breast pathology Flashcards
how is fine needle aspiration performed
needle inserted into mass
material drawn into needle
needle is moved around mass to sample different areas
material expelled from needle
small amount of material in needle when withdrawn
what are the classifications of FNA (C1-C5)
C1 - unsatisfactory sample C2 - benign C3 - atypia, probably benign C4 - suspicious of malignancy C5 - malignant
apart from FNA, what other materials can be used for cytopathology investigation
fluid
nipple discharge
nipple scrape
how is needle core biopsy performed
needle covered with sheath inserted
sheath withdrawn and released again
sheath cuts small sample that is removed in the needle
core needle biopsy classification (B1-B5)
B1 - unsatisfactory B2 - benign B3 - atypia, probably benign B4 - suspicious of malignancy B5 - malignant B5a - CIS B5b: invasive
what are developmental anomalies in the breast
hypoplasia
juvenile hypertrophy
accessory breast tissue
accessory nipple
what is gynaecomastia
breast development in the male
how does gynaecomastic breast tissue differ from female breast tissue
ductal growth without lobular development
what causes gynaecomastia
exogenous/endogenous hormones (oestrogen)
cannabis
prescription drugs
liver disease
in what ages group does fibrocystic change present
20-50
mostly 40-50
fibrocystic change is associated with which other gynaecologist signs
early menarche
late menopause
menstrual abnormalities
how does fibrocystic change present
smooth discrete lumps
sudden/cyclical pain
incidental finding
gross pathology of fibrocystic change
blue domed with pale fluid
usually multiple
intervening fibrosis
what causes the fibrosis in fibrocystic change
rupture of cysts and subsequent scarring
microscopic pathology of fibrocystic change
thin walled cysts that may have fibrotic wall
lined by apocrine epithelium
management of 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 of distribution
presentation of fibroadenoma
painless, firm, discrete, mobile mass
clinical features of fibroadenoma
localised hyperplasia
proliferation of interlobular storm
circumscribed, rubbery, grey-white lesions
management of fibroadenoma
exclude malignancy
reassure
excise
what are sclerosing lesions
benign, disorderly proliferation of acini and stroma
features of sclerosing adenosis
pain, tenderness or lumpiness/thickening
what is the difference between radial scar and complex sclerosing lesion
radial scar = 1-9 mm
CSL = >10 mm
appearance of radial scar on mammogram
stellate architecture
central puckering
radiating fibrosis
histological appearance of radial scar
fibroelastic core
radiating fibrosis containing distorted ductules
fibrocystic change
epithelial proliferation
why is radial scar/CSL clinically relevant
mimics cancer radiologically
most likely benign but may contain CIS or invasive carcinoma
treatment of sclerosing lesions
excise or sample extensively by vacuum biopsy
cause of fat necrosis
trauma
often seat belt trauma
often no memorable history of trauma
what cause fat necrosis
damage and disruption of adipocytes
infiltration of acute inflammatory cells
foamy macrophages (full of fat droplets)
subsequent fibrosis and scarring
clinical features of duct ectasia
affects sub-areolar ducts pain acute episodic inflammatory changes bloody and/or purulent discharge (green/yellow colour) fistulation nipple retraction and distortion
what is commonly associated with duct ectasia
smoking
management of duct ectasia
treat acute infections
exclude malignancy
stop smoking
excise ducts
common causes of acute mastitis/abscess
duct ectasia
lactation
which organisms are associated with mastitis caused by duct ectasia
mixed organisms
anaerobes
which organisms are associated with mastitis caused lactation
staph aureus
strep pyogenes
management of mastitis/abscess
antibiotics
percutaneous drainage
incision and drainage
treat underlying cause
which type of mostly benign breast tumour is prone to recurrence if not properly excised
phyllodes tumour
clinical features of phyllodes tumour
slow growing unilateral breast mass
presentation of introduction papilloma
nipple discharge +/-blood
how are intraductal papilloma picked up at screening
nodules and calcification
how to intraductal papilloma appear histologically
papillary fronds containing a fibrovascular core
how is intraductal papilloma classified
benign IDP
IDP with atypical ductal hyperplasia (ADH)
IDP with ductal carcinoma in situ (DCIS)
which type of tumour has a sarcomatous stromal component
malignant phyllodes tumour
which breast tumour is associated with radiotherapy
angiosarcoma
which cancer metastasise to the breast
bronchial carcinoma ovarian serous carcinoma clear cell carcinoma of the kidney malignant melanoma soft tissue tumours
what is the difference between atypical lobular hyperplasia and lobular CIS
atypical lobular hyperplasia <50% of lobule affected
lobular CIS >50% of lobular affected
features of lobular CIS
small-intermediate sized nuclei solid proliferation intra-cytoplasmic lumens/vacuoles ER positive e-cadherin negative
where does ductal CIS arise
in terminal duct lobular unit
what is Paget’s disease of the nipple
high grade DCIS extending along ducts to reach the epidermis of the nipple
still in situ as hasn’t breached basement membrane
what is the progression from normal cells to DCIS
normal cells epithelial hyperplasia of usually type columnar cell change atypical ductal hyperplasia DCIS
risk factors for breast Ca
age reproductive hx hormones (OCP/HRT) previous breast disease Western Europe high weight smoking/alcohol genetics
breast Ca will invade which local tissues
stroma of breast
skin
muscles of chest wall
blood borne mets spread where?
bone liver brain lungs abdominal viscera genital tract
what is the most common type of breast ca
ductal
how is breast ca graded
tubular differentiation 1-3
nuclear pleomorphism 1-3
mitotic activity 1-3
score 3-5 = grade 1
score 6-7 = grade 2
score 8-9 = grade 3
the majority of breast ca is ER +ve; true or false
true
which drugs can be used if ER +ve
tamoxifen
aromatase inhibitors
GnRH antagonists
HER2 +ve means that which drug can be used
trastuzamab (Herceptin)
what can be used to predict prognosis
Nottingham prognostic index
adjuvant! online
PREDICT (NHS)
