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Reproduction > Breast Pathology 1 (Incomplete) > Flashcards

Breast Pathology 1 (Incomplete) Flashcards

1
Q

Features of assesment of a ptaient with breast disease

A

TRIPLE ASSESMENT

  1. Clinical: history and exam
  2. Imaging: Mammography, US, MRI
  3. Pathology: cyto and histopathology
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2
Q

Methods of breast cytopathology

A

Fine Needle Aspiration (FNA)
Fluid
Nipple discharge
Nipple scrape

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3
Q

Slide image 1 (slide 9)

A

Typiacl benign sample
Apocrine cells
Normal ductal epithelial cells - stuck together to form sheets and tight junction

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4
Q

Slide 10

A

Degenerate cells which are falling apart
Malignant aspirate
Diagnosis: carcinoma
Treatment: surgery

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5
Q

Breast FNA cytology classification

A 
C1 - Unsatisfactory
C2 - Benign
C3 - Atypia, probably benign
C4 - Suspicious of malignancy
C5 - Malignant (doesn't tell us if it is invasive)
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6
Q

Diagnostic methods of breast histopathology

A

(Needle) Core biopsy
Vaccum assisted biopsy
Skin biopsy
Incisional biopsy of mass

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7
Q

Classification of needle core biopsy results

A 
B1 - Unsatisfactory / normal
B2 - Benign
B3 - Atypia, probably benign
B4 - Suspicious of malignancy
B5 - Malignant
B5a - carcinoma in situ
B5b - invasive carcinoma
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8
Q

List the developmental anomalies of the breast

A

Hypoplasia
Juvenile hypertrophy
Accessory breast tissue
Accessory nipple

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9
Q

List non-neoplastic breast diseases

A 
Gynaecomastia
Fibrocystic change
Hamartoma
Fibroadenoma
Sclerosing lesions 
- Sclerosing adenosis
- Radial scar/complex sclerosing lesions
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10
Q

List inflammatory breast diseases (Benign)

A

Fat necrosis
Duct ectasia
Acute mastitis

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11
Q

List benign tumours of the breast

A

Phyllodes

Intraduct papilloma

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12
Q

What is Gyanecomastia?

A

Breast development in the male

Ductal growth without lobular development

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13
Q

Histology of gynaecomastia

A

hyperplastic epithelium

small number associated with progression to malignancy

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14
Q

Causes of gynaecomastia?

A

Exogenous/endogenous hormones
Cannabis
Prescription drugs
Liver disease - metabolism of cholesterol based hormone is disruptive ending up with an excess of oestrogen and therefore gynaecomastia

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15
Q

Epidemiology of fibrocystic change

A

Women aged 20-50
Majority 40-50
Very common

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16
Q

Risk factors of fibrocystic change

A

Menstrual abnormalities
Late menopause
Early menarche

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17
Q

Presentation of fibrocystic change

A 
Smooth discrete lumps
Sudden pain
Cyclical pain
Lumpiness
Incidental finding
Might be picked up during breast screening
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18
Q

Gross pathology of fibrocystic change

A 
Cysts: 
1mm - several cm
Blue domes with pale fluid
Usually multiple
Associaetd with other benign changes

Intervening fibrosis

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19
Q

Microscopic appearance of fibrocystic change

A

Apocrine lining rather than eccrine lining of regular breast
Metaplastic change
Low nuclear cytoplasm ratio

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20
Q

Management of fibrocystic change

A

Exclude malignancy
Reassure
Excise if necessary

21
Q

Define hamartoma

A

“Circumscribed lesion composed of cell types normal to the breast but present in an abnormal proportion or distribution”

22
Q

Features of fibroadenoma

A 
Common (17% in autopsy studies)
Usually solitary (10% multiple)
Commoner in African women
23
Q

Clinical features of fibroadenoma

A

Peak incidence in 3rd decade
Common in pre-menopausal women
Screening
Painless, firm, discrete, mobile mass
“Breast mouse”- move away from finger when trying to examine
Solid on ultrasound (helps eliminate cyst)

24
Q

Appearance of fibroadenoma

A

Circumscribed

Rubbery

Grey-white colour

Biphasic tumour/lesion with 2 components:
Epithelium
Stroma

25
Q

Treatment of fibroadenoma

A

Diagnose
Reassure
Excise

26
Q

Types of sclerosing lesions

A

Sclerosing adenosis
Radial scar/ complex sclerosing lesion

(both feel malignant, essentially the same thing but of different sizes)

27
Q

What are sclerosing lesions?

A

Benign, disorderly proliferation of acini and stroma
Can cause a mass or calcification
May mimic carcinoma

28
Q

Clinical features of sclerosing adenosis

A

Pain, tenderness or lumpiness/thickening

Asymptomatic

Age: 20-70

Benign, negligible risk of subsequent Ca

29
Q

Features of radial scar

A 
Wide age range
Common
Incidental finding
Mammographically detected
Mimic carcinoma radiologically
Probably not premalignant per se
Often show epithelial proliferation
In situ or invasive carcinoma may occur within these lesions
30
Q

Pathology of radial scar

A 
RS – 1-9mm
CSL - >10mm
Stellate architecture 
central puckering
Radiating fibrosis
31
Q

Treatment of radial scar

A

Excise or sample extensively by vacuum biopsy

32
Q

Causes of fat necrosis

A

Local trauma - seat belt injury, frequently no history

Warfarin therapy

33
Q

Pathophysiology of fat necrosis

A 
Damage and disruption of adipocytes
Infiltration by acute inflammatory cells
“foamy” macrophages
Subsequent fibrosis and scarring
CALCIFICATION ON MAMMOGRAM (d/t saponification)
34
Q

Management of fat necrosis

A

Confirm diagnosis

Exclude malignancy

35
Q

What is duct ectasia?

A

Inflammation with dilation of the sub-areolar ducts

36
Q

Clinical features of duct ectasia

A 
Pain
Acute episodic inflammatory changes
Bloody and/or purulent D/C - green-brown in colour (inflammatory debris)
Fistulation
Nipple retraction and distortion
37
Q

Risk factors of ductal ectasia

A

Smoking
Perimenopausal
Multiparous

38
Q

Pathology of ductal ectasia

A

Sub-areolar duct dilatation
Periductal inflammation
Periductal fibrosis
Scarring and distortion

39
Q

Management of ductal ectasia

A

Treat acute infections
Exclude malignancy
Stop smoking
Excise ducts

40
Q

What are the 2 main aetiologies of acute mastitis/abscess?

A
  1. Duct ectasia - mixed organisms, anaerobes

2. Lactation - staph aureus, strep pyogenes

41
Q

Management of acute mastitis/breast abscess

A

Antibiotics
Percutaneous drainage
Incision and drainage
Treat underlying cause

42
Q

Clinical features of acute mastitis

A

Erythematous breast with purulent nipple discharge; may progress to abscess formation

43
Q

What is periductal mastitis?

A

Inflammation of the sub-areolar ducts, usually seen in smokers

44
Q

Clinical features of periductal mastitis

A

Sub-areolar mass with nipple retraction

45
Q

What are phyllodes tumours?

A

Fibroadenoma-like tumor with overgrowth of the fibrous component

46
Q

What are the histologic features of a phyllodes tumour?

A

Biphasic tumour

Stromal overgrowth

Behaviour depends on stromal features:

  • Benign
  • Borderline
  • Malignant (sarcomatous)
47
Q

What is the behaviour of phyllodes tumour?

A

Pathology helps to predict
Prone to local recurrence if not adequately excised
Rarely metastasize

48
Q

Clinical features of phyllodes tumour

A

40-50 (postmenopausal)

Slow growing unilateral breast mass

49
Q

Which tumour appears on biopsy with “leaf-like” projections?

A

Phyllodes tumour

Reproduction (32 decks)

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