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Reproduction Year 3 > Breast Pathology > Flashcards

Breast Pathology Flashcards

1
Q

what is the assessment method for a patient with breast disease

A

TRIPLE ASSESSMENT

  1. clinical history + examination
  2. Imaging- mammography/USS/MRI
  3. Pathology- cytopathology/histopathology
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2
Q

how is breast cytopathology obtained

A

NNA
Nipple discharge
Nipple scrape

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3
Q

5 stages of breast FNA cytology

A 
C1- Unsatisfactory
C2- Benign
C3- Atypical 
C4- Suspicious
C5- Malignant
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4
Q

5 stages of a needle core biopsy

A 
B1- Normal 
B2- Benign 
B3- Atypical 
B4- Suspicious 
B5- Malignant 
B5a = carcinoma in situ 
B5b =  invasive carcinoma
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5
Q

developmental benign breast diseases

A

hypoplasia- one of both breasts don’t develop properly during puberty
Juvenile hypertrophy - breasts continue to grow
Accessory breast tissue / accessory nipple

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6
Q

Examples of non-neoplastic benign breast disease

A 
Gynaecomastia 
fibrocystic change
Hamartoma
Fibroadenoma
Sclerosing lesions
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7
Q

Inflammatory benign breast disease

A

Fat necrosis
Duct ectasia
Acute mastitis/abscess

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8
Q

benign breast tumours

A

phyllodes tumour

intra-duct papilloma

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9
Q

what is gynaecomastia

A

breast development in males

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10
Q

pathology of gynaecomastia

A

ductal growth without lobular development

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11
Q

causes of gynaecomastia

A

Exogenous/endogenous hormones
cannabis
liver disease
prescription drugs (e.g. spironolactone)

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12
Q

what age range are fibrocystic changes seen in

A

majority aged 40-50

also seen as early as 20s

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13
Q

how does a breast with fibrocystic change appear

A

lumpy, cobblestone appearance

Lumps are smooth with defined edges and are usually free moving

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14
Q

what is fibrocystic change associated with

A

menstrual abnormalities
early menarche
late menopause

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15
Q

what happens with fibrocystic changes after menopause

A

resolves/diminishes

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16
Q

pathology of fibrocystic change

A

cysts- 1mm to several cm
Blue domed with pale fluid
usually multiple

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17
Q

what are fibrocystic cysts lined with

A

apocrine epithelium

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18
Q

presentation of fibrocystic change

A

smooth discrete lumps
sudden pain
cyclical pain
lumpiness

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19
Q

what is a hamartoma

A

circumscribed lesion composed of normal cell types but in an abnormal distribution/proportion

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20
Q

features of a fibroadenoma

A

Common- usually African women, peak incidence in 30s

Solitary lesion- painless, firm, mobile mass

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21
Q

presentation of fibroadenoma on USS

A

Solid

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22
Q

pathology of fibroadenoma

A

circumscribed
rubbery
grey-white colour

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23
Q

what often co-exists with fibrocystic change

A

sclerosing adenosis

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24
Q

what is sclerosing adenosis

A

benign proliferative condition of the terminal duct lobular units
increase number of stroma, acini and their glands

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25
Q

what can sclerosisng adenosis cause

A

mass or calcification

may mimic carcinoma

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26
Q

presentation of sclerosing adenosis

A

pain, tenderness, lumpiness, thickening
may be asymptomatic
age 20-70

27
Q

pathology of a radial scar

A

central fibrous core with central puckering

28
Q

how is a radial scar diagnosed

A

incidental finding
not palpable
detected by mammogram

29
Q

histology of radial scar

A

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

30
Q

differential of a radial scar

A

carcinomas- can mimic them radiologically

31
Q

causes of fat necrosis

A

local trauma

warfarin therapy

32
Q

pathology of fat necrosis

A

damage and disruption of adipocytes
infiltration by acute inflammatory cells- foamy macrophages
subsequent fibrosis + scarring

33
Q

what is duct ectasia

A

lactiferous duct becomes blocked or clogged

can cause greenish discharge

34
Q

what is duct ectasia associated with

A

smoking

35
Q

features of duct ectasia

A 
affects sub-areolar ducts
pain 
acute episodic/inflammatory changes
discharge can be bloody/green 
nipple retraction and distortion
36
Q

pathology of duct ectasia

A

sub-areolar duct dilatation
periductal inflammation + fibrosis
scarring + distortion

37
Q

management of duct ectasia

A

treat acute infections
exclude malignancy
stop smoking
excise ducts

38
Q

management of acute mastitis/abscess

A

antibiotics
percutaneous drainage
incision &amp
treat underlying cause

39
Q

features of a phyllodes tumour

A

age 40-50
slow growing
unilateral breast mass

40
Q

examples of papillary lesions

A

intraduct papilloma
nipple adenoma
encysted papillary carcinoma

41
Q

features of a intra-duct papilloma

A

age 35-60

nipple discharge +/- blood

42
Q

what is an intra-duct papilloma

A

benign breast lesions

43
Q

classifications of intra-duct papilloma

A

central

peripheral

44
Q

where are peripheral intra-duct papillomas found

A

terminal duct lobular unit

45
Q

potential complications of intra-duct papillomas

A

if they are big enough they may block ducts and cause cysts

46
Q

what is a ductal carcinoma in situ

A

breast carcinoma limited to the ducts
no extension beyond the basement membrane
cancer has not infiltrated the parenchyma/lymphatics -> cannot metastasise

47
Q

what tumours often metastasise to the breast

A

bronchial
ovarian serous carcinoma
clear cell carcinoma of the kidney
melanoma

48
Q

definition of breast carcinoma

A

a malignant tumour of breast epithelial cells

49
Q

where does breast carcinoma arise from

A

glandular epithelium of the terminal duct lobular unit

50
Q

2 types of breast carcinoma

A

ductal carcinoma

lobular carcinoma

51
Q

pre-cursors of ductal carcinoma

A

epithelial hyperplasia
columnar cell change
atypical ductal hyperplasia
ductal carcinoma in situ

52
Q

pre-cursors of lobular carcinoma

A

atypical lobular hyperplasia

lobular carcinoma in situ

53
Q

what is meant by in situ carcinoma

A

confined within basement membrane

malignant but non invasive

54
Q

atypical lobular hyperplasia

A

<50% of lobule involved

55
Q

lobular carcinoma in situ

A

> 50% of lobule involved

56
Q

features of lobular carcinoma in situ (LCIS)

A

ER positive
incidence decreases after menopause
may calcify

57
Q

which intra-ductal pre-cursor has the highest risk of progressing to cancer

A

DCIS

58
Q

Features of DCIS

A

Arises in terminal ductal lobular unit

typically affects a single duct system

59
Q

what is DCIS that invades the nipple called

A

pagets disease

60
Q

what is pagets disease of the nipple

A

high grade DCIS extending along ducts to reach the epidermis of the nipple
Still in situ- non invasive

61
Q

management of DCIS

A

Surgery + radiotherapy

62
Q

definition of invasive

A

malignant cells have invaded the basement membrane

infiltration of normal tissues

63
Q

what factors affect prognosis of breast cancer

A

ER

HER2

64
Q

treatment if tumour is HER 2 positive

A

trastuzumab

Reproduction Year 3 (36 decks)

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