Breast pathology Flashcards
What are the three principle constituents of breast tissue?
- Fat, soft and radiolucent
- Fibrous connective tissue which is radiodense
- Epithelial tissue which resides in in the fibrous bits of the breast
Is younger breast tissue more or less glandular?
More - therefore more fibrous
What is the significance of younger breast tissue being more glandular?
They are often more ‘lumpy’ and more radiodense due to having more fibrous tissue. Mammograms are less good at finding tumours in young people ad even palpation may be difficult.
What are the proven risk factors for breast cancer?
- Alcohol
- Diethylstilbestrol
- Oestrogen-progestorone contraceptives
- Oestrogen-progestorone HRT
- X-ray and gamma radiation
- High BMI (post-menopause only)
- Adult attained height (post-menopause only)
What may decrease the risk of developing breast cancer?
Breastfeeding
What is the presentation of breast pathology?
- Lumps
- Puckered skin/indrawn nipple
- Pain
- Inflammation/infection
- Nipple discharge
- Abnormal/sore nipple
- Radiology/Screening
How are breast changes investigated?
- All breast lumps should be considered in three parameters
- Clinical- i.e clinical examination and palpation
- Radiological
- Pathological- either cytology or histopathology
- The results of all of these need to be triangulated at a multidisciplinary team meeting.
What is a fibroadenoma?
- Fibroepithelial neoplasms in which there is co-ordinated growth of the glandular and connective tissue( stromal) element.
- common and present as mobile lumps or radiological masses
- As such cause concern – but if confirmed by biopsy may be left alone
What are phyllodes tumours?
- rare fibroepithelial neoplasm which form a spectrum of lesions. At one end are lesions very similar to fibroadenomas
- More aggressive phyllodes tumours show overgrowth of the stromal element, which in some cases may be frankly sarcomatous.
- have a characteristic leaf-like architecture
What are the possible causes of benign lumps?
- Physiological
- Lipoma, - fibroadenoma
- fibrocystic change
What kind of lumps may or may not become malignant?
Phyllodes tumours
What kinds of lumps may co-exist?
Fibroadenoma
Lipoma
Phyllodes
Malignant
What is fibrocystic change?
- A constellation of changes
Includes usual type ductal hyperplasia, apocrine metaplasia and cysts - May present as a lump
- May be associated with microcalcifications
- May share risk factors with breast cancer but probably not a precursor
- Can be tricky for the histopathologist to interpret correctly in rare cases and limited samples
What are the growth features of benign vs invasive breast tumours?
- Generally expansile and do not invade- typically leading to a rounded border
- whereas invasive tumours irregularly take over the adjacent tissues
What is the cause of the puckered skin/indrawn nipple symptom?
- Fat necrosis (non-cancerous)
- Carcinoma; puckering and also peau d’orange (resembles an orange) - inflammatory breast cancer, loads of tumour blocking lymphatics, breast swells
- Contraction via fibroblasts
