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Reproduction and Sexual Health > Breast Pathology 1 > Flashcards

Breast Pathology 1 Flashcards

1
Q

What kind of assessment is done in someone with breast disease?

A

A triple assessment

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2
Q

Outline the 3 categories of the triple assessment.

A

Clinical:

  • History
  • Examination

Imaging:

  • Mammography
  • US
  • MRI

Pathology:

  • Cytopathology
  • Histopathology
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3
Q

List the 4 different samples that can be used in breast cytopathology.

A
  • Fine needle aspiration (FNA)
  • Fluid
  • Nipple discharge
  • Nipple scrape
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4
Q

How are breast samples taken via FNA categories? (hints C)

A 
C1 - Unsatisfactory
C2 - Benign
C3 - Atypia, probably benign
C4 - Suspicious of malignancy
C5 - Malignant
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5
Q

Breast histopathology can be __________ or ___________

A

Diagnostic or therapeutic

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6
Q

Outline the 4 different methods of diagnostic breast histopathology.

A
  • (Needle) core biopsy (this is similar to how the implant is inserted but vice versa)
  • Vacuum assisted biopsy (large volume/mammotome)
  • Skin biopsy
  • Incisional biopsy of mass
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7
Q

Outline the 2 different methods of therapeutic breast histopathology.

A
  • Excisional biopsy of mass

* Resection of cancer – wide local excision/mastectomy

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8
Q

Histopathology samples obtained via core needle biopsy are categoriesd. How is this done?

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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9
Q

What stage of carcinoma will spread beyond the BM of where it started?

A

B5b

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10
Q

Carcinoma in situ can become invasive

A

FALSE - it is confined to the BM

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11
Q

Name 4 benign developmental abnormalities of the breast.

A
  • Hypoplasia
  • Juvenile hypertrophy
  • Accessory breast tissue
  • Accessory nipple – this can occur anywhere on the ‘milk line’
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12
Q

Where can accessory nipple occur?

A

Anywhere on the milk line

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13
Q

Name 5 benign non-invasive pathologies of the breast

A
  • Gynaecomastia
  • Fibrocystic change
  • Hamartoma
  • Fibroadenoma
  • Sclerosing lesions – sclerosing adenosis and radial scar/complex sclerosing lesions
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14
Q

Name 3 benign inflammatory pathologies that can occur in the breast.

A
  • Fat necrosis
  • Duct ectasia
  • Acute mastitis/abscess
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15
Q

Name 2 benign tumours of the breast?

A
  • Phyllodes tumour

* Intraduct Papilloma

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16
Q

What is gynaecomastia?

A

Breast development in the male

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17
Q

Describe gynaecomastia in males.

A

Duct growth with NO lobular development

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18
Q

List 4 causes of gynaecomastia.

A
  • Exogenous/endogenous hormones
  • Cannabis
  • Prescription drugs
  • Liver disease
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19
Q

What is a good way to think of the pathology of gynaecomastia in males?

A

InDUCTion of breasts in males

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20
Q

In what women do fibrocystic changes occur?

A

20-50 years but mostly 40-50 years

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21
Q

Fibrocystic breast changes are very rare

A

FALSE - they are very common

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22
Q

List 4 common features of fibrocystic changes of the breast.

A
  • Menstrual abnormalities
  • Early menarche
  • Late menopause
  • Often resolve or diminish after menopause
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23
Q

Outline the presentation of someone with fibrocystic breast changes.

A
  • Smooth discrete lumps
  • Sudden pain – if bleeding or rupture of cyst
  • Cyclical pain
  • Lumpiness
  • Incidental finding
  • Screening
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24
Q

What are the 2 most common presenting features of someone with fibrocystic changes in their breast?

A

Sudden pain

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25
Q

Describe the appearance of cysts.

A

Blue with pale fluid

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26
Q

How big are breast cysts?

A

Anywhere from 1mm to several cm’s

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27
Q

What are breast cysts usually associated with?

A

Other benign changes

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28
Q

Cysts are usually multiple

A

TRUE

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29
Q

Describe the microscopic appearance of cysts.

A
  • Thin walled but may have fibrotic wall

* Lined by apocrine epithelium

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30
Q

Outline the management of cysts.

A
  • Exclude malignancy
  • Reassure
  • Excise if necessary
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31
Q

What is a hamartoma?

A

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

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32
Q

What is a fibroadenoma?

A

A broad range of solid, benign breast lesions that commonly effect premenopausal women.

Fibroadenomas often present as a palpable breast lump that might feel firm, smooth, rubbery or hard, perhaps like a pea or a grape.

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33
Q

Are fibroadenomas common?

A

YES - found in around 17% of autopsies

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34
Q

Who are fibroadenomas more common in?

A

African women and premenopausal women

35
Q

Are fibroadenomas usually singular or multiple?

A

Singular - although 10% are multiple

36
Q

How does a fibroadenoma appear on US?

A

Solid

37
Q

What is the colloquial term for a fibroadenoma?

A

Breast mouse

38
Q

Describe the macroscopic appearance of a fibroadenoma.

A

Painless, firm, discrete (you can feel around the lesion), mobile mass

  • Circumscribed
  • Rubbery
  • Grey-white colour
39
Q

Describe the microscopic appearance of a fibroadenoma?

A

Biphasic tumour/lesion - with both components:

  • epithelium
  • stroma

NOTE: both these components are in equal quantities

40
Q

Outline the management of a fibroadenoma.

A
  • Diagnose
  • Reassure
  • Excise (not really offered anymore unless they are growing or changing)
41
Q

What are the 2 different types of sclerosing breast lesions?

A
  • Sclerosing adenosis

* Radial scar/ complex sclerosing lesion

42
Q

What are sclerosing lesions of the breast?

A

Benign, disorderly proliferation acini and stroma which can cause a mass or calcification

43
Q

What benign breast pathology may mimic a carcinoma?

A

Sclerosing lesions

44
Q

Does sclerosing adenosis have a risk of becoming cancerous?

A

NO

45
Q

Describe the presentation of sclerosing adenosis.

A
  • Pain
  • Tenderness
  • Lump/thickness
  • Asymptomatic
  • Age 20-70
46
Q

Who gets radial scars?

A

A wide range of women

47
Q

When are radial scars often incidentally found?

A

Mammograms

48
Q

What is the difference between a radial scar and CSL?

A

Radial scar – if 1-9 mm

CSL (complex sclerosing lesion) – if >10 mm

49
Q

Describe the key pathological features of a radial scar.

A
  • Stellate architecture
  • Central puckering
  • Radiating fibrosis
50
Q

Outline the key histological features of a radial scar.

A
  • Fibroelastoic core
  • Radiating fibrosis, containing distorted ductules
  • Fibrocystic change
  • Epithelial proliferation
51
Q

What may a radial scar mimic radiologically?

A

Carcinoma

52
Q

Is a radial scar premalignant?

A

NO

53
Q

What can occur within radial scars?

A

In situ or invasive carcinoma

54
Q

Outline the management of radial scars.

A

Excise or sample extensively by vacuum biopsy

55
Q

List the 2 most common causes of fat necrosis in the breast.

A
  • Local trauma – seat belt injury, frequently no history, dog jumping up
  • Warfarin !!
56
Q

What is the key pathological feature of fat necrosis?

A

‘Foamy’ macrophages

57
Q

Outline the 4 main pathological features of fat necrosis.

A
  • Damage and disruption of adipocytes
  • Infiltration by acute inflammatory cells
  • ‘Foamy’ macrophages
  • Subsequent fibrosis and scarring
58
Q

Outline the management of fat necrosis.

A
  • Confirm diagnosis

* Exclude malignancy

59
Q

Outline the key clinical features of duct eurasia.

A
  • Affects sub-areolar ducts
  • Pain
  • Acute episodic inflammatory changes
  • Bloody +/- discharge
  • Fistulation
  • Nipple retraction and distortion
60
Q

What happens in duct ectasia?

A

The lactiferous duct becomes blocked or clogged.

61
Q

What lifestyle choice is duct ectasia associated with?

A

SMOKING

62
Q

Why does smoking cause duct ectasia?

A

Smoking causes squamous metaplasia in ducts, the ducts become blocked and swollen and secretions get stuck, this can develop into an abscess

63
Q
  • Sub-areolar duct dilatation
  • Periductal inflammation
  • Periductal fibrosis
  • Scarring and distortion

The above are all pathological features of what condition?

A

Duct Ectasia

64
Q

Outline the management of duct ectasia.

A
  • Treat acute infection
  • Exclude malignancy
  • Stop smoking
  • Excise ducts
65
Q

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

A
  1. Duct ectasia – mixed organisms, anaerobes

2. Lactation – Staph aureus, Strep pyogenes

66
Q

Why is breastfeeding a common cause of mastitis?

A

Breastfeeding is a common cause of this due to skin trauma from suckling

67
Q

Outline the management of mastitis.

A
  • Antibiotics
  • Percutaneous drainage
  • Incision and drainage
  • Treat underlying cause
68
Q

What tumour is leaf shape?

A

Phyllodes

69
Q

Describe the main clinical features of phyllodes tumour?

A
  • 40-50 years
  • Slow growing unilateral breast mass
  • LEAF shape !!
70
Q

Biphasic tumour with stromal overgrowth. What is this?

A

Phyllodes tumour

71
Q

What are the 3 different categories of phyllodes tumour?

A
  • ‘Benign.’
  • Borderline
  • Malignant (sarcomatous)
72
Q

What is the management for borderline/malignant phyllodes tumour?

A

Wide excision

73
Q

Phyllodes tumour rarely mets

A

TRUE

74
Q

The main 3 breast papillary lesions are …

A
  • Intraduct papilloma
  • Nipple adenoma
  • Encysted papillary carcinoma
75
Q

What age group gets intraduct papilloma?

A

35-60 years

76
Q

What is the characteristic symptom of intraduct papilloma?

A

Nipple discharge +/- blood !! – but may be asymptomatic at screening

77
Q

Discharge + blood is very worrying. What must you exclude?

A

Malignancy

78
Q

What is seen on breast screening of someone with an intraduct papilloma?

A
  • Calcification

* Nodules

79
Q

Where is intraduct papilloma usually found?

A

Sub-areolar ducts

80
Q

How big are intraduct papillomas?

A

2-20 mm diameter

81
Q

Different types of epithelial proliferation may occur in these types of papilloma. What are the different types of proliferation?

A
  • None
  • Usual type hyperplasia
  • Atypical ductal hyperplasia
  • Ductal carcinoma in situ
82
Q

Papillary fronds containing a fibrovascular core

Covered by myoepithelium and epithelium

What are both the above features of?

A

Intraduct papilloma

83
Q

What may epithelium of an intraduct papilloma show?

A

Proliferative activity

Reproduction and Sexual Health (51 decks)

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