Breast Pathology 1: Benign Breast Disease Flashcards
Describe the part of the triple assessment
Clinical = history and examination Imaging= Ultrasound, mammography or MRI Pathology = cytopathology or histopathology
What specimens can be sent for cytopathology
Fine needle aspiration
Fluid
Nipple discharge
Nipple scrape
Describe the results that can come back on FNA cytology
C1- unsatisfactory C2- benign C3- atypia, probably benign C4- suspicious of malignancy C5 - malignant
Describe the results that can come back for a needle core biopsy
B1 - Unsatisfactory / normal B2 - Benign B3 - Atypia, probably benign B4 - Suspicious of malignancy B5 - Malignant B5a - carcinoma in situ B5b - invasive carcinoma
Define cynaecomastia
Breast development in the male
Ductal growth without lobular development
Causes of gynaecomastia
Exogenous/endogenous hormones
Cannabis
Prescription drugs e.g.rispiredone, spironolactone
Liver disease
What age group does fibrocystic change usually occur in
woman aged 40-50 most commonly
can occur in 20-50s group though
What usually causes fibrocystic change
menstrual changes/abnormalities
early menarche
late menopause
usually resolves after menopause
How does fibrocystic change present
Smooth discrete lumps Sudden pain Cyclical pain Lumpiness Incidental finding Can be detected at screening
What is a hamartoma
A circumscribed lesion of cell types normal to the breast but present in abnormal proportion or distribution.
It is benign.
In what race are fibroadenomas more common
African
How common is it to have multiple fibroadenomas
only 10 percent have multiple
usually solitary
What are the clinical features of a fibroadenoma
Peak incidence in 3rd decade Screening Painless, firm, discrete, mobile mass “Breast mouse” Solid on ultrasound
What is a fibroadenoma
localised hyperplasia
Proliferation of intralobular stroma
what are the features of a fibroadenoma
Circumscribed Rubbery Grey-white colour Biphasic tumour/lesion Epithelium Stroma
How are fibroadenomas treated
Rule out malignancy
Reassure
Exise
What are sclerosing breast lesions
benign, disorderly proliferation of acini and stroma causing a mass or calcification which may mimic carcinoma
What are the main causes of breast sclerosinf lesions
radial scar
sclerosing adenosis
When does sclerosis adenosis usually present and how does it usually present
any age between 20-70
pain, tenderness, lump/thickening
asymptomatic sometimes
Is there a risk of carcinoma developing from a sclerosing adenosis
yes but it is negligible
WHat is a radial scar
is a benign breast lesion that can radiologically mimic malignancy
how common are bilateral radial scars
in about 43 percent of cases they are bilateral
what is the difference between a radial scar and complex sclerosing lesion
RS is 1-9mm
CSL- more than 10mm
what are the histological features of a radial scar
Fibroelastotic core
Radiating fibrosis containing distorted ductules
Fibrocystic change
Epithelial proliferation
Is a radial scar pre malignant
No but often show epithelial proliferation
In situ or invasic carcino may occur within these lesions
What is fat necrosis of the breast
damage and disruption of adipocytes usually following trauma to the breast
infiltration of acute inflammatory cells
subsqequent fibrosis and scarring
what are the usual causes for fat necrosis
local trauma such as seat belt injury
can occur with no history or history of very insignificant/minor trauma
warfarin therapy
what are the symptoms of duct ectasia
Pain Acute episodic inflammatory changes Bloody and/or purulent D/C Fistulation Nipple retraction and distortion
Where does duct ectasia affect
sub areolar ducts
What is the risk factor for duct ectasia
smoking
what are the pathological features of duct ectasia
Sub-areolar duct dilatation
Periductal inflammation
Periductal fibrosis
Scarring and distortion
What are the two main aetiologies of mastitis or abscess in the breast
duct ectasia
lactation
What is usually the causal organism of mastitis/abscess in lactation
Staph aureus
Step pyogenes
What usually causes an infection in duct ectasia
mixed organisms
anaerobes
How is mastitis/abscesses managed
Antibiotics
Percutaneous drainage
Incision & drainage
Treat underlying cause
what is a phyllodes tumour
A tumour of the breast characterised by peri ductal stromal overgrowth. can be benign, borderline or malignant.
how do phyllodes tumours behave
they are prone to local recurrence if not excised adequately
rarely metastasize
What papillary lesions can occur in the breast
intraductal papilloma
nipple adenoma
encysted papillary carcinoma
what age range do intraductal papillomas usually occur in
35-60
What is a common symptom of intraduct papillomas
nipple discharge +/- blood
What may be seen on screening with an intraductal papilloma
nodules
calcification
what are the features of an intraductal papilloma
Sub-areolar ducts
2-20 mm diameter
Papillary fronds containing a fibrovascular core
covered by myoepithelium and epithelium
Epithelium may show proliferative activity
What epithelial proliferation may be seen in intraductal papillomas
None
Usual type hyperplasia
Atypical ductal hyperplasia
Ductal carcinoma in situ
