Breast Pathology 1 Flashcards
What is triple breast assessment?
clinical; imaging and pathology
What are the sampling methods for breast cytopatholgoy?
FNA; fluid; nipple discharge; nipple scrape
What is C1 on breast FNA cytology?
unsatisfactory
What is C2 on breast FNA cytology?
benign
What is C3 on breast FNA cytology?
atypia; probably benign
What is C4 on breast FNA cytology?
suspicious of malignancy
What is C5 on breast FNA cytology?
malignant
What are the diagnostic biopsies for breast histopathology?
needle core biopsy; vacuum assisted biopsy; skin biopsy; incisional biopsy of mass
What are the option for B5 needle core biopsy?
B5a- carcinoma in situ
B5b- invasive carcinoma
What developmental anomalies are seen in the breast?
hypoplasia; juvenile hypertrophy; accessory breast tissue; accessory nipple
What is gynaecomastia?
breast devlopment in the male
What seen pathologicall with gynaecomastia?
ductal growth without lobular devleopment
What are the causes of gynaecomastia?
exogenous/endogenous hormones; cannabis; prescription drugs; liver disease
What age group gets fibrocystic change of the breast?
20-50 years but mainly 40-50
What is fibrocystic change in the breast associated with?
menstrual abnormalities–early menarche; late menopause
When does fibrocystic change in the breast often resolve or diminish?
post-menopause
What is the presentation of fibrocytic change of the breast?
smooth discrete lumps; sudden/cyclical pain; lumpiness
What is seen on pathology with fibrocystic change?
usually multiple blue domed cysts with pale fluid with intervening fibrosis
What is the seen microscopically on pathology with fibrocystic change?
thin walled cysts- may have fibrotic wall; lined by apocrine epithelium
What is metaplasia?
change from one fully differentiated cell type to another fully differentiated cell type
What is hamartoma?
circumscribed benign lesion composed of cell types normal to the breast but in abnormal proportion or distribution
What race tends to get fibroadenoma?
African women
When is the peak incidence of fibroadenoma?
3rd decade
How do fibroadenomas present?
painless; firm; discrete; mobile mass
What other name is given to fibroadenomas?
breast mosue
What is the appearance of fibroadenomas on USS?
solid
What is seen on pathology with fibroadenoma?
circumscribed; rubbery; grey-white; biphasic tumour- epithelium and stroma
What are sclerosing lesions of the breast?
benign; disorderly proliferation of acini and stroma
What makes diagnosis of sclerosing lesions of hte breast?
cause a mass or calcification so my mimic carcinoma
What is the presentation of sclerosing adenosis?
pain; tenderness or lumpiness/thickening; may be asymptomatic
What age group gets sclerosing adenosis?
20-70
What is the prognossi for sclerosing adenosis?
benign with negligible risk of carcinoma
What is the difference between radial scar and complex sclerosing lesion?
radial scar is between 1-9mm; complex sclerosing lesion is >10mm
What are the gross features of a radial scar?
stellate architecture; central puckering; radiating fibrosis;
What are the histological features of a radial scar?
fibroelastotic core; radiating fibrosis containind distored ductules; fibrocystic change; epithlelial proliferation
What is the treatment for radial scar?
excise or sample extensively by vacuum biospy
Why is a radial scar excised if it is benign?
in situ or invasive carcinoma may occur within the lesion
What are the causes of fat necrosis?
local trauma- seat belt injury or surgery; warfarin therapy
What is seen with fat necrosis of the breast?
damage and disruption of adipocytes; infiltration by acute inflammatory cells- “foamy” macrophages; subsequent fibrosis and scarring
What are the clinical features of duct ectasia?
acute episodic inflammatory changes; bloodt and/or purulent discharge; fistulation and nipple retraction and distortion
Which ducts does duct ectasia affect?
sub-areolar ducts
What are the pathological changes with duct ectasia?
sub-areolar duct dilatation; periductal inflammation; periductal fibrosis ; scarring and distortion
What is the main risk factor for developing duct ectasia?
smoking
What is the management of duct ectasia?
treat acute infections; stop smoking; excise ducts
What are the 2 main causes of acute mastitis/abscess?
duct ectasia; lactation
What bugs are involved in acute mastitis caused by duct ectasia?
mixed organisms and anaerobes
What bugs are invovled in acute mastitis caused by lactation?
staph. aureus; strep. pyogenes
What is the management of acute mastitis/abscess?
antibiotics; percut drainage; infection and drainage; treat underlying cause
What age group gets Phyllodes tumour?
40-50 years
What is the clinical feature of phyllodes tumour?
slow growing unilateral breast mass
What are the types of phyllodes tumour?
benign; bordelrine and sarcomatous
What are the pathological features of a phyllodes tumour?
biphasic; stromal overgrowth
What is the prognosis of phyllodes tumour?
prone to local reccurence if not adequately excised; rarely metastasise
Who gets intraduct papilloma?
35-60 years
What are the clinical features of intraduct papilloma?
nipple discharge +/- blood; nodules; calcification
Which ducts does intraduct papilloma affect?
sub-areolar ducts
What is seen pathologically with intraduct papilloma?
papillary fronds containing a fibrovascular core covered with myoepithelium and epithelium- may show proliferative activity
What are the different types of epithelial proliferation seen with intraduct papilloma?
none; usual type hyperplasia; atypical ductal hyperplasia; ductal carcinoma in situ
