Breast Pathology 1 Flashcards
1
Q
What kind of assessment is done in someone with breast disease?
A
A triple assessment
2
Q
Outline the 3 categories of the triple assessment.
A
Clinical:
- History
- Examination
Imaging:
- Mammography
- US
- MRI
Pathology:
- Cytopathology
- Histopathology
3
Q
List the 4 different samples that can be used in breast cytopathology.
A
- Fine needle aspiration (FNA)
- Fluid
- Nipple discharge
- Nipple scrape
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
5
Q
Breast histopathology can be __________ or ___________
A
Diagnostic or therapeutic
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
7
Q
Outline the 2 different methods of therapeutic breast histopathology.
A
- Excisional biopsy of mass
* Resection of cancer – wide local excision/mastectomy
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
9
Q
What stage of carcinoma will spread beyond the BM of where it started?
A
B5b
10
Q
Carcinoma in situ can become invasive
A
FALSE - it is confined to the BM
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’
12
Q
Where can accessory nipple occur?
A
Anywhere on the milk line
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
14
Q
Name 3 benign inflammatory pathologies that can occur in the breast.
A
- Fat necrosis
- Duct ectasia
- Acute mastitis/abscess
15
Q
Name 2 benign tumours of the breast?
A
- Phyllodes tumour
* Intraduct Papilloma
16
Q
What is gynaecomastia?
A
Breast development in the male
17
Q
Describe gynaecomastia in males.
A
Duct growth with NO lobular development
18
Q
List 4 causes of gynaecomastia.
A
- Exogenous/endogenous hormones
- Cannabis
- Prescription drugs
- Liver disease
19
Q
What is a good way to think of the pathology of gynaecomastia in males?
A
InDUCTion of breasts in males
20
Q
In what women do fibrocystic changes occur?
A
20-50 years but mostly 40-50 years
21
Q
Fibrocystic breast changes are very rare
A
FALSE - they are very common
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
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
24
Q
What are the 2 most common presenting features of someone with fibrocystic changes in their breast?
A
Sudden pain
25
Describe the appearance of cysts.
Blue with pale fluid
26
How big are breast cysts?
Anywhere from 1mm to several cm's
27
What are breast cysts usually associated with?
Other benign changes
28
Cysts are usually multiple
TRUE
29
Describe the microscopic appearance of cysts.
* Thin walled but may have fibrotic wall
| * Lined by apocrine epithelium
30
Outline the management of cysts.
* Exclude malignancy
* Reassure
* Excise if necessary
31
What is a hamartoma?
“Circumscribed lesion composed of cell types normal to the breast but present in an abnormal proportion or distribution”
32
What is a fibroadenoma?
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.
33
Are fibroadenomas common?
YES - found in around 17% of autopsies
34
Who are fibroadenomas more common in?
African women and premenopausal women
35
Are fibroadenomas usually singular or multiple?
Singular - although 10% are multiple
36
How does a fibroadenoma appear on US?
Solid
37
What is the colloquial term for a fibroadenoma?
Breast mouse
38
Describe the macroscopic appearance of a fibroadenoma.
Painless, firm, discrete (you can feel around the lesion), mobile mass
* Circumscribed
* Rubbery
* Grey-white colour
39
Describe the microscopic appearance of a fibroadenoma?
Biphasic tumour/lesion - with both components:
* epithelium
* stroma
NOTE: both these components are in equal quantities
40
Outline the management of a fibroadenoma.
* Diagnose
* Reassure
* Excise (not really offered anymore unless they are growing or changing)
41
What are the 2 different types of sclerosing breast lesions?
* Sclerosing adenosis
| * Radial scar/ complex sclerosing lesion
42
What are sclerosing lesions of the breast?
Benign, disorderly proliferation acini and stroma which can cause a mass or calcification
43
What benign breast pathology may mimic a carcinoma?
Sclerosing lesions
44
Does sclerosing adenosis have a risk of becoming cancerous?
NO
45
Describe the presentation of sclerosing adenosis.
* Pain
* Tenderness
* Lump/thickness
* Asymptomatic
* Age 20-70
46
Who gets radial scars?
A wide range of women
47
When are radial scars often incidentally found?
Mammograms
48
What is the difference between a radial scar and CSL?
Radial scar – if 1-9 mm
| CSL (complex sclerosing lesion) – if >10 mm
49
Describe the key pathological features of a radial scar.
* Stellate architecture
* Central puckering
* Radiating fibrosis
50
Outline the key histological features of a radial scar.
* Fibroelastoic core
* Radiating fibrosis, containing distorted ductules
* Fibrocystic change
* Epithelial proliferation
51
What may a radial scar mimic radiologically?
Carcinoma
52
Is a radial scar premalignant?
NO
53
What can occur within radial scars?
In situ or invasive carcinoma
54
Outline the management of radial scars.
Excise or sample extensively by vacuum biopsy
55
List the 2 most common causes of fat necrosis in the breast.
* Local trauma – seat belt injury, frequently no history, dog jumping up
* Warfarin !!
56
What is the key pathological feature of fat necrosis?
‘Foamy’ macrophages
57
Outline the 4 main pathological features of fat necrosis.
* Damage and disruption of adipocytes
* Infiltration by acute inflammatory cells
* ‘Foamy’ macrophages
* Subsequent fibrosis and scarring
58
Outline the management of fat necrosis.
* Confirm diagnosis
| * Exclude malignancy
59
Outline the key clinical features of duct eurasia.
* Affects sub-areolar ducts
* Pain
* Acute episodic inflammatory changes
* Bloody +/- discharge
* Fistulation
* Nipple retraction and distortion
60
What happens in duct ectasia?
The lactiferous duct becomes blocked or clogged.
61
What lifestyle choice is duct ectasia associated with?
SMOKING
62
Why does smoking cause duct ectasia?
Smoking causes squamous metaplasia in ducts, the ducts become blocked and swollen and secretions get stuck, this can develop into an abscess
63
* Sub-areolar duct dilatation
* Periductal inflammation
* Periductal fibrosis
* Scarring and distortion
The above are all pathological features of what condition?
Duct Ectasia
64
Outline the management of duct ectasia.
* Treat acute infection
* Exclude malignancy
* Stop smoking
* Excise ducts
65
What are the 2 main causes of acute mastitis/abscess?
1. Duct ectasia – mixed organisms, anaerobes
| 2. Lactation – Staph aureus, Strep pyogenes
66
Why is breastfeeding a common cause of mastitis?
Breastfeeding is a common cause of this due to skin trauma from suckling
67
Outline the management of mastitis.
* Antibiotics
* Percutaneous drainage
* Incision and drainage
* Treat underlying cause
68
What tumour is leaf shape?
Phyllodes
69
Describe the main clinical features of phyllodes tumour?
* 40-50 years
* Slow growing unilateral breast mass
* LEAF shape !!
70
Biphasic tumour with stromal overgrowth. What is this?
Phyllodes tumour
71
What are the 3 different categories of phyllodes tumour?
* ‘Benign.’
* Borderline
* Malignant (sarcomatous)
72
What is the management for borderline/malignant phyllodes tumour?
Wide excision
73
Phyllodes tumour rarely mets
TRUE
74
The main 3 breast papillary lesions are ...
* Intraduct papilloma
* Nipple adenoma
* Encysted papillary carcinoma
75
What age group gets intraduct papilloma?
35-60 years
76
What is the characteristic symptom of intraduct papilloma?
Nipple discharge +/- blood !! – but may be asymptomatic at screening
77
Discharge + blood is very worrying. What must you exclude?
Malignancy
78
What is seen on breast screening of someone with an intraduct papilloma?
* Calcification
| * Nodules
79
Where is intraduct papilloma usually found?
Sub-areolar ducts
80
How big are intraduct papillomas?
2-20 mm diameter
81
Different types of epithelial proliferation may occur in these types of papilloma. What are the different types of proliferation?
* None
* Usual type hyperplasia
* Atypical ductal hyperplasia
* Ductal carcinoma in situ
82
Papillary fronds containing a fibrovascular core
Covered by myoepithelium and epithelium
What are both the above features of?
Intraduct papilloma
83
What may epithelium of an intraduct papilloma show?
Proliferative activity
