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Year 5 Pathology: Histopatholgy > Breast pathology > Flashcards

Breast pathology Flashcards

1
Q

What are the 3 key investigations for breast disease?

A

1) Clinical examination

2) Imaging (Sonography/mammography)

3) Pathology (cytopathology/histopathology)

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2
Q

What are the two types of imaging available for patients with breast diseaase?

A

Sonography

Mammography

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3
Q

What are the two main investigations available for determining pathology of breast disease?

A

Cytopathology

Histopathology

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4
Q

What is the difference between cytopathology and histopathology?

A

Cytopathology: Cells thinly spread across a slide and stained

Histopathology: intact tissues removed showing
architectural and cellular detail.

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5
Q

How are samples for cytopathology obtained?

A

Via fine needle aspiration (FNA)

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6
Q

w a

What does a C1 result indicate in cytopathology coding?

A

Inadequate sample

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7
Q

What does a C2 result indicate in cytopathology coding?

A

Benign

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8
Q

What does a C3 result indicate in cytopathology coding?

A

Atypical

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9
Q

What does a C4 result indicate in cytopathology coding?

A

suspicious of malignancy

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10
Q

What does a C5 result indicate in cytopathology coding?

A

Malignant

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11
Q

How are histopathology samples obtained?

A

Via core biopsy

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12
Q

What is considered normal breast histological findings?

A

ductal-lobular system
lined by inner glandular epithelium

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13
Q

What pathological investigation is gold-standard diagnostic for breast cancer?

A

Histopathology

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14
Q

Name three examples of inflammatory breast conditions

A

Acute mastitis

Mammary duct ectasia

Fat necrosis

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15
Q

What are the common clinical presentations of acute mastitis?

A

Painful, red breast, hot to touch, and fever.

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16
Q

What are the two types of acute mastitis

A

Lactational and non-lactational.

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17
Q

What is the most common cause of lactational mastitis?

A

Staphylococcal infection, often polymicrobial, entering through cracks in the nipple.

AND

Stasis of milk.

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18
Q

What does fine needle aspiration (FNA) cytology typically show in lactational mastitis?

A

An abundance of neutrophils.

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19
Q

What is the treatment for lactational mastitis?

A

Continued expression of milk, antibiotics, and possibly surgical drainage.

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20
Q

What causes non-lactational mastitis?

A

Keratinizing squamous metaplasia that blocks lactiferous ducts, leading to peri-ductal inflammation and rupture.

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21
Q

How does non-lactational mastitis differ from lactational mastitis in terms of pathology?

A

Non-lactational mastitis involves keratinizing squamous metaplasia, while lactational mastitis is primarily due to bacterial infection and milk stasis.

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22
Q

What is the significance of milk stasis in lactational mastitis?

A

Milk stasis can provide a medium for bacterial growth, leading to infection and inflammation.

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23
Q

When might surgical drainage be necessary in the treatment of lactational mastitis?

A

If there is an abscess formation that needs to be drained to resolve the infection.

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24
Q

In non-lactational mastitis, what can the peri-ductal inflammation and rupture lead to?

A

Chronic inflammation and possible formation of abscesses or fistulas.

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25
In which demographic is mammary duct ectasia most commonly seen?
It occurs mainly in multiparous women aged 40-60 years, with smoking being the biggest risk factor.
26
What are the main pathological features of mammary duct ectasia?
Inflammation and dilatation of large breast ducts
27
How does mammary duct ectasia typically present clinically?
As a poorly defined palpable periareolar mass with thick, white nipple secretions.
28
What type of secretion is found in the dilated lactiferous ducts in mammary duct ectasia?
Stagnant brown or green secretion, which may discharge.
29
What secondary complications can arise from mammary duct ectasia?
Periductal mastitis, abscess, and fistula formation due to irritant reaction in surrounding tissue.
30
What can chronic cases of mammary duct ectasia mimic, both clinically and on mammograms?
A carcinoma Due to a chronic indurated mass beneath the areola and fibrosis causing slit-like nipple retraction.
31
What is typically seen in the cytology of mammary duct ectasia?
Proteinaceous material and macrophages
32
What histological features are characteristic of mammary duct ectasia?
Duct dilation, periductal inflammation, and proteinaceous material inside the duct.
33
Why is smoking considered a significant risk factor for mammary duct ectasia?
Smoking is thought to promote inflammation and fibrosis within the breast ducts, contributing to ductal ectasia and related complications.
34
What is fat necrosis in the breast?
Fat necrosis is an inflammatory reaction to damaged adipose tissue, often seen in obese, middle-aged women.
35
How does fat necrosis typically present clinically?
Painless breast mass, skin thickening, or a mammographic lesion, which may mimic carcinoma with features like skin tethering and nipple retraction.
36
What are common causes of fat necrosis in the breast?
Trauma Radiotherapy Surgery Nodular panniculitis (skin condition)
37
What does cytology typically show in cases of fat necrosis?
Empty fat spaces, histiocytes, and giant cells.
38
What role do histiocytes and giant cells play in fat necrosis?
Histiocytes and giant cells are involved in the inflammatory response and help to clean up damaged fat cells.
39
What are empty fat spaces in the context of fat necrosis?
Empty fat spaces represent areas where fat cells have been destroyed, leaving behind gaps that are often surrounded by an inflammatory reaction.
40
What is the most common benign breast tumor?
Fibroadenoma
41
From which tissue does a fibroadenoma arise?
It arises from the stroma (the connective tissue of the breast).
42
At what age is fibroadenoma most commonly found?
It typically occurs at any age within the reproductive period, most commonly between 20-30 years.
43
How does fibroadenoma typically present in terms of physical characteristics?
As a spherical, freely mobile, rubbery mass of variable size.
44
How do fibroadenomas respond to hormonal changes, such as those during pregnancy or menopause?
They can increase in size during pregnancy and may calcify after menopause.
45
What is the characteristic cytological finding in fine needle aspiration (FNA) of a fibroadenoma?
Branching sheets of epithelium Bare bipolar nuclei Stroma.
46
What histological features are seen in a fibroadenoma?
A multinodular mass of expanded intralobular stroma.
47
What is the underlying pathology of fibroadenoma?
Overgrowth of collagenous mesenchyme (connective tissue)
48
What is the typical treatment for fibroadenoma?
"Shelling out" (surgical removal of the fibroadenoma) which is usually curative.
49
What is an intraductal papilloma?
A benign papillary tumor arising within the duct system of the breast.
50
What are the two types of intraductal papillomas based on their location?
Peripheral papillomas (small terminal ductules) and central papillomas (larger lactiferous ducts).
51
What is a common symptom of an intraductal papilloma?
Bloody discharge from the nipple.
52
How does intraductal papilloma typically appear on mammography?
It is not usually seen on mammography.
53
What is the characteristic cytological finding in nipple discharge from an intraductal papilloma?
Branching papillary groups of epithelium.
54
What does the histology of an intraductal papilloma show?
A papillary mass within a dilated duct lined by epithelium.
55
What is a potential complication of intraductal papilloma?
Breast cancer N.B. Especially if multiple papillomas present
56
What is a radial scar?
A benign sclerosing lesion characterized by central scarring surrounded by proliferating glandular tissue in a stellate pattern.
57
How does a radial scar typically present on mammography?
As a stellate mass, which closely mimics carcinoma.
58
What are "complex sclerosing lesions" in relation to radial scars?
Lesions larger than 1 cm that are sometimes referred to as complex sclerosing lesions.
59
What does histology reveal in a radial scar?
A central fibrous area with a stellate (star-shaped) pattern.
60
Where do phyllodes tumors arise from?
From the interlobular stroma, similar to fibroadenomas, and can arise within existing fibroadenomas.
61
At what age do phyllodes tumors commonly present?
Typically in women over 50 years of age.
62
What is the typical treatment approach for phyllodes tumors?
Wide local excision or mastectomy to limit local recurrence.
63
What is the risk of metastasis in phyllodes tumors?
Metastasis is very rare, but the tumor can be aggressive.
64
How are phyllodes tumors categorized?
Into low grade or high grade lesions based on their cellularity and mitotic activity.
65
What is fibrocystic disease?
A condition with lumpiness in the breasts and changes according to the menstrual cycle, often hormone-responsive.
66
How common is fibrocystic disease among pre-menopausal women?
It occurs in about one-third of pre-menopausal women.
67
What does the histology of fibrocystic disease reveal?
Dilated large ducts which may become calcified.
68

Year 5 Pathology: Histopatholgy (7 decks)

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