Breast Pathology 1 Flashcards
What is the triple assessment of the breast?
Clinical examination
Imaging
Pathology
What are ways to assess Breast cytopathology?
Fine needle aspiration
Fluid
Nipple discharge
Nipple scrape
What are the breast FNA cytology?
C1 - Unsatisfactory C2 - Benign C3 - Atypia, probs benign C4 - Suspicious of malignancy C5 - Malignant
What are diagnostic measures of breast histopathology?
Core biopsy
Vacuum assisted biopsy
Skin biopsy
Incisional biopsy of mass
What are therapeutic measures of breast histopathology?
Excisional biopsy of mass
Resection of cancer - Wide local excision
- Mastectomy
What are the results of a core biopsy?
B1 - Unsatisfactory/Normal B2 - Benign B3 - Atypia, probs benign B4 - Suspicious B5 - Malignant B5a - Carcinoma in situ B5b - Invasive carcinoma
Name developmental anomalies of benign breast disease? (4)
Hypoplasia
Juvenile hypertrophy
Accessory breast tissue
Accessory nipple
What are non-neoplastic pathologies of benign breast disease? (5)
Gynaecomastia Fibrocystic change hamartoma Fibroadenoma Sclerosing lesions - Sclerosing adenosis - Radial scar/complex sclerosing lesions
What are inflammatory pathologies of benign breast disease? (3)
Fat necrosis
Duct ectasia
Acute mastitis/abscess
What are tumour pathologies of benign breast disease? (2)
Phyllodes tumour
Intraduct papilloma
What is Gynaecomastia?
Breast development in males
Ductal growth without lobular development
What can cause gynaecomastia?
Exogenous/endogenous hormones
Cannabis
Prescription drugs
Liver disease
Who are more likely to get fibrocystic change?
Women aged 20-50
Mainly 40-50
What are causes of fibrocystic change?
Menstrual abnormalities
Early menarche
late menopause
When is fibrocystic change usually resolved or diminished?
After menopause
How does fibrocystic change present?
Smooth discrete lumps Sudden pain Cyclical pain Lumpiness Incidental finding Screening
What are the cysts like in fibrocystic change with regards to gross pathology?
1mm - several cm's Blue domed with pale fluid usually multiple Assoc. with other benign changes Intervening fibrosis
What are the cysts like in fibrocystic change with regards to microscopic pathology?
Thin walled but may have fibrotic wall
Lined by apocrine epithelium
Intervening fibrosis
What is the management of fibrocystic change?
Exclude malignancy
Reassure
Excise of necessary
What is a Hamartoma?
Circumscribed lesion composed of cell types normal to the breast but present in an abnormal proportion or distribution
Who are more likely to get a fibroadenoma?
African women
What are the clinical features of fibroadenoma?
Peak incidence in 3rd decade
Screening
Painless, firm, discrete, mobile mass
“Breast mouse”
How does a fibroadenoma appear on USS?
Solid
Describe a fibroadenoma?
Circumscribed Rubbery Grey-white colour Biphasic tumour/lesion - Epithelium - Stroma
How do you manage a fibroadenoma?
Diagnose
Reassure
Excise
Describe sclerosing lesions?
Sclerosing adenosis Radial scar/ complex sclerosing lesion Benign, disorderly proliferation of acini and storma Can cause a mass or calcification May mimic carcinoma
What are the signs/symptoms of sclerosing adenosis?
Pain Tenderness Lumpiness/thickening Asymptomatic Age 20-70
Is sclerosing adenosis benign or malignant?
Benign
Describe a radial scar?
Stellate architecture Central punching Radiating fibrosis RS =1-9mm CSL=>10mm
What is the histology of a radial scar?
Fibroelastotic core
Radiating fibrosis containing distorted ductules
Fibrocystic change
Epithelial proliferation
What does a radial scar often show?
Epithelial proliferation
How do you manage a radial scar?
Excise or sample via vacuum biopsy
What cancers may arise from a radial scar?
In situ carcinoma
Invasive carcinoma
What can cause fat necrosis?
Seat belt trauma
Warfarin therapy
What happens in fat necrosis?
Damage and disruption of adipocytes
Infiltration by acute inflammatory cells
“foamy” macrophages
Subsequent fibrosis and scarring
How do you manage fat necrosis?
Confirm diagnosis and exclude malignancy
What are clinical features of duct ectasia?
It affects the sub-areolar ducts Pain Acute episodic inflam changes Bloody and or purelent discharge Fistulation Nipple retraction and distortion
What happens in duct ectasia and what is it associated with?
Assoc. with smoking Sub-areolar duct dilatation Periductal inflammation Periductal fibrosis Scarring and distortion
How do you manage duct ectasia?
Treat acute infections
Exclude malignancy
Stop smoking
Excise ducts
What are the 2 causes of acute mastitis/ an abscess?
Duct ectasia - mixed organisms and anaerobes
Lactation - Staph.aureus, Strep pyogenes
How do you manage Acute mastitis / Abscess?
Antibiotics
Percutaneous drainage
Incision and drainage
Treat underlying cause
What are clinical features of Phyllodes tumour?
40-50 y/o
Slow growing unilateral breast mass
Describe a Phyllodes tumour?
Cystosarcoma phyllodes Biphasic tumour Stromal overgrowth Behaviour depends on stromal features Benign borderline, malignant (sacromatous)
What are 3 papillary lesions?
Intraduct papilloma
Nipple adenoma
Encysted papillary carcinoma
What are the clinical features of Intraduct papilloma?
Age 35-60 Nipple discharge +/- blood Asymptomatic at screening - nodules - calcification
Describe intraduct papilloma?
Sub-areolar ducts
2-20mm diameter
Papillary fronds containing a fibrovascular core
Covered by myoepithelium and epithelium
Epithelium may show proliferative activity
What type of epithelial proliferation occurs in intraduct papilloma?
Usual type is hyperplasia
Atypical ductal hyperplasia
Ductal carcinoma in situ
