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Repro > Breast pathology 1 > Flashcards

Breast pathology 1 Flashcards

1
Q

what is the triple assessment of a patient

A

clinical - history and exam
imaging - mammography, USS, MRI
pathology - cytopathology, histopathology

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2
Q

how is breast cytopathology taken

A

fluid needle aspiration
fluid
nipple discharge
nipple scrape

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3
Q

how is FNA staged from C1-5

A 
C1 unsatisfactory 
C2 benign 
C3 atypia, probs benign 
C4 suspicious of malignancy 
C5 malignancy
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4
Q

what are the two types of breast histopathology and how is each one done

A

diagnostic - needle core biopsy, vacuum assisted biopsy, skin biopsy, incisional biopsy

therapeutic - excision biopsy of mass, resection of cancer (wide local excision of mastectomy)

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5
Q

how is a needle core biopsy graded from B1-5

A 
B1A unstisfactory/normal 
B2 benign 
B3 atypia, probs benign 
B4 suspicious of malignancy 
B5 malignant 
B5a carcinoma in situ
B5b invasive carcinoma
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6
Q

what are some developmental anomalies of breasts

A

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

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7
Q

inflammatory benign breast disease (3)

A

fat necrosis
duct ectasia
acute mastitis/abscess

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8
Q

what is gynaecomastia

what kind of growth

A

breast develop,emt in the male

ductal growth without lobular development

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9
Q

what are some causes of gynaecomastia

A

exogenous/endogenous hormone
cannabis
prescription drugs
liver disease

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10
Q

who does fibrocystic change occur in

A

women aged 20-50 but commonest in women aged 40-50

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11
Q

risk factors for fibrocystic change

A

menstrual abnormalities
early menarche
late menopause
often resolve or diminish after menopause

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12
Q

link between breast cancer and fibrocystic change

A

same risk factors

can have co existing breast cancer

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13
Q

fibrocystic change presentation

A 
smooth discrete lumps 
sudden pain form rupture of cysts 
cyclic pain which changes with menstrual cycle 
lumpiness
incidental finding 
screening
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14
Q

gross pathology of fibrocystic change of the cysts

A

1mm- several cm
blue domes with pale fluid
usually multiple
associated with other benign changes

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15
Q

microscopic pathology of cysts with fibrocystic change

A

thin walled but may have fibrotic wall

lined by apocrine epithelium

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16
Q

management of fibrocystic change

A

exclude malignancy
reassure
excise if necessary

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17
Q

what is hamartoma

A

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

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18
Q

treatment of hamartoma

A

left alone as it does not cause issues

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19
Q

how common is fibroadenoma

A

common
commoner in african women
usually solitary (10% multiple)

doesn’t invade the tissue like cancer does

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20
Q

fibroadenoma age

presentation

A

peak incidence in 30s
can be picked up on screening
painless, firm, discrete mobile mass
“breast mouse”

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21
Q

US of fibroadenoma

A

solid on USS

22
Q

description of a fibroadenoma

A

circumscribed
rubbery
grey-white colour
biphasic tumour/lesion - epithelium, stroma

23
Q

treatment of fibroadenoma

A

diagnose
reassure
excise

24
Q

when can a fibroadenoma grow rapidly

A

during pregnancy

25
Q

what are the types of scelrosing lesions

A

sclerosis adenomas

radial scar/complex sceloring lesion (CSL)

26
Q

what are sclerosising lesions
what can they cause
what can they mimic

A

benign
disorderly proliferation of acini and stroma

mass or calcification

carcinoma

27
Q

sclerosising adenosis presentation

A

pain, tenderness, lumpiness/thickening
often asymp
age 20-70

28
Q

risk of carcinoma + sclerosising adenosis

A

its benign and there is no risk of subsequent carcinoma

29
Q

radial scar age
is it common
how is it found
ix

A

wide age range
common - 67% multi centric, 43% bilateral
incidental finding
mamographically detected

30
Q

different between a radial scar and CSL

A

RS 1-9mm

CSL >10mm

31
Q

pathology of a radial scar

A

stellate architecture
central puckering
radiating fibrosis

32
Q

histology of radial scar

A

fibroelastic core
radiating fibrosis contains distorted ductules
fibrocystic change
epithelial proliferation

33
Q

what does a radial scar mimic
is it premalignant
what it often show and what can happen in these

A

mimic carcinoma radiologically

not exactly

epitelial proliferation - in situ or invasive carcinoma may occur within these lesions

34
Q

treatment of radial scar

A

excise or sample extensively by vacuum biopsy

now biopsy done more

35
Q

causes for fat necrosis

what is it associated with

A

local trauma e.g. seat belt injury

associated with warfarin therapy - minor trauma can cause bleeding and damage to the fat

36
Q

what happen during fat necrosis and what does it lead to

A

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

37
Q

management of fat necrosis

A

confirm diagnosis
exclude malignancy
reassure

38
Q

duct ectasia clinicas features

A

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

39
Q

why does duct ectasia occur

A

keratin plugging causing stasis of secretion which can lead to infection

40
Q

what is associated with duct ectasia

A

smoking

41
Q

management of duct eurasia

A

treat acute infections
exclude malignancy
stop smoking
excise ducts

42
Q

two main causes for acute mastitis/abscess

A

duct ectasia - mixed organisms, anaerobes

lactation - SA, strep pyogenes

43
Q

management of acute mastitis/abscess

A

antibiotics
percutaneous drainage under USS guidance
incision and drainage
treat underlying cause - correct way for breastfeeding

44
Q

what does phyllodes tumour look like

clinical features

A

cut surface looks like a leaf
40-50
slow growing unilateral breast mass

45
Q

what kind of tumour is phyllodes
what does its behaviour depend on
graded how

A

biphasic - stromal overgrowth

behaviour depends on stromal features

benign, borderline, malignant (sarcomatous)

46
Q

behaviour of phyllodes tumour

A

prone to local recurrence if not adequately excised

rarely metastasise

47
Q

3 types of papillary lesions

A

introduct papilloma
nipple adenoma
encysted papillary carcinoma

48
Q

age intraduct

signs/symp

A

35-60
nipple discharge +/or blood
asymp at screening - nodules and calcifications

49
Q

description of intraduct papilloma

A

sub areolar ducts
2-20 mm diameter
papillary fronds containing a fibrovascular core
covered by my-epithelium and epithelium
epithelium may show proliferative activity

50
Q

grading of epithelial proliferation in intraduct papilloma

A

none (benign)
usually type hyperplasia (benign)
atypical ductal hyperplasia - IDP with ADH
ductal carcinoma in situ - IDP with DCIS

51
Q

treatment for intraduct papilloma

A

mostly excise other than the in situ carcinoma with is treated like an in situ carcinoma

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