breast pathology Flashcards by holly strachan

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small amount of material in needle when withdrawn

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what are the classifications of FNA (C1-C5)

C1 - unsatisfactory sample 
C2 - benign 
C3 - atypia, probably benign
C4 - suspicious of malignancy 
C5 - malignant

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apart from FNA, what other materials can be used for cytopathology investigation

fluid
nipple discharge
nipple scrape

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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sheath withdrawn and released again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

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core needle biopsy classification (B1-B5)

B1 - unsatisfactory 
B2 - benign 
B3 - atypia, probably benign 
B4 - suspicious of malignancy 
B5 - malignant 
B5a - CIS
B5b: invasive

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what are developmental anomalies in the breast

hypoplasia
juvenile hypertrophy
accessory breast tissue
accessory nipple

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what is gynaecomastia

breast development in the male

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how does gynaecomastic breast tissue differ from female breast tissue

ductal growth without lobular development

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what causes gynaecomastia

exogenous/endogenous hormones (oestrogen)
cannabis
prescription drugs
liver disease

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in what ages group does fibrocystic change present

20-50

mostly 40-50

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fibrocystic change is associated with which other gynaecologist signs

early menarche
late menopause
menstrual abnormalities

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how does fibrocystic change present

smooth discrete lumps
sudden/cyclical pain
incidental finding

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gross pathology of fibrocystic change

blue domed with pale fluid
usually multiple
intervening fibrosis

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what causes the fibrosis in fibrocystic change

rupture of cysts and subsequent scarring

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microscopic pathology of fibrocystic change

thin walled cysts that may have fibrotic wall

lined by apocrine epithelium

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management of fibrocystic change

exclude malignancy
reassure
excise if necessary

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what is a hamartoma

circumscribed lesion composed of cell types normal to the breast but present in an abnormal proportion of distribution

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presentation of fibroadenoma

painless, firm, discrete, mobile mass

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clinical features of fibroadenoma

localised hyperplasia
proliferation of interlobular storm
circumscribed, rubbery, grey-white lesions

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management of fibroadenoma

exclude malignancy
reassure
excise

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what are sclerosing lesions

benign, disorderly proliferation of acini and stroma

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features of sclerosing adenosis

pain, tenderness or lumpiness/thickening

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what is the difference between radial scar and complex sclerosing lesion

radial scar = 1-9 mm

CSL = >10 mm

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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)