Breast Pathology Flashcards
what is the assessment method for a patient with breast disease
TRIPLE ASSESSMENT
- clinical history + examination
- Imaging- mammography/USS/MRI
- Pathology- cytopathology/histopathology
how is breast cytopathology obtained
NNA
Nipple discharge
Nipple scrape
5 stages of breast FNA cytology
C1- Unsatisfactory C2- Benign C3- Atypical C4- Suspicious C5- Malignant
5 stages of a needle core biopsy
B1- Normal B2- Benign B3- Atypical B4- Suspicious B5- Malignant
B5a = carcinoma in situ B5b = invasive carcinoma
developmental benign breast diseases
hypoplasia- one of both breasts don’t develop properly during puberty
Juvenile hypertrophy - breasts continue to grow
Accessory breast tissue / accessory nipple
Examples of non-neoplastic benign breast disease
Gynaecomastia fibrocystic change Hamartoma Fibroadenoma Sclerosing lesions
Inflammatory benign breast disease
Fat necrosis
Duct ectasia
Acute mastitis/abscess
benign breast tumours
phyllodes tumour
intra-duct papilloma
what is gynaecomastia
breast development in males
pathology of gynaecomastia
ductal growth without lobular development
causes of gynaecomastia
Exogenous/endogenous hormones
cannabis
liver disease
prescription drugs (e.g. spironolactone)
what age range are fibrocystic changes seen in
majority aged 40-50
also seen as early as 20s
how does a breast with fibrocystic change appear
lumpy, cobblestone appearance
Lumps are smooth with defined edges and are usually free moving
what is fibrocystic change associated with
menstrual abnormalities
early menarche
late menopause
what happens with fibrocystic changes after menopause
resolves/diminishes
pathology of fibrocystic change
cysts- 1mm to several cm
Blue domed with pale fluid
usually multiple
what are fibrocystic cysts lined with
apocrine epithelium
presentation of fibrocystic change
smooth discrete lumps
sudden pain
cyclical pain
lumpiness
what is a hamartoma
circumscribed lesion composed of normal cell types but in an abnormal distribution/proportion
features of a fibroadenoma
Common- usually African women, peak incidence in 30s
Solitary lesion- painless, firm, mobile mass
presentation of fibroadenoma on USS
Solid
pathology of fibroadenoma
circumscribed
rubbery
grey-white colour
what often co-exists with fibrocystic change
sclerosing adenosis
what is sclerosing adenosis
benign proliferative condition of the terminal duct lobular units
increase number of stroma, acini and their glands
what can sclerosisng adenosis cause
mass or calcification
may mimic carcinoma
presentation of sclerosing adenosis
pain, tenderness, lumpiness, thickening
may be asymptomatic
age 20-70
pathology of a radial scar
central fibrous core with central puckering
how is a radial scar diagnosed
incidental finding
not palpable
detected by mammogram
histology of radial scar
fibro-elastic core
radiating fibrosis containing distorted ductules
fibrocystic change
epithelial proliferation
differential of a radial scar
carcinomas- can mimic them radiologically
causes of fat necrosis
local trauma
warfarin therapy
pathology of fat necrosis
damage and disruption of adipocytes
infiltration by acute inflammatory cells- foamy macrophages
subsequent fibrosis + scarring
what is duct ectasia
lactiferous duct becomes blocked or clogged
can cause greenish discharge
what is duct ectasia associated with
smoking
features of duct ectasia
affects sub-areolar ducts pain acute episodic/inflammatory changes discharge can be bloody/green nipple retraction and distortion
pathology of duct ectasia
sub-areolar duct dilatation
periductal inflammation + fibrosis
scarring + distortion
management of duct ectasia
treat acute infections
exclude malignancy
stop smoking
excise ducts
management of acute mastitis/abscess
antibiotics
percutaneous drainage
incision &
treat underlying cause
features of a phyllodes tumour
age 40-50
slow growing
unilateral breast mass
examples of papillary lesions
intraduct papilloma
nipple adenoma
encysted papillary carcinoma
features of a intra-duct papilloma
age 35-60
nipple discharge +/- blood
what is an intra-duct papilloma
benign breast lesions
classifications of intra-duct papilloma
central
peripheral
where are peripheral intra-duct papillomas found
terminal duct lobular unit
potential complications of intra-duct papillomas
if they are big enough they may block ducts and cause cysts
what is a ductal carcinoma in situ
breast carcinoma limited to the ducts
no extension beyond the basement membrane
cancer has not infiltrated the parenchyma/lymphatics -> cannot metastasise
what tumours often metastasise to the breast
bronchial
ovarian serous carcinoma
clear cell carcinoma of the kidney
melanoma
definition of breast carcinoma
a malignant tumour of breast epithelial cells
where does breast carcinoma arise from
glandular epithelium of the terminal duct lobular unit
2 types of breast carcinoma
ductal carcinoma
lobular carcinoma
pre-cursors of ductal carcinoma
epithelial hyperplasia
columnar cell change
atypical ductal hyperplasia
ductal carcinoma in situ
pre-cursors of lobular carcinoma
atypical lobular hyperplasia
lobular carcinoma in situ
what is meant by in situ carcinoma
confined within basement membrane
malignant but non invasive
atypical lobular hyperplasia
<50% of lobule involved
lobular carcinoma in situ
> 50% of lobule involved
features of lobular carcinoma in situ (LCIS)
ER positive
incidence decreases after menopause
may calcify
which intra-ductal pre-cursor has the highest risk of progressing to cancer
DCIS
Features of DCIS
Arises in terminal ductal lobular unit
typically affects a single duct system
what is DCIS that invades the nipple called
pagets disease
what is pagets disease of the nipple
high grade DCIS extending along ducts to reach the epidermis of the nipple
Still in situ- non invasive
management of DCIS
Surgery + radiotherapy
definition of invasive
malignant cells have invaded the basement membrane
infiltration of normal tissues
what factors affect prognosis of breast cancer
ER
HER2
treatment if tumour is HER 2 positive
trastuzumab
