includes multiple small cysts and intervening fibrosis
Clinical features of fibrocystic breast disease?
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
Investigations for fibrocystic breast disease?
Physical examination and mammogram /ultrasound/biopsy in order to exclude any malignancy
Management of fibrocystic breast disease?
Often resolves or diminishes after menopause - reassurance often enough
Analgesia for pain relief
Excise if necessary (unusual)
What is a hamartoma?
AKA fibroadenolipomas
Circumscribed lesion composed of cell types normal to the breast but presents in an abnormal proportion or distribution
What is the most common benign growth in the breast?
Fibroadenoma
At what age and ethnicity is fibroadenoma most common in?
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
Features of fibroadenoma?
Peak incidence in 3rd decade.
Screening.
Painless, firm, discrete, mobile mass.
“Breast mouse”. Known as this due to their high mobility
Solid on ultrasound.
Pathological features of fibroadenoma?
Circumscribed.
Rubbery.
Grey-white colour.
Biphasic tumour/lesion:
- Epithelium.
- Stroma.
Management of fibroadenoma?
Diagnose
Reassure
Excise
What are sclerosing lesions?
Benign, disorderly proliferation of acini (small saclike cavity in a gland, surrounded by secretory cells) and stroma
Can cause a mass or calcification
Clinical features of sclerosing adenosis?
Pain, tenderness or lumpiness/
thickening.
Asymptomatic.
Age 20-70.
What is a radial scar of the breast?
A radial scar is a growth that looks like a scar when the tissue is viewed under a microscope.
Age range for radial scar of breast?
Wide age range of 20-70 years
How is a radial scar detected?
Incidental finding.
Mammographically detected.
Classical features of radial scar?
Fibro-elastotic core.
Radiating fibrosis containing distorted
ductules.
Fibrocystic change.
Epithelial proliferation.
Summary of radial scar?
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).
What are phyllodes tumour?
Rare fibroepithelial tumours which most commonly affects women aged 40-50 years
Appears as a slow growing unilateral breast mass
What is stroma?
Stroma (tissue), the connective, functionally supportive framework of a biological cell, tissue, or organ
What are pathological features of phyllodes tumours?
Tumour border.
Stromal cellularity.
Stromal atypia.
Mitotic activity.
Stromal ‘overgrowth’.
Malignant heterologous elements.
Typical pattern of behaviour for phyllodes tumour?
Pathology helps to predict.
Prone to local recurrence if not.
adequately excised.
Rarely metastasise.
Clinical features of papillary lesions?
Age 35-60.
Nipple discharge +/- blood.
Asymptomatic at screening.
Nodules.
Calcification.
Pathological features of papillary lesions?
Sub-areolar ducts.
2-20 mm diameter.
Papillary fronds containing a fibrovascular core.
Covered by myoepithelium and epithelium.
Epithelium may show proliferative activity.
General management of benign breast lumps?
- 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
For some women, benign breast lumps may cause symptoms, such as pain or discomfort if they grow, what should be done for this?
If they grow, excision may be the best option
What is the triple assessment for breast screening?
Triple assessment, as the name indicates, includes three modalities, physical examination, imaging (mammography and/or ultrasound), and biopsy (FNA and core biopsy).
