Breast Pathology Flashcards
How does breast pathology usually present?
- Painful breast
- Palpable mass
- Nipple discharge
How can one classify different breast pathologies?
- Inflammatory conditions
- Benign proliferative conditions
- Benign neoplastic conditions
- Malignant neoplastic conditions
Name some inflammatory pathologies of the breast
- Mammary duct ectasia
- Acute mastitis
- Fat necrosis
What is mammary duct ectasia? What is the epidemiology? Symptoms? Cytology?
It is granulomatous inflammation and dilatation of the breast ducts.
It usually affects women ages 40-60.
It presents with a periareolar mass, and thick white nipple secretions.
On cytology, there are large dilated ducts, with proteinaceous material and inflammatory cells.
What is acute mastitis? What is the epidemiology? Symptoms? Cytology? How is it treated? Are there any other variations?
This is an acute infection of the breast.
It most commonly occurs during lactation or breastfeeding, as a result of staphylococcus infection through cracks in the nipple.
It presents as a painful, tender red breast and fever.
On cytology, the breast tissue is necrotic, and infiltrated with neutrophils.
It is treated with antibiotics and drainage.
There is also periductal mastitis, associated with smoking (not lactation) that shows keratinising squamous epithelium extending deep into nipple duct orifices.
What is fat necrosis? What is the epidemiology? Symptoms? Cytology?
This is an inflammatory reaction to damaged adipose tissue.
It is usually caused by trauma, radiotherapy or surgery.
It presents as a painless breast mass.
Name some benign proliferative conditions of the breast
- Fibrocystic disease/fibroadenosis
- Phyllodes tumour
- Gynaecomastia
- Epithelial hyperplasia
- Flat epithelial hyperplasia
- In situ lobular neoplasia
How does one investigate any breast pathology?
- Clinical history and examination
- Imaging (mammogram, US or MRI)
- Cytology/histopathology (fine needle aspirate or core biopsy)
What is the gold standard in diagnosing malignancy in the breast?
Histopathology
How is cytological evaluation of breast tissue divided to summarise the suspicion of malignancy?
C1-5
- C1 = inadequate sample
- C2 = benign
- C3 = atypical but benign
- C4 = suspicion of malignancy
- C5 = malignant
What is fibrocystic disease? What is the epidemiology? Symptoms? Cytology?
What is fibroadenosis
This is fibrous and cystic tissue changes within the breast, caused by an exaggerated normal response to hormones.
This is very common.
It presents as a ‘lumpy breast’.
On cytology, one can see small cysts which contain fluid, and inflammation and fibrosis secondary to cyst rupture.
Fibroadenosis involved fibrous changes with an increased number of acini per lobule.
What is phyllodes tumour? What is the epidemiology? Symptoms? Cytology?
This is a leaf-like tumour arising from the interlobular stroma. They are mostly benign, but can be aggressive and malignant.
They usually affect those above the age of 50.
They usually present as a palpable mass.
What is gynaecomastia? What is the epidemiology? Symptoms? Histology?
This is unilateral/bilateral enlargement of the male breast, usually caused by a hyperoestrogenic state (alcohol, liver damage, testicular tumour).
It most commonly affects prepubertal boys and men over the age of 50.
It presents as enlargement of the breast tissue.
On histology, there is epithelial hyperplasia and finger like projection into ducts.
Name some benign neoplastic conditions of the breast
- Fibroadenoma
- Duct papilloma
- Radial scar
What is a fibroadenoma? What is the epidemiology? Symptoms? Cytology?
What is the treatment?
This is a benign tumour from the stroma.
It can occur at any age, but most commonly affects those in reproductive age. They can increase in size during pregnancy, and calcify after menopause.
They usually present as a painless, mobile hard lump.
On cytology, there is an overgrowth of collagenous mesenchyme.
Treat by surgical removal.
