Breast Pathology

Question 1

Breast contains what two tissues?

Answer 1

• Fat

- Glands

Question 2

Glandular tissue consists of _______ and _______?

Answer 2

• Ducts

- Lobules

Question 3

Lobules have a secretory function and are lined with an internal layer of _________ and a peripheral layer of _________.

Answer 3

• Epithelial cells

- Myoepithelial cells

Question 4

List the important features of breast pain/cyclical mystalgia.

Answer 4

• Reassure patient that not likely to be malignant
• Pain usually greatest pre-menstrually
• Often responds to simple analgesia

Question 5

A patient presents with clear discharge - what is the differential?

Answer 5

• Physiological

- Prolactinoma (rare)

Question 6

A patient presents with thick green or white discharge expressed from multiple ducts.

Answer 6

• Duct ectasia (especially if older woman/smoker)

Question 7

Discharge from a single duct - sometimes can be blood stained.

Answer 7

• Intraductal papilloma

- Rarely malignant

Question 8

List the benign breast lumps.

Answer 8

• Simple cysts
• Fibrocystic change
• Fibroepithelial lesions
• Papilloma
• Fat necrosis

Question 9

Describe fibrocystic change.

Answer 9

• Very common
• Usually no signs or symptoms
• Lumps, bumps, or thickening of breast
• Usually found on breast screening programme as calcification

Question 10

Describe a fibroadenoma.

Answer 10

• Very common
• Palpable mass ‘breast mouse’ - as mobile
• Contains epithelial and stromal elements
• Responds to hormones (fluctuates in size during menstrual cycle and during pregnancy)
• Can be excised

Question 11

Neoplastic cells confined to the basement membrane. No potential for metastatic spread. Will probably progress to invasive form if left untreated. What am I?

Answer 11

• In-situ carcinoma.

Question 12

Neoplastic cells that have breached the basement membrane - now have potential to spread.

Answer 12

• Invasive carcinoma.

Question 13

Outline the characteristic of invasive ductal carcinoma.

Answer 13

• Clincal findings: well-defined lump
• Radiology: circumscribed mass
• Macroscopically: firm, clearly outlined tumour
• Microscopic: abnormal glandular structures

Question 14

Outline the characteristic of invasive lobular carcinoma.

Answer 14

• Clincal findings: vague thickening
• Radiology: less distinct
• Macroscopically: poorly defined
• Microscopic: single cells/”Indian filing”