Breast Pathology Flashcards
How to assess a patient with breast disease?
By TRIPLE assessment
- Clinical (hx and exam)
- Imaging (Mammography/USG/MRI)
- Pathology (cyto-/histo-pathology)
How is cytopathology assessed?
- by: Fine needle aspiration/ fluid/ nipple discharge/ nipple scrape
- easy extraction of epithelial cells
What may the FNA cytology indicate in classification?
- helps classify the breast lump to:
1. C1: unsatisfactory/ normal
2. C2: benign
3. C3: atypia, probably benign
4. suspicious malignancy (surgery not done yet)
5. C5: malignant (don’t know if INVASIVE or IS) > SURGERY
How is breast histopathology assessed?
dx by core biopsy
- vacuum assisted biopsy
- skin biopsy
- incisional biopsy of mass
What can be performed in response to the breast histopathology results?
- vacuum assisted excision
- excisional biopsy of mass
- resection of CANCER
(wide local excision/ mastectomy- if disease is too extensive)
Classification of the lesion by the needle core biopsy is…
B1: normal/unsatis. B2: Benign B3: Atypia (probably benign) B4: suspicious malignancy B5: Malignant - B5a (CA in situ) ....- B5b: invasive CA
Name 4 developmental anomalies of breast tissue.
- hypoplasia
- juvenile hypertrophy (one or both grow MASSIVELy)
- accessory breast tissue
- accessory nipple (anywhere along the milk line)
What are non-neoplastic conditions of the breast?
- gynaecomastia
- fibrocystic change
- hamartoma
- fibroadenoma
- sclerosing lesions (sclerosing adenosis/ radial scars)
Name 3 inflammatory conditions of the breast.
- fat necrosis (with trauma and seat belt injurieS)
- duct ectasia
- acute mastitis/ abscess
What are some benign tumors of the breast tissue?
- intraduct papilloma
- phyllodes tumor (benign—-> malign.)
What occurs in gynaecomastia?
- ductal growth without lobar develop.
- don’t see acini
- hyperplastic epithelium
- ductal proliferation
What causes gynaecomastia?
- cannabis
- prescription drugs
- liver disease
- exogenous/endogenous hormones (estrogenic hormones)
Fibrocystic change commonly occur at what age?
- age 40-50
(seen 20-50y.o)
—very common
What causes these changes?
- menstrual abnormalities
(early menarche-late menopause) –esp. ANOVULATORY cycle (prolonged estrogenic stimulation)
—–RESOLVES after menopause
Hisyopathology and cytopathology diff.
HISTO= looks at biopsy specimens
Cytopathology= fluid specimens (V. QUICK process; done in a day)
DIff. with needle core biopsy vs FNA?
- can tell with biopsy if invasive
- ——if so AXILLARY breast is removed
Vacuum assisted biopsy advs?
- needle stays in situ
- pt doesn’t need to stay in
- no need local anaesthetic
How does fibrocystic mass present as?
Smooth discrete lumps Sudden pain (d/t rupture) Cyclical pain Lumpiness Incidental finding Screening
What is a red flag for breast tissue gross pathology?
- BLOOD staining is bad on gross pathology
How do the cysts present as?
1mm – several cm
blue domed with pale fluid
Usually multiple
Associated with other benign changes
—-intervening fibrosis