Breast Pathology 1 Flashcards
what is the triple assessment for a patient with breast disease
clinical (history and exam)
imaging (mammogram, ultrasound, MRI)
pathology (cytopathology (cells), histopathology (tissue))
how do you obtain samples for breast cytopathology
Fine needle aspiration
Fluid from cysts
Nipple discharge
Nipple scrape
what do normal breast epithelial cells look like
honeycomb sheets
lots of small cells
normal nucleus to cytoplasm ratio
what do malignant breast epithelial cells look like
swollen cells
high nuclear to cytoplasm ratio
how do you classify fine needle aspiration cytology (breast)
C1- unsatisfactory C2- benign C3- atypia, probably benign C4- suspicious of malignancy C5- malignant
what diagnostic procedures are done to get a sample
needle core biopsy
vacuum assisted biopsy (large volume)
skin biopsy
incisional biopsy of mass
what therapeutic procedures are done to obtain tissue
Vacuum assisted excision
Excisions biopsy of mass
Resection of cancer (wide local excision, mastectomy)
how do you classify Needle Core Biopsy samples
B1 - unsatisfactory B2- benign B3- atypia, probably benign B4- suspicious of malignancy B5- malignant B5a - carcinoma in situ B5b - invasive carcinoma
what are benign developmental abnormalities of the breast
hypoplasia
juvenile hypertrophy
accessory breast tissue (most common in axilla)
accessory nipple
what are some non-neoplasia breast pathologies
Gynaecomastia Fibrocystic change Hamartoma Fibroadenoma Sclerosing lesions (sclerosiing adenomas, radial scar/complec sclerosing lesions)
what are some inflammatory benign breast diseases
fat necrosis
duct ectasia
acute mastitis/abcess
what are some benign tumours of the breast
phyllodes tumour
intraduct papilloma
what is gynaecomastia
breast development in the male
ductal growth without lobar development
causes of gynacomastia
exogenous/endogenous hormones
cannabis
prescription drugs
liver disease
what is fibrocystic change
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
how does fibrocystic change present
smooth discrete lumps (cysts) sudden pain cyclical pain lumpiness incidental finding picked up in screening
pathology of cysts in fibrocystic change
cysts are 1mm - several cm
blue domed with pale fluid
usually multiple
associated with other benign changed
intervening fibrosis
what does fibrocystic change look like in microscopic pathology
cysts have an apocrine lining
thin walled
abundant pink cytoplasm
how do you manage fibrocystic change
exclude malignancy
reassure
excise if necessary
what is a hamartoma
circumscribed lesion composed of cell types normal to the breast but present in an abnormal proportion or distribution
what is a fibroadenoma
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
treatment for fibroadenoma
diagnose
reassure
excise
what are the types of sclerosing lesions
sclerosisng adenosis
radial scar/complex sclerosing lesion
what are sclerosing lesions
benign disorderly proliferation of acini and storm
can cause mass or calcification
may mimic carcinoma
what is sclerosing adenosis
pain, tenderness or lumpiness/thickening
asymptomatic
age 20-70
what is a radial scar
common
usually asymptomatic benign breast change
1-9cm (if >10cm it is a complex sclerosing lesion)
pathology of a radial scar
stellate architecture
central puckering
radiating fibrosis
histology of a radial scar
fibroelastic core
radiating fibrosis containing distorted ductules
fibrocystic change
epithelial proliferation
what does a radial scar mimic radiologically
carcinoma
not premalignant but insitu or invasive carcinoma can occur within the lesions
treatment for radial scar
excise or sample extensively by vacuum biopsy
what is fat necrosis
inflammation caused by local trauma
- seat belt injury
- can be caused by warfarin therapy
pathology of fat necrosis
damage and disruption of adipocytes
infiltration by acute inflammatory cells
‘foamy’ macrophages
subsequent fibrosis and scarring
how do you manage fat necrosis
confirm diagnosis
exclude malignancy
what is duct ectsia
inflammation effecting the sub-areolar ductus
presents with:
- pain
- acute episodic inflammatory changes
- bloody/purulent discharge
- fistulation
- nipple retraction and distortion
what is duct ectasia associated with
smoking
management of duct ectasia
treat acute infections
exclude malignancy
stop smoking
excise ducts
what is acute mastitis/absess
2 types
duct ectasia
-mixed organisms
lactation
- staph aureus
- strep pyroxenes
management of acute mastitis/abscess
antibiotics
percutaneous drainage
incision and drainage
treat underlying cause
what benign breast tumours are there
phyllodes tumour
intraduct papilloma
what is a phyllodes tumour
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
what breast papillary lesions are there
intraduct papilloma
nipple adenoma
encapsulated papillary carcinoma
what is an intraduct papilloma
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
what types of epithelial proliferation are seen with intraduct papillomas
none - benign
usual type hyperplasia - benign
atypical ductal hyperplasia (IDP with ADH)
ductal carcinoma in situ (IDP with DCIN, papillary DCIS)
