Breast Pathology Flashcards
breast cytopathology classifications
C1 - unsatisfactory
C2 - Benign
C3 - Atypia, probably benign (equivocal)
C4 - atypia, suspicious of malignancy
C5 - malignant
epithelial and myoepithelial cells lie on the _________ __________
basement membrane
gynaecomastia causes
- exogenous/endogenous hormones
- cannabis
- prescription drugs
- liver disease
what age of women does fibrocystic change most commonly affect
40-50
fibrocystic change presentation
- smooth discrete lumps
- sudden pain
- cyclical pain
- lumpiness
- incidental finding
- screening
fibrocystic change pathology
-cysts, blue domed with pale fluid
- intervening fibrosis around them
- metaplasia (from ductal lineage cell to apocrine)
fibrocystic change management
- exclude malignancy
- reassure
- excise if necessary (unusual)
hamartoma definition
circumscribed lesion composed of cell types normal to the breast but present in an abnormal proportion or distribution
fibroadenoma epidemiology
- common
- usually solitary
- commoner in African women
fibroadenoma clinical features
- screening
- painless, firm, discrete, mobile mass
- “breast mouse”
- solid on ultrasound
when is fibroadenoma peak incidence
age 20s
fibroadenoma is a biphasic tumour/lesion because it contains both _____ and _____
epithelium and stroma
fibroadenoma pathological features
- circumscribed
- rubbery
- grey-white colour
- biphasic tumour/lesion
fibroadenoma management
diagnose
reassure
excise
what are sclerosing lesions
benign, disorderly proliferation of acini and stroma
can cause a mass or calcification
sclerosing lesions may mimic ___________
carcinoma
what age do people get sclerosing adenosis
age 20-70 (wide range)
sclerosing adenosis clinical features
- pain, tenderness or lumpiness/thickening
- asymptomatic
Radial scar vs complex sclerosing lesion
radial scar is <10mm, CSL is >10mm
radial scar pathological features
- 10mm or less
- stellate architecture
- central puckering
- radiating fibrosis
- stromal elastosis
radial scar classical features
- fibro-elastotic core
- radiating fibrosis containing distorted ductules
- fibrocystic change
- epithelial proliferation
radial scar can mimic ____ radiologically and pathologically
carcinoma
radial scar management
excise if large, awkward position, or had atypia, or associated malignancy
otherwise, if no atypia, sample extensively by vacuum biopsy to prove there is nothing of concern.
two types of breast biopsy
- core (14 G) biopsy
- vacuum assisted biopsy
why would axilla be scanned
look for lymph node mets
what percentage of breast cancer patients have mets at presentation
4-6%
what is fat necrosis usually due to
local trauma e.g. seat belt injury, falls
what is fat necrosis
common condition caused by an acute inflammatory response in the breast, leading to ischaemic necrosis of fat lobules
pathophysiology of fat necrosis
- damage and disruption of adipocytes
- infiltration by acute inflammatory cells
- aggregation of ‘foamy’ macrophages
- subsequent fibrosis and scarring
fat necrosis management
confirm diagnosis
exclude malignancy
duct ectasia clinical features
- affects sub-areolar (behind nipple) ducts
- pain
- acute episodic inflammatory changes
- bloody and/or purulent discharge
- can lead to abscess formation and fistulation
- nipple retraction and distortion can follow
- associated with smoking
is duct ectasia associated with smoking
yes
duct ectasia pathological features
- periductal inflammation
- periductal fibrosis
- scarring and distortion
duct ectasia management
- treat acute infections
- exclude malignancy
- stop smoking
- excise affected ducts if severe
what organisms are involved in acute mastitis/abscess if lactation is the aetiology
- staph aureus
- strep pyogenes
acute mastitis/abscess management
- antibiotics
- percutaneous drainage
- incision and drainage
- treat underlying cause
what is a phyllodes tumour
slow growing unilateral breast mass
phyllodes tumour typical age
40-50
true or false, phyllodes tumours can be benign, borderline, or malignant
true
intraduct papilloma age
35-60
what is an intraduct papilloma
benign tumour that develops within the milk ducts of the breast.
typically small wart-like growth that may be found near the nipple or deeper within the breast tissue.
intraduct papilloma clinical features
- nipple discharge +/- blood
- asymptomatic at screening
- palpable nodules
- calcification
intraduct papilloma treatment
depends on symptoms/wishes/atypia or malignancy
- excise
- vacuum excision - if there’s no malignancy or atypia
