Breast Pathology 1 Flashcards
triple assessment in breast disease?
clinical (history + examination)
imaging
pathology
4 types of breast cytopathology?
fine needle aspiration
fluid
nipple discharge
nipple scrape
normal breast epithelial cells on NFA?
honeycomb appearance
classification in FNA cytology?
C1-5 1 = unsatisfactory/normal 2 = benign 3 = atypia, probably benign 4 = suspicious of malignancy 5 = malignant
drawback of FNA?
cant tell if malignancy is invasive or still in the ducts
diagnostic histopathology?
needle core biopsy
vacuum assisted biopsy (large volume)
skin biopsy
incisional biopsy of mass
therapeutic histopathology?
vacuum assisted excision
excisional biopsy of mass
resection of cancer (wide local excision or mastectomy)
classification of needle core biopsy?
B1-5 1 = unsatisfactory/normal 2 = benign 3 = atypia, probably benign 4 = suspicious of malignancy 5 = malignancy (5a = in situ, 5b = invasive)
advantage of needle core biopsy over FNA?
can show whether invasive or in situ
4 examples of developmental anomalies in breast?
hypoplasia
juvenile hypertrophy
accessory breast tissue
accessory nipple
non-neoplastic growth in breast?
gynaecomastia fibrocystic change hamartoma fibroadenoma sclerosing lesions (sclerosing adenosis, radial scar/complex sclerosing lesions)
3 benign inflammatory breast diseases?
fat necrosis
duct ectasia
acute mastitis/abscess
benign tumours in breast?
phyllodes tumour
intraduct papilloma
what is gynaecomastia?
breast growth in male
ductal growth without lobular development
what can cause gynaecomastia?
exogenous/endogenous hormones (can have female hormones coming through in breast milk)
cannabis
prescription drugs
liver disease
what is associated with fibrocystic change?
menstrual abnormalities
early menarche
late menopause
often resolve in diminish after menopause
in women of child bearing age (usually late reproductive age)
how might fibrocystic change present?
smooth discrete lumps or general lumpiness
sudden pain (rupture)
cyclical pain
can be an incidental finding
gross pathology in fibrocystic change?
cysts (1mm - several cm) - blue domed with pale fluid - usually multiple - associated with other benign changes can also have intervening fibrosis
describe the cysts seen in fibrocystic change?
thin walled but may have fibrotic wall
lined by apocrine epithelium
abundant pink cytoplasm (low nucleo-cytoplasmic ratio)
management of 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
clinical features of fibroaenoma?
painless, firm, discrete, mobile mass (“breast mouse”)
solid on US
peak incidence in 3rd decade and usually found on screening
physical features of fibroadenoma?
circumscribed
rubbery
grey-white colour
biphasic tumour/lesion (epithelium/stroma)
how is fibroadenoma managed?
diagnose
reassure
excise if needed
types of sclerosing lesions?
sclerosing adenosis
radial scar/complex sclerosing leison
describe sclerosing leisons
benign disorderly proliferation of acini and stroma
can cause a mass or calcification
can mimic carcinoma
describe sclerosing adenosis
pain, tenderness or lumpiness/thickening
can be asymptomatic
usually age 20-70
benign with negligible risk of carcinoma
how are radial scar usually found?
incidental finding on mammogram
very common
features of radial scar?
stellate architecture
central puckering
radiating fibrosis
1-9mm (>10mm = comples sclerosing lesion)
histology of radial scar?
fibroelastic core
radiating fibrosis containing distorted ductules
fibrocystic change
epithelial proliferation
are radial scare malignant?
mimic carcinoma radiologically but probably not pre-malignant per se
often show epithelial proliferation
insitu or invasive carcinoma can occur within the lesion
how is radial scar managed?
excise or sample extensively by vacuum biopsy
what can cause fat necrosis?
local trauma (seat belt injury etc) warfarin therapy
what happens in fate necrosis?
damage and disruption of adipocytes
infiltration by acute inflammatory cells
foamy macrophages form
subsequent fibrosis and scarring
management of fat necrosis?
confirm diagnosis
exclude malignancy
clinical features of duct ectasia?
in sub-areolar ducts pain acute episodic inflammatory changes bloody and/or purulent D/C fistulation nipple retraction and distortion
associations in duct ectasia?
smoking sub-areolar duct dilation peri-ductal inflammation peri-ductal fibrosis scarring and distortion
management of duct ectasia?
treat acute infections
exclude malignancy
stop smoking
excise ducts
2 main causes of acute mastitis/abscess?
duct ectasia (mixed organisms or anaerobes) lactation (staph aureus or strep pyogenes)
management of acutes mastitis/abscess?
antibiotics
percutaneous drainage
incision and drainage
treat underlying cause
clinical features of phyllodes tumour?
40-50 y/o
slow growing unilateral biphasic breast mass
stromal overgrowth
is phyllodes tumour benign or malignant?
depends on stromal features
can be benign, borderline or malignant (sarcoma like)
rarely metastasise
types of papillary lesions in breast?
intraduct papilloma
nipple adenoma
encapsulated papillary carcinoma
clinical features of intraduct papilloma?
usually in age 35-60
nipple discharge +/- blood
nodules and calcification seen at screening
describe the actual growth in intraduct papilloma?
sub areolar ducts
2-20mm diameter
papillary fronds containing a fibrovascular core
covered by myoepithelium and epithelium
epithelium may show proliferative activity (normal/atypical ductal hyperplasia or ductal carcinoma in situ)
types of epithelial proliferation in intraduct papillary leisons?
none
usual type hyperplasia
atypical ductal hyperplasia (still benign)
ductal carcinoma in situ
