Breast pathology Flashcards
Who is involved in the Multi Disciplinary Team (MDT)?
Surgeon Radiologist Pathologist Oncologist Breast care nurse
What imaging is used?
Mammography
USS
MRI
What pathology is looked at?
Cytopathology
Histopathology
What is used for breast cytopathology?
Fine needle aspiration
Fluid
Nipple discharge
Nipple scrape
How is Breast FNA Cytology classified?
C1 - Unsatisfactory C2 - Benign C3 - Atypia, probably benign C4 - Suspicious C5 - Malignant
How is breast histopathology done (Diagnostic)?
Needle core biopsy
Vacuum assisted biopsy (large volume/mammotome)
Skin biopsy
Incisional biopsy of mass
How is breast histopathology done (Therapeutic)?
Excisional biopsy of mass
Resection of cancer - wide local excision, masectomy
How are Needle Core Biopsy results categorised?
B1 - Unsatisfactory/ normal B2 - Benign B3 - Atypia, probably benign B4 - Suspicious B5 - Malignant B5a - carcinoma in situ B5b - Invasive carcinoma
What developmental problem can occur in benign breast disease?
Hypoplasia
What anomalies can occur in benign breast disease?
Juvenile hypertrophy
Accessory breast tissue
Accessory nipple
What non-neoplastic problems can occur in benign breast disease?
Gynaecomastia Fibrocystic change Hamartoma Fibroadenoma Sclerosing lesions - sclerosing adenosis, radial scar/complex sclerosing lesions
What inflammatory problems can occur in benign breast disease?
Fat necrosis
Duct ectasia
Acute mastitis/abscess
What tumours can occur in benign breast disease?
Phyllodes tumour
Intraduct papilloma
What is gynaecomastia?
Breast development in males
Ductal growth without lobular development
What are causes of gynaecomastia?
Exogenous/endgenous hormones
Cannabis
prescription drugs
Liver disease
Describe Fibrocystic change
Women aged 20-50 (Majority 40-50) Very common Menstrual abnormalities Early menarche Late menopause Often resolved or diminished after menopause
How do fibrocystic changes present?
Smooth discrete lumps Sudden pain Cyclical pain Lumpiness Incidental finding Screening
How do fibrocystic changes look? (Gross pathology)
Cysts 1mm-several cm Blue domed with pale fluid usually multiple Associated with other benign changes Intervening fibrosis
What is the microscopic pathology of fibrocystic changes?
Cysts
Thin walled but may have fibrotic wall
Lined by apocrine epithelium
Intervening fibrosis
How do you manage fibrocystic change?
Exclude malignancy
Reassure
Excise if necessary
What is a hamartoma?
Circumscribed lesion composed of cell types normal to the breast but present in an abnormal proportion or distribution
In whom is Fibroadenoma more common in?
African women
Describe clinically fibroadenoma?
Peak incidence in 3rd decade Screening used Painless, firm, discrete, mobile mass "Breast mouse" Solid on USS
Describe a fibroadenoma?
Circumscribed
Rubbery
Grey-white colour
Biphastic tumour/lesion- Epithelium, stroma
How do you manage a fibroadenioma?
Diagnose
Reassure
Excise
What are sclerosing lesions?
Sclerosing adenosis Radial scar / complex sclerosing lesion Benign, disorderly proliferation of acini and stroma Can cause a mass or calcification May mimic carcinoma
How do sclerosing adenosis present?
pain, tenderness or lumpiness/thickening
Asymptomatic
Age 20-70
Is sclerosing adnosis malignant?
Benign
Describe a radial scar?
Wide age range
Common
Incidental finding
Mammographically detected
Describe the pathology of a radial scar?
RS - 1-9mm CSL - >10mm Stellate architecture Central punching Radiating fibrosis
What’s the histology of a radial scar?
Fibroelastotic core
Radiating fibrosis containing distorted ductules
Epithelial proliferation
