Breast Pathology

Question 1

List the different methods of obtaining breast histopathology specimens

Answer 1

Needle core biopsy
Fine needle aspiration
Vacuum-assisted biopsy
Skin biopsy
Incisional biopsy of mass

Question 2

What types of therapeutic excision can be done for breast pathology?

Answer 2

Excisional biopsy of mass
Wide local excision of cancer
Mastectomy

Question 3

What is gynaecomastia?

Answer 3

Breast development in the male with ductal growth without lobular development

Question 4

List some causes of gynaecomastia

Answer 4

Exogenous/endogenous hormones
Cannabis
Drugs (furosemide)
Liver disease

Question 5

Fibrocystic change is non-neoplastic and typically affects women of what ages?

Answer 5

Aged 20-50, majority are 40-50

Question 6

List the clinical features of fibrocystic change of the breasts

Answer 6

Menstrual disturbance
Smooth, discrete lump
Sudden/cyclical pain

Question 7

Fibrocystic change of the breasts is associated with late menarche and late menopause. True/False?

Answer 7

False

Early menarche, late menopause

Question 8

Describe the pathological appearance of fibrocystic change of the breasts

Answer 8

Blue-domed cysts with pale fluid

Thin-walled but may be fibrous

Question 9

How is fibrocystic change managed?

Answer 9

Reassurance

Excision if necessary/symptomatic

Question 10

What is a hamartoma?

Answer 10

Circumscribed lesion consisting of normal breast tissue but present in abnormal proportion or distribution

Question 11

A fibroadenoma is a common benign lesion of the breasts - list some clinical features

Answer 11

Painless
Discrete, mobile mass
Peak incidence in 30’s

Question 12

Describe the pathological appearance of fibroadenoma of the breasts

Answer 12

Circumscribed
Rubbery
Grey-white colour
Biphasic - consists of epithelium and stroma

Question 13

How is fibroadenoma of the breasts managed?

Answer 13

Reassurance

Excision if necessary

Question 14

What is sclerosing adenosis?

Answer 14

Benign, disordered proliferation of acini and stroma that can cause a mass or calcification

Question 15

Describe the pathological appearance of a radial scar

Answer 15

Stellate architecture

Central puckering

Question 16

Sclerosing adenosis and radial scars may mimic carcinoma. True/False?

Answer 16

True

Question 17

List some common causes of fat necrosis of the breasts

Answer 17

Local trauma (seatbelt injury)
Warfarin

Question 18

What is duct ectasia of the breast?

Answer 18

Lactiferous duct becomes blocked/clogged

Question 19

List clinical features of duct ectasia

Answer 19

Pain
Bloody/purulent discharge
Fistulation
Nipple retraction/distortion

Question 20

What are the 2 main aetiologies that cause acute mastitis?

Answer 20

Duct ectasia
Lactatory infection (Staph aureus, Step pyogenes)

Question 21

What is a Phyllodes tumour?

Answer 21

Slow-growing unilateral benign breast mass

Question 22

List the main metastatic tumours to the breast

Answer 22

Bronchial carcinoma
Ovarian serous carcinoma
Clear cell carcinoma of kidney
Malignant melanoma
Leiomyosarcoma

Question 23

Where does breast carcinoma arise?

Answer 23

Glandular epithelium of terminal duct lobular unit (TDLU)

Question 24

What type of carcinoma is breast carcinoma?

Answer 24

Adenocarcinoma

Question 25

List the precursor lesions that can give rise to breast carcinoma

Answer 25

``` Epithelial hyperplasia Columnar cell hyperplasia Atypical ductal hyperplasia Ductal carcinoma in situ Lobular in situ neoplasia ```

Question 26

How is in situ carcinoma of the breast defined?

Answer 26

Confined to basement membrane of acini and ducts, i.e. non/pre -invasive

Question 27

What are the 2 subtypes of lobular in situ neoplasia and how are they defined?

Answer 27

Atypical lobular hyperplasia (less than 50% of lobule affected) Lobular carcinoma in situ (more than 50% of lobule affected)

Question 28

Lobular in situ neoplasia is palpable. True/False?

Answer 28

False | Not palpable or grossly visible

Question 29

Which disease is essentially high-grade ductal carcinoma in situ involving the nipple skin?

Answer 29

Paget's disease

Question 30

What is the peak age range of incidence of breast carcinoma?

Answer 30

50-70's

Question 31

List risk factors for breast carcinoma

Answer 31

``` Age Abnormal reproductive history Hormone therapy (OCP, HRT) Previous breast disease Poor lifestyle Genetics ```

Question 32

NSAIDs lower the risk of breast carcinoma. True/False?

Answer 32

True

Question 33

An affected first-degree relative increases the risk of breast cancer by how much?

Answer 33

Doubles the risk

Question 34

What 2 factors/receptors help predict and offer prognosis for breast carcinoma?

Answer 34

``` HER2 Oestrogen receptor (ER) ```