Breast pathology 1 Flashcards
what is the triple assessment of a patient
clinical - history and exam
imaging - mammography, USS, MRI
pathology - cytopathology, histopathology
how is breast cytopathology taken
fluid needle aspiration
fluid
nipple discharge
nipple scrape
how is FNA staged from C1-5
C1 unsatisfactory C2 benign C3 atypia, probs benign C4 suspicious of malignancy C5 malignancy
what are the two types of breast histopathology and how is each one done
diagnostic - needle core biopsy, vacuum assisted biopsy, skin biopsy, incisional biopsy
therapeutic - excision biopsy of mass, resection of cancer (wide local excision of mastectomy)
how is a needle core biopsy graded from B1-5
B1A unstisfactory/normal B2 benign B3 atypia, probs benign B4 suspicious of malignancy B5 malignant B5a carcinoma in situ B5b invasive carcinoma
what are some developmental anomalies of breasts
hypoplasia
juvenile hypertrophy - usually one but can be both
accessory breast tissue - commonly at the axilla and becomes evident when hormonal state changes
accessory nipple
inflammatory benign breast disease (3)
fat necrosis
duct ectasia
acute mastitis/abscess
what is gynaecomastia
what kind of growth
breast develop,emt in the male
ductal growth without lobular development
what are some causes of gynaecomastia
exogenous/endogenous hormone
cannabis
prescription drugs
liver disease
who does fibrocystic change occur in
women aged 20-50 but commonest in women aged 40-50
risk factors for fibrocystic change
menstrual abnormalities
early menarche
late menopause
often resolve or diminish after menopause
link between breast cancer and fibrocystic change
same risk factors
can have co existing breast cancer
fibrocystic change presentation
smooth discrete lumps sudden pain form rupture of cysts cyclic pain which changes with menstrual cycle lumpiness incidental finding screening
gross pathology of fibrocystic change of the cysts
1mm- several cm
blue domes with pale fluid
usually multiple
associated with other benign changes
microscopic pathology of cysts with fibrocystic change
thin walled but may have fibrotic wall
lined by apocrine epithelium
management of fibrocystic change
exclude malignancy
reassure
excise if necessary
what is hamartoma
circumscribed lesion composed of cell types normal to the breast but present in an abnormal proportion or distribution
treatment of hamartoma
left alone as it does not cause issues
how common is fibroadenoma
common
commoner in african women
usually solitary (10% multiple)
doesn’t invade the tissue like cancer does
fibroadenoma age
presentation
peak incidence in 30s
can be picked up on screening
painless, firm, discrete mobile mass
“breast mouse”
US of fibroadenoma
solid on USS
description of a fibroadenoma
circumscribed
rubbery
grey-white colour
biphasic tumour/lesion - epithelium, stroma
treatment of fibroadenoma
diagnose
reassure
excise
when can a fibroadenoma grow rapidly
during pregnancy
what are the types of scelrosing lesions
sclerosis adenomas
radial scar/complex sceloring lesion (CSL)
what are sclerosising lesions
what can they cause
what can they mimic
benign
disorderly proliferation of acini and stroma
mass or calcification
carcinoma
sclerosising adenosis presentation
pain, tenderness, lumpiness/thickening
often asymp
age 20-70
risk of carcinoma + sclerosising adenosis
its benign and there is no risk of subsequent carcinoma
radial scar age
is it common
how is it found
ix
wide age range
common - 67% multi centric, 43% bilateral
incidental finding
mamographically detected
different between a radial scar and CSL
RS 1-9mm
CSL >10mm
pathology of a radial scar
stellate architecture
central puckering
radiating fibrosis
histology of radial scar
fibroelastic core
radiating fibrosis contains distorted ductules
fibrocystic change
epithelial proliferation
what does a radial scar mimic
is it premalignant
what it often show and what can happen in these
mimic carcinoma radiologically
not exactly
epitelial proliferation - in situ or invasive carcinoma may occur within these lesions
treatment of radial scar
excise or sample extensively by vacuum biopsy
now biopsy done more
causes for fat necrosis
what is it associated with
local trauma e.g. seat belt injury
associated with warfarin therapy - minor trauma can cause bleeding and damage to the fat
what happen during fat necrosis and what does it lead to
damage and disruption of adipocytes
infiltration by acute inflam cells
fibrosis and scarring - can cause contraction and a mass - can be month after initial injury
management of fat necrosis
confirm diagnosis
exclude malignancy
reassure
duct ectasia clinicas features
affect sub areolar ducts leading to dilatation
pain
acute episodic inflam changes - periductal inflam
bloody and or purulent discharge
fistulation
nipple retraction and distortion
periductal fibrosis
why does duct ectasia occur
keratin plugging causing stasis of secretion which can lead to infection
what is associated with duct ectasia
smoking
management of duct eurasia
treat acute infections
exclude malignancy
stop smoking
excise ducts
two main causes for acute mastitis/abscess
duct ectasia - mixed organisms, anaerobes
lactation - SA, strep pyogenes
management of acute mastitis/abscess
antibiotics
percutaneous drainage under USS guidance
incision and drainage
treat underlying cause - correct way for breastfeeding
what does phyllodes tumour look like
clinical features
cut surface looks like a leaf
40-50
slow growing unilateral breast mass
what kind of tumour is phyllodes
what does its behaviour depend on
graded how
biphasic - stromal overgrowth
behaviour depends on stromal features
benign, borderline, malignant (sarcomatous)
behaviour of phyllodes tumour
prone to local recurrence if not adequately excised
rarely metastasise
3 types of papillary lesions
introduct papilloma
nipple adenoma
encysted papillary carcinoma
age intraduct
signs/symp
35-60
nipple discharge +/or blood
asymp at screening - nodules and calcifications
description of intraduct papilloma
sub areolar ducts
2-20 mm diameter
papillary fronds containing a fibrovascular core
covered by my-epithelium and epithelium
epithelium may show proliferative activity
grading of epithelial proliferation in intraduct papilloma
none (benign)
usually type hyperplasia (benign)
atypical ductal hyperplasia - IDP with ADH
ductal carcinoma in situ - IDP with DCIS
treatment for intraduct papilloma
mostly excise other than the in situ carcinoma with is treated like an in situ carcinoma
