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Year 3 Pathology > Breast Pathology 1 > Flashcards

Breast Pathology 1 Flashcards

1
Q

What does triple assessment of a patient with breast disease involve?

A

Clinical:
• History
• Examination

Imaging:
• Mammography
• USS
• MRI

Pathology:
• Cytopathology
• Histopathology

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2
Q

Methods of undertaking breast cytopathology?

A

Fine Needle Aspiration (FNA)

Fluid

Nipple discharge

Nipple scrape

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3
Q

Results of breast FNA cytology?

A

C1 - unsatisfactory

C2 - benign

C3 - atypia, probably benign

C4 - suspicious of malignancy

C5 - malignant

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4
Q

Methods of undertaking breast histopathology?

A 
Diagnostic:
• (Needle) core biopsy
• Vacuum assisted biopsy (large volume / mammotome) 
• Skin biopsy
• Incisional biopsy of mass

Therapeutic:
• Excisional biopsy of mass
• Resection of cancer (wide local excision or mastectomy)

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5
Q

Results of needle core biopsy?

A

B1 - unsatisfactory / normal

B2 - benign

B3 - atypia, probably benign

B4 - suspicious of malignancy

B5 - malignant:
• B5a - carcinoma-in-situ
• B5b - invasive carcinoma

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6
Q

Broad classifications of benign breast disease?

A
  1. Developmental anomalies
  2. Non-neoplastic
  3. Inflammatory
  4. Tumours
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7
Q

Types of developmental anomalies affecting the breast?

A

Hypoplasia

Juvenile hypertrophy

Accessory breast tissue

Accessory nipple

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8
Q

Non-neoplastic issues affecting the breast?

A

Gynaecomastia

Fibrocystic change

Hamartoma

Fibroadenoma

Sclerosing lesions:
• Sclerosing adenosis
• Radial scar / complex sclerosing lesions (same pathology but size determines the name)

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9
Q

Inflammatory issues affecting the breast?

A

Fat necrosis

Duct ectasia

Acute mastitis / abscess

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10
Q

Benign tumours of breast?

A

Phyllodes tumour

Intraduct papilloma

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11
Q

What is gynaecomastia?

A

Breast development in the male; there is ductal growth WITHOUT lobular development

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12
Q

Causes of gynaecomastia?

A

Exogenous / endogenous hormones

Cannabis use

Prescription drugs

Liver disease (higher levels of circulating oestrogen)

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13
Q

Occurrence of fibrocystic changes?

A

Very common

Women aged 20-50 years (mostly 40-50 years of age)

Most common in women with:
• Menstrual abnormalities,
• Early menarche
• Late menopause, etc

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14
Q

Treatment of fibrocystic changes?

A

Often resolve or diminish after menopause

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15
Q

PC of fibrocystic changes?

A

Smooth discrete lumps

Sudden pain

Cyclical pain

Lumpiness

Could be an incidental finding or picked up at screening

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16
Q

Gross pathology of fibrocystic change?

A

Cysts and intervening fibrosis

Cysts vary from 1mm to several cm in size; they are blue-domed and filled with fluid

NOTE - fibrocystic changes are often assoc. with other benign changes, e.g: sclerosing adenosis

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17
Q

Microscopic pathology of fibrocystic change?

A

Cysts - thin-walled but may have fibrotic wall it is lined by apocrine epithelium

There is intervening fibrosis

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18
Q

Define metaplasia?

A

Change from 1 fully differentiated cell type to another fully differentiated cell type

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19
Q

Management of fibrocystic change?

A

Exclude malignancy and then reassure

Only excise if necessary, e.g: symptomatic

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20
Q

Define a hamartoma?

A

Circumscribed lesion composed of cell types normal to the breast but present in an abnormal proportion or distribution, e.g: mammary hamartoma

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21
Q

Occurrence of fibroadenomas?

A

Common and usually solitary (10% multiple)

More common in African women

Peak incidence in the 3rd decade of life

22
Q

Symptoms of fibroadenoma?

A

Painless, firm, discrete, mobile mass

“breast mouse” - mobile and not fixed

Can be picked up at screening

23
Q

USS appearance of fibroadenoma?

A

Solid on USS

Wider than they are deep

24
Q

Gross pathology of fibroadenoma?

A

Circumscribed, rubbery and grey-white in colour

25
Q

2 components of a fibroadenoma?

A

A biphasic tumour/lesion, i.e: there are 2 elements, of epithelium and stroma

26
Q

Treatment of a fibroadenoma?

A

Diagnose and reassure

Only excise if necessary

27
Q

What are sclerosing lesions?

A

Benign, disorderly proliferation of acini and stroma

May present as a mass or calcification and so it may mimic carcinoma

28
Q

Types of sclerosing lesions?

A
  1. Sclerosing adenosis - occurs between ages of 20-70 years; it is benign and there is negligible risk of subsequent carcinoma
  2. Radial scar / complex sclerosing lesion - affect a wide age range and are common, although often an incidental finding or detected on mammogram (mimic carcinoma); possess stellate architecture, with a central puckering and radiating fibrosis:
    • Radial scar if 1-9mm in size
    • Complex Sclerosing Lesion (CSL) if >10mm
29
Q

Symptoms of sclerosing adenosis?

A

Pain, tenderness or lumpiness/thickening

Can be asymptomatic

30
Q

Histology of a radial scar?

A

Fibroelastic core with radiating fibrosis, containing distorted ductules

Fibrocystic changes

Often show epithelial proliferation, although they are probably not pre-malignant
NOTE - in-situ or invasive carcinoma may occur within these lesions

31
Q

Radiological appearance of radial scar?

A

Mimic carcinoma

NOTE - as they look malignant on radiology, biopsy is required for diagnosis

32
Q

Treatment of radial scar?

A

Excise or sample extensively by vacuum biopsy

33
Q

Inflammatory issues of the breast?

A

Fat necrosis

Duct ectasia

Acute mastitis / abscess

34
Q

Causes of fat necrosis?

A

Local trauma, e.g: seat belt injury, although there is frequently no history

Warfarin therapy

35
Q

Histology of fat necrosis?

A

Damage and disruption of adipocytes

Infiltration by acute inflammatory cells

“Foamy” macrophages

Subsequent fibrosis and scarring

36
Q

Management of fat necrosis?

A

Confirm diagnosis and exclude malignancy

37
Q

What is duct ectasia?

A

Sub-areolar duct dilatation, with periductal inflammation and fibrosis, leading to scarring and distortion

38
Q

Occurrence of duct ectasia?

A

ASSOC. WITH SMOKING

39
Q

Clinical features of duct ectasia?

A

Pain

Acute, episodic inflammatory changes

Bloody and/or purulent discharge

Fistulation

Nipple retraction and distortion

40
Q

Management of duct ectasia?

A

Treat acute infections

Exclude malignancy

Smoking cessation

Excise ducts

41
Q

2 main aetiologies of mastitis / abscess?

A

Duct ectasia (assoc. with smoking) - mixed organisms and anaerobes

Lactating mastitis - mainly Staph. aureus and Strep. pyogenes

42
Q

Management of mastitis / abscess?

A

Antibiotics +/- drainage (if there is an abscess), e.g: percutaneous drainage or incision drainage

Treat underlying cause

43
Q

Benign tumours of breast?

A

Phyllodes tumour (cystosarcoma phyllodes) - biphasic tumour with stromal overgrowth; its behaviour depends on the stromal features. Can be benign, borderline or malignant (sarcomatous)

Intraduct papilloma

44
Q

Occurrence of Phyllodes tumour?

A

Ages 40-50 years

45
Q

PC of Phyllodes tumour?

A

Slow-growing unilateral breast mass

46
Q

Behaviour of Phyllodes tumour?

A

Pathology helps to predict this

If not adequately excised, often recur

Rarely metastasise

47
Q

Papillary lesions of the breast?

A

Intraduct papilloma - occurs at ages 35-60 years; affects the sub-areolar ducts and are 2-20mm in diameter

Nipple adenoma

Encysted papillary carcinoma

48
Q

PC of intraduct papilloma?

A

Nipple discharge +/- blood

Often asymptomatic at screening, where nodules or calcification are found

49
Q

Structure of intraduct papillomas?

A

Papillary fronds containing a fibrovascular core

Covered with myoepithelium and epithelium; the epithelium may show proliferative activity

50
Q

Types of epithelial proliferation with intraduct papillomas (IDP)?

A
  1. None = benign IDP
  2. Usual type hyperplasia = benign IDP
  3. Atypical ductal hyperplasia = IDP with ADH
  4. Ductal carcinoma-in-situ (DCIS):
    • IDP with DCIS
    • Papillary DCIS
51
Q

Do IDPs require treatment?

A

Yes

Year 3 Pathology (9 decks)

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