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3 Reproduction > Breast Pathology 1 > Flashcards

Breast Pathology 1 Flashcards

1
Q

what is the triple assessment for a patient with breast disease

A

clinical (history and exam)

imaging (mammogram, ultrasound, MRI)

pathology (cytopathology (cells), histopathology (tissue))

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2
Q

how do you obtain samples for breast cytopathology

A

Fine needle aspiration

Fluid from cysts

Nipple discharge

Nipple scrape

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3
Q

what do normal breast epithelial cells look like

A

honeycomb sheets

lots of small cells

normal nucleus to cytoplasm ratio

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4
Q

what do malignant breast epithelial cells look like

A

swollen cells

high nuclear to cytoplasm ratio

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5
Q

how do you classify fine needle aspiration cytology (breast)

A 
C1- unsatisfactory 
C2- benign 
C3- atypia, probably benign 
C4- suspicious of malignancy 
C5- malignant
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6
Q

what diagnostic procedures are done to get a sample

A

needle core biopsy
vacuum assisted biopsy (large volume)
skin biopsy
incisional biopsy of mass

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7
Q

what therapeutic procedures are done to obtain tissue

A

Vacuum assisted excision
Excisions biopsy of mass
Resection of cancer (wide local excision, mastectomy)

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8
Q

how do you classify Needle Core Biopsy samples

A 
B1 - unsatisfactory 
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 are benign developmental abnormalities of the breast

A

hypoplasia
juvenile hypertrophy
accessory breast tissue (most common in axilla)
accessory nipple

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10
Q

what are some non-neoplasia breast pathologies

A 
Gynaecomastia 
Fibrocystic change 
Hamartoma 
Fibroadenoma 
Sclerosing lesions 
(sclerosiing adenomas, radial scar/complec sclerosing lesions)
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11
Q

what are some inflammatory benign breast diseases

A

fat necrosis
duct ectasia
acute mastitis/abcess

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12
Q

what are some benign tumours of the breast

A

phyllodes tumour

intraduct papilloma

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13
Q

what is gynaecomastia

A

breast development in the male

ductal growth without lobar development

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14
Q

causes of gynacomastia

A

exogenous/endogenous hormones
cannabis
prescription drugs
liver disease

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15
Q

what is fibrocystic change

A

cyst formation in the breast

associated with: 
menstrul abnormalities 
early menarche 
late menopause 
often resolve or diminish after menopause

very common

women aged 20-50

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16
Q

how does fibrocystic change present

A 
smooth discrete lumps (cysts) 
sudden pain 
cyclical pain 
lumpiness 
incidental finding  
picked up in screening
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17
Q

pathology of cysts in fibrocystic change

A

cysts are 1mm - several cm

blue domed with pale fluid

usually multiple

associated with other benign changed

intervening fibrosis

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18
Q

what does fibrocystic change look like in microscopic pathology

A

cysts have an apocrine lining

thin walled

abundant pink cytoplasm

19
Q

how do you manage fibrocystic change

A

exclude malignancy
reassure
excise if 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

what is a fibroadenoma

A

painless, firm, discrete, mobile mass

solid on ultrasound

‘breast mouse’ - move away from your finger as you try to examine

rubbery

grey-white colour

biphasic tumour/lesion

  • localised hyperplasia
  • proliferation of interlobular stroma and epithelium
22
Q

treatment for fibroadenoma

A

diagnose
reassure
excise

23
Q

what are the types of sclerosing lesions

A

sclerosisng adenosis

radial scar/complex sclerosing lesion

24
Q

what are sclerosing lesions

A

benign disorderly proliferation of acini and storm

can cause mass or calcification

may mimic carcinoma

25
Q

what is sclerosing adenosis

A

pain, tenderness or lumpiness/thickening

asymptomatic

age 20-70

26
Q

what is a radial scar

A

common
usually asymptomatic benign breast change

1-9cm (if >10cm it is a complex sclerosing lesion)

27
Q

pathology of a radial scar

A

stellate architecture
central puckering
radiating fibrosis

28
Q

histology of a radial scar

A

fibroelastic core
radiating fibrosis containing distorted ductules
fibrocystic change
epithelial proliferation

29
Q

what does a radial scar mimic radiologically

A

carcinoma

not premalignant but insitu or invasive carcinoma can occur within the lesions

30
Q

treatment for radial scar

A

excise or sample extensively by vacuum biopsy

31
Q

what is fat necrosis

A

inflammation caused by local trauma

  • seat belt injury
  • can be caused by warfarin therapy
32
Q

pathology of fat necrosis

A

damage and disruption of adipocytes

infiltration by acute inflammatory cells

‘foamy’ macrophages

subsequent fibrosis and scarring

33
Q

how do you manage fat necrosis

A

confirm diagnosis

exclude malignancy

34
Q

what is duct ectsia

A

inflammation effecting the sub-areolar ductus

presents with:

  • pain
  • acute episodic inflammatory changes
  • bloody/purulent discharge
  • fistulation
  • nipple retraction and distortion
35
Q

what is duct ectasia associated with

A

smoking

36
Q

management of duct ectasia

A

treat acute infections
exclude malignancy
stop smoking
excise ducts

37
Q

what is acute mastitis/absess

A

2 types

duct ectasia
-mixed organisms

lactation

  • staph aureus
  • strep pyroxenes
38
Q

management of acute mastitis/abscess

A

antibiotics
percutaneous drainage
incision and drainage
treat underlying cause

39
Q

what benign breast tumours are there

A

phyllodes tumour

intraduct papilloma

40
Q

what is a phyllodes tumour

A

slow growing unilateral breast mass

caused by a stomal overgrowth

can be malignant but mostly benign (depends on the stomal features)

most common ages 40-50

prone to local recurrence if not adequately excised

rarely metastasise

41
Q

what breast papillary lesions are there

A

intraduct papilloma
nipple adenoma
encapsulated papillary carcinoma

42
Q

what is an intraduct papilloma

A

nodules and calcification in sub-areolar ducts

2-20mm diameter

papillary fronds containing a fibrovascular care

covered by myoepithelium and epithelium

epithelium may show proliferative activity

nipple discharge + blood

age 35-60

different types of epithelial proliferation seen

43
Q

what types of epithelial proliferation are seen with intraduct papillomas

A

none - benign

usual type hyperplasia - benign

atypical ductal hyperplasia (IDP with ADH)

ductal carcinoma in situ (IDP with DCIN, papillary DCIS)

3 Reproduction (49 decks)

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