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Repro > Breast Pathology 1 > Flashcards

Breast Pathology 1 Flashcards

1
Q

What is the triple assessment of the breast?

A

Clinical examination
Imaging
Pathology

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2
Q

What are ways to assess Breast cytopathology?

A

Fine needle aspiration
Fluid
Nipple discharge
Nipple scrape

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3
Q

What are the breast FNA cytology?

A 
C1 - Unsatisfactory
C2 - Benign
C3 - Atypia, probs benign
C4 - Suspicious of malignancy
C5 - Malignant
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4
Q

What are diagnostic measures of breast histopathology?

A

Core biopsy
Vacuum assisted biopsy
Skin biopsy
Incisional biopsy of mass

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5
Q

What are therapeutic measures of breast histopathology?

A

Excisional biopsy of mass
Resection of cancer - Wide local excision
- Mastectomy

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6
Q

What are the results of a core biopsy?

A 
B1 - Unsatisfactory/Normal
B2 - Benign
B3 - Atypia, probs benign
B4 - Suspicious
B5 - Malignant
B5a - Carcinoma in situ
B5b - Invasive carcinoma
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7
Q

Name developmental anomalies of benign breast disease? (4)

A

Hypoplasia
Juvenile hypertrophy
Accessory breast tissue
Accessory nipple

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8
Q

What are non-neoplastic pathologies of benign breast disease? (5)

A 
Gynaecomastia
Fibrocystic change
hamartoma
Fibroadenoma
Sclerosing lesions
- Sclerosing adenosis 
- Radial scar/complex sclerosing lesions
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9
Q

What are inflammatory pathologies of benign breast disease? (3)

A

Fat necrosis
Duct ectasia
Acute mastitis/abscess

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10
Q

What are tumour pathologies of benign breast disease? (2)

A

Phyllodes tumour

Intraduct papilloma

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11
Q

What is Gynaecomastia?

A

Breast development in males

Ductal growth without lobular development

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12
Q

What can cause gynaecomastia?

A

Exogenous/endogenous hormones
Cannabis
Prescription drugs
Liver disease

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13
Q

Who are more likely to get fibrocystic change?

A

Women aged 20-50

Mainly 40-50

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14
Q

What are causes of fibrocystic change?

A

Menstrual abnormalities
Early menarche
late menopause

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15
Q

When is fibrocystic change usually resolved or diminished?

A

After menopause

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16
Q

How does fibrocystic change present?

A 
Smooth discrete lumps
Sudden pain 
Cyclical pain
Lumpiness
Incidental finding
Screening
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17
Q

What are the cysts like in fibrocystic change with regards to gross pathology?

A 
1mm - several cm's
Blue domed with pale fluid
usually multiple
Assoc. with other benign changes
Intervening fibrosis
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18
Q

What are the cysts like in fibrocystic change with regards to microscopic pathology?

A

Thin walled but may have fibrotic wall
Lined by apocrine epithelium
Intervening fibrosis

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19
Q

What is the management of fibrocystic change?

A

Exclude malignancy
Reassure
Excise of necessary

20
Q

What is a Hamartoma?

A

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

21
Q

Who are more likely to get a fibroadenoma?

A

African women

22
Q

What are the clinical features of fibroadenoma?

A

Peak incidence in 3rd decade
Screening
Painless, firm, discrete, mobile mass
“Breast mouse”

23
Q

How does a fibroadenoma appear on USS?

A

Solid

24
Q

Describe a fibroadenoma?

A 
Circumscribed
Rubbery
Grey-white colour
Biphasic tumour/lesion
- Epithelium
- Stroma
25
Q

How do you manage a fibroadenoma?

A

Diagnose
Reassure
Excise

26
Q

Describe sclerosing lesions?

A 
Sclerosing adenosis
Radial scar/ complex sclerosing lesion
Benign, disorderly proliferation of acini and storma
Can cause a mass or calcification
May mimic carcinoma
27
Q

What are the signs/symptoms of sclerosing adenosis?

A 
Pain
Tenderness
Lumpiness/thickening
Asymptomatic
Age 20-70
28
Q

Is sclerosing adenosis benign or malignant?

A

Benign

29
Q

Describe a radial scar?

A 
Stellate architecture
Central punching
Radiating fibrosis
RS =1-9mm
CSL=>10mm
30
Q

What is the histology of a radial scar?

A

Fibroelastotic core
Radiating fibrosis containing distorted ductules
Fibrocystic change
Epithelial proliferation

31
Q

What does a radial scar often show?

A

Epithelial proliferation

32
Q

How do you manage a radial scar?

A

Excise or sample via vacuum biopsy

33
Q

What cancers may arise from a radial scar?

A

In situ carcinoma

Invasive carcinoma

34
Q

What can cause fat necrosis?

A

Seat belt trauma

Warfarin therapy

35
Q

What happens in fat necrosis?

A

Damage and disruption of adipocytes
Infiltration by acute inflammatory cells
“foamy” macrophages
Subsequent fibrosis and scarring

36
Q

How do you manage fat necrosis?

A

Confirm diagnosis and exclude malignancy

37
Q

What are clinical features of duct ectasia?

A 
It affects the sub-areolar ducts
Pain
Acute episodic inflam changes
Bloody and or purelent discharge
Fistulation
Nipple retraction and distortion
38
Q

What happens in duct ectasia and what is it associated with?

A 
Assoc. with smoking
Sub-areolar duct dilatation
Periductal inflammation
Periductal fibrosis
Scarring and distortion
39
Q

How do you manage duct ectasia?

A

Treat acute infections
Exclude malignancy
Stop smoking
Excise ducts

40
Q

What are the 2 causes of acute mastitis/ an abscess?

A

Duct ectasia - mixed organisms and anaerobes

Lactation - Staph.aureus, Strep pyogenes

41
Q

How do you manage Acute mastitis / Abscess?

A

Antibiotics
Percutaneous drainage
Incision and drainage
Treat underlying cause

42
Q

What are clinical features of Phyllodes tumour?

A

40-50 y/o

Slow growing unilateral breast mass

43
Q

Describe a Phyllodes tumour?

A 
Cystosarcoma phyllodes
Biphasic tumour
Stromal overgrowth
Behaviour depends on stromal features
Benign borderline, malignant (sacromatous)
44
Q

What are 3 papillary lesions?

A

Intraduct papilloma
Nipple adenoma
Encysted papillary carcinoma

45
Q

What are the clinical features of Intraduct papilloma?

A 
Age 35-60
Nipple discharge +/- blood
Asymptomatic at screening
- nodules
- calcification
46
Q

Describe intraduct papilloma?

A

Sub-areolar ducts
2-20mm diameter
Papillary fronds containing a fibrovascular core
Covered by myoepithelium and epithelium
Epithelium may show proliferative activity

47
Q

What type of epithelial proliferation occurs in intraduct papilloma?

A

Usual type is hyperplasia
Atypical ductal hyperplasia
Ductal carcinoma in situ

Repro (46 decks)

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