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
What are the cyst walls like?
thin walled
- fibrotic wall
- lined by aprocrine epithelium
Define metaplasia.
change from one fully differentiated cell type to another fully differentiated cell type
Define hamartoma.
Circumscribed lesion composed of cell types normal to the breast but present in an abnormal proportion or distribution
How to manage fibrocystic change?
Exclude malignancy
Reassure
Excise if necessary
How common is fibroadenoma and in whom?
- common
- SOLITARY and MOBILE
- COMMON in african women
- 30s
How does a fibroadenoma present as?
- solid on USG
- breast “mouse”
- painless/firm/discretemobile
Fibroadenoma are said to biphasic tumors…what does that mean
epithlium and stromal content
—also appears gre-white color and rubbey
How to treat fibroadenoma?
Diagnose
Reassure
Excise
How do sclerosing lesions appear?
- mass and calcification
- MIMIC CA
How do scleorising lesions appear microscopically?
Benign, disorderly proliferation of acini and stroma
How and whom does sclerosing adenosis appear in?
-breast LUMP
- BREAST PAIN
-Asymptomatic
Age 20-70
Does sclerosing adenosis have CA risk?
How to manage?
- no
- as it is a d.o of INVOLUTION (no malignant risk)
- lesion should be BIOPSIED (excision not a must)
What does a radial scar appear as?
- STELLATE w. Central puckering
- dense center (fibroelastic)
- Radiating fibrosis containing distorted ductules
- Fibrocystic change
- Epithelial proliferation
Are radial scars premalignant?
- probable development of in situ or invasive CA is possible
- rapid epithelial proliferation
How to treat radial scar?
- excise or sample extensively by VACUUM biopsy
How may fat necorsis occur of the breast?
Local trauma
- Seat belt injury
- Frequently no history
Warfarin therapy
How to treat Duct ecatsia?
Treat acute infections
Exclude malignancy
Stop smoking
Excise ducts
What is the etiology of acute mastitis?
- Duct ecatsia
2. Lactation (S.Aureus/ Strep.pyogenes)
How to manage acute mastitis?
Antibiotics
Percutaneous drainage
Incision and drainage
Treat underlying cause
What is a key ft of phyllodes tumor?
- stromal overgrowth (more than epithelium)
How does the phyllodes tumor present clinically?
- in 40s-50s
- slow growing UNILATERAL breast mass
The behaviour of the phyllodes tumor (bening/malignant) depends on what fts of the tumor?
- stromal fts
What is the risk of an inadequately excised phyllodes tumor?
- prone to LOCAL recurrence
- —-rarely metastasis
Name papillary lesions of the breast.
- intraduct papilloma
- nipple adenoma
- encapsulated papillary carcinoma
intraductal papilloma is commonly seen in which people of what age?
- 35-60
What is seen clinically and with imaging in intraductal papilloma?
- Nipple DISCHARGE +/- blood
- nodules and calcification
What is seen histologically in intraduct papilloma?
- involves sub-areolar ducts
- 2-20mm diameter
- branching fibrovascular cores with an OVERLYING epithelial and myoepithelial layers
What is duct ectasia?
- (clogged ducts)
- subareolar
- dilated LARGE ducts with fibrous thickening of the walls
- foamy macrophages in lumen
- —-eventual ductal obliteration
How does ductal ectasia present as?
- inverted nipple
- redness around nipple and areolar
- nipple discharge
- pain in affected nipple
In whom is ductal ectasia commonly seen in?
- those approaching menopause or going through menopause
- ducts become shorter and wider with age (easily clogged)
Does a breast cyst have a risk of malignancy?
- YES
- SMALL, risk (esp. if younger)
How to manage breast cysts?
- aspirate
- –if BLOOD filled or PERSISTENT; mass should be BIOPSIED or EXCISED
