breast pathology 1 Flashcards
state the different methods of obtaining breast tissue for diagnostic biopsy
FNA core biopsy vacuum assisted biopsy skin biopsy incisional biopsy of mass
state the categories for FNA cytology and core biopsy ?
FNA C1- unsatisfactory C2- benign C3- Atypic, probs benign C4- suspicious of malignancy C5-Malignant
Core Biopsy B1 - Unsatisfactory / normal B2 - Benign B3 - Atypia, probably benign B4 - Suspicious of malignancy B5 - Malignant B5a - carcinoma in situ B5b - invasive carcinoma
name 4 developmental anomalies of the breast
-hypoplasia
juvenile hypertrophy
accessory breast tissue
accessory nipple
give 5 non-neoplastic breast diseases
Gynaecomastia Fibrocystic change Hamartoma Fibroadenoma Sclerosing lesions (sclerosing adenosis/ radial scar/complex sclerosing lesion)
give 3 inflammatory breast diseases
Fat necrosis
duct ectasia
Acute mastitis/abscess
Give 2 benign breast tumours
phyllodes tumour
intraduct papilloma
What is Gynaecomastia?
-causes? (4)
breast development in the male, i.e. ductal growth with out lobular development
-exogenous/endogenous hormones
cannabis
prescription drugs
Liver disease
Fibrocystic change
- most common in what group
- predisposing factors? (3)
- presentation? (5)
- describe the gross & microscopic pathology of cysts
- management
-women aged40-50
-menstrual abnormalities
early menarche
late menopause (often diminish post menopause)
-smooth discrete lumps sudden pain cyclical pain lumpiness incidental finding (common on screening)
-GROSS 1mm-several cm blue domes with pale fluid usually multiple assoc with other benign changes MICRO -thin walled but may have fibrotic wall -lined by apocrine epithelium
-exclude malignancy
reassure
excise if necessary
Hamartoma
-what is it?
-circumscribed lesion composed of cell types normal to the breast but present in normal proportion/distribution
fibroadenoma
- commoner in what group?
- presentation?
- Gross pathology?
- micropathology
- management
-African women, 3rd decade
-painless, firm, discrete, mobile mass
solid on US
tissue planes are pushed apart and not infiltrated
-Circumscribed
Rubbery
Grey-white colour
Biphasic tumour/lesion
-localised hyperplasia
proliferation of interlobular stroma
-diagnose, reassure, excise
breast tissue remodels rapidly after excision
can grow rapidly in pre/COCP
Sclerosing lesions
- what are they?
- general characteristics
- benign, disorderly proliferation of acini and stroma
- can cause a mass or calcification and may mimc carcinoma
Sclerosing adenosis
- presentation
- risk of subsequent carcinoma?
-pain/tenderness or lumpiness/thickening
can also be asymptomatic
from 20-70 yrs old
-negligible
Radial scar
- common pattern?
- pathology?
- histology?
- management
-multicentric and bilateral
often incidental finding on mammography
-1-9mm (becomes complex sclerosing lesion if >10mm) stellate architecture central puckering radiating fibrosis (can appear like a stellate carcinoma)
-fibroelastotic core
radiating fibrosis containing distorted ductules
fibrocystic change
epithelial proliferation
-can mimic carcinoma radiologically
in situ or invasive carcinoma may occur within these lesions so better to treat and excise
fat necrosis
- causes?
- pathology
- management
-Local trauma e.g. seat belt, often no Hx
might be on Warfarin
- cytoplasm appears foamy
- confirm Dx and exclude malignancy
Duct ectasia
- what is it?
- clinical features?
- associated with?
- pathology?
- management?
-stasis of secretions resulting in blockage of ducts
-affects subareolar ducts painful acute and episodic inflammatory changes bloody and/or purulent discharge fistulation Nipple retraction and dostortion
-smoking
-periductal inflammation
periductal fibrosis
+ scarring and distortion
-treat acute infections
exclude malignancy
stop smoking
excise ducts
