Breast Pathology

Question 1

breast cytopathology classifications

Answer 1

C1 - unsatisfactory
C2 - Benign
C3 - Atypia, probably benign (equivocal)
C4 - atypia, suspicious of malignancy
C5 - malignant

Question 2

epithelial and myoepithelial cells lie on the _________ __________

Answer 2

basement membrane

Question 3

gynaecomastia causes

Answer 3

• exogenous/endogenous hormones
• cannabis
• prescription drugs
• liver disease

Question 4

what age of women does fibrocystic change most commonly affect

Answer 4

40-50

Question 5

fibrocystic change presentation

Answer 5

• smooth discrete lumps
• sudden pain
• cyclical pain
• lumpiness
• incidental finding
• screening

Question 6

fibrocystic change pathology

Answer 6

-cysts, blue domed with pale fluid
- intervening fibrosis around them
- metaplasia (from ductal lineage cell to apocrine)

Question 7

fibrocystic change management

Answer 7

• exclude malignancy
• reassure
• excise if necessary (unusual)

Question 8

hamartoma definition

Answer 8

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

Question 9

fibroadenoma epidemiology

Answer 9

• common
• usually solitary
• commoner in African women

Question 10

fibroadenoma clinical features

Answer 10

• screening
• painless, firm, discrete, mobile mass
• “breast mouse”
• solid on ultrasound

Question 11

when is fibroadenoma peak incidence

Answer 11

age 20s

Question 12

fibroadenoma is a biphasic tumour/lesion because it contains both _____ and _____

Answer 12

epithelium and stroma

Question 13

fibroadenoma pathological features

Answer 13

• circumscribed
• rubbery
• grey-white colour
• biphasic tumour/lesion

Question 14

fibroadenoma management

Answer 14

diagnose
reassure
excise

Question 15

what are sclerosing lesions

Answer 15

benign, disorderly proliferation of acini and stroma

can cause a mass or calcification

Question 16

sclerosing lesions may mimic ___________

Answer 16

carcinoma

Question 17

what age do people get sclerosing adenosis

Answer 17

age 20-70 (wide range)

Question 18

sclerosing adenosis clinical features

Answer 18

• pain, tenderness or lumpiness/thickening
• asymptomatic

Question 19

Radial scar vs complex sclerosing lesion

Answer 19

radial scar is <10mm, CSL is >10mm

Question 20

radial scar pathological features

Answer 20

• 10mm or less
• stellate architecture
• central puckering
• radiating fibrosis
• stromal elastosis

Question 21

radial scar classical features

Answer 21

• fibro-elastotic core
• radiating fibrosis containing distorted ductules
• fibrocystic change
• epithelial proliferation

Question 22

radial scar can mimic ____ radiologically and pathologically

Answer 22

carcinoma

Question 23

radial scar management

Answer 23

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.

Question 24

two types of breast biopsy

Answer 24

• core (14 G) biopsy
• vacuum assisted biopsy

Question 25

why would axilla be scanned

Answer 25

look for lymph node mets

Question 26

what percentage of breast cancer patients have mets at presentation

Answer 26

4-6%

Question 27

what is fat necrosis usually due to

Answer 27

local trauma e.g. seat belt injury, falls

Question 28

what is fat necrosis

Answer 28

common condition caused by an acute inflammatory response in the breast, leading to ischaemic necrosis of fat lobules

Question 29

pathophysiology of fat necrosis

Answer 29

1. damage and disruption of adipocytes 2. infiltration by acute inflammatory cells 3. aggregation of 'foamy' macrophages 4. subsequent fibrosis and scarring

Question 30

fat necrosis management

Answer 30

confirm diagnosis exclude malignancy

Question 31

duct ectasia clinical features

Answer 31

- 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

Question 32

is duct ectasia associated with smoking

Answer 32

yes

Question 33

duct ectasia pathological features

Answer 33

- periductal inflammation - periductal fibrosis - scarring and distortion

Question 34

duct ectasia management

Answer 34

- treat acute infections - exclude malignancy - stop smoking - excise affected ducts if severe

Question 35

what organisms are involved in acute mastitis/abscess if lactation is the aetiology

Answer 35

- staph aureus - strep pyogenes

Question 36

acute mastitis/abscess management

Answer 36

- antibiotics - percutaneous drainage - incision and drainage - treat underlying cause

Question 37

what is a phyllodes tumour

Answer 37

slow growing unilateral breast mass

Question 38

phyllodes tumour typical age

Answer 38

40-50

Question 39

true or false, phyllodes tumours can be benign, borderline, or malignant

Answer 39

true

Question 40

intraduct papilloma age

Answer 40

35-60

Question 41

what is an intraduct papilloma

Answer 41

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.

Question 42

intraduct papilloma clinical features

Answer 42

- nipple discharge +/- blood - asymptomatic at screening - palpable nodules - calcification

Question 43

intraduct papilloma treatment

Answer 43

depends on symptoms/wishes/atypia or malignancy - excise - vacuum excision - if there's no malignancy or atypia