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repro > Breast Pathology > Flashcards

Breast Pathology Flashcards

1
Q

How to assess a patient with breast disease?

A

By TRIPLE assessment

  1. Clinical (hx and exam)
  2. Imaging (Mammography/USG/MRI)
  3. Pathology (cyto-/histo-pathology)
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2
Q

How is cytopathology assessed?

A
  • by: Fine needle aspiration/ fluid/ nipple discharge/ nipple scrape
  • easy extraction of epithelial cells
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3
Q

What may the FNA cytology indicate in classification?

A
  • 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
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4
Q

How is breast histopathology assessed?

A

dx by core biopsy

  • vacuum assisted biopsy
  • skin biopsy
  • incisional biopsy of mass
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5
Q

What can be performed in response to the breast histopathology results?

A
  • vacuum assisted excision
  • excisional biopsy of mass
  • resection of CANCER
    (wide local excision/ mastectomy- if disease is too extensive)
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6
Q

Classification of the lesion by the needle core biopsy is…

A 
B1: normal/unsatis.
B2: Benign 
B3: Atypia (probably benign) 
B4: suspicious malignancy 
B5: Malignant - B5a (CA in situ) ....- B5b: invasive CA
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7
Q

Name 4 developmental anomalies of breast tissue.

A
  • hypoplasia
  • juvenile hypertrophy (one or both grow MASSIVELy)
  • accessory breast tissue
  • accessory nipple (anywhere along the milk line)
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8
Q

What are non-neoplastic conditions of the breast?

A
  • gynaecomastia
  • fibrocystic change
  • hamartoma
  • fibroadenoma
  • sclerosing lesions (sclerosing adenosis/ radial scars)
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9
Q

Name 3 inflammatory conditions of the breast.

A
  • fat necrosis (with trauma and seat belt injurieS)
  • duct ectasia
  • acute mastitis/ abscess
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10
Q

What are some benign tumors of the breast tissue?

A
  • intraduct papilloma

- phyllodes tumor (benign—-> malign.)

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11
Q

What occurs in gynaecomastia?

A
  • ductal growth without lobar develop.
  • don’t see acini
  • hyperplastic epithelium
  • ductal proliferation
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12
Q

What causes gynaecomastia?

A
  • cannabis
  • prescription drugs
  • liver disease
  • exogenous/endogenous hormones (estrogenic hormones)
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13
Q

Fibrocystic change commonly occur at what age?

A
  • age 40-50
    (seen 20-50y.o)
    —very common
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14
Q

What causes these changes?

A
  • menstrual abnormalities
    (early menarche-late menopause) –esp. ANOVULATORY cycle (prolonged estrogenic stimulation)
    —–RESOLVES after menopause
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15
Q

Hisyopathology and cytopathology diff.

A

HISTO= looks at biopsy specimens

Cytopathology= fluid specimens (V. QUICK process; done in a day)

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16
Q

DIff. with needle core biopsy vs FNA?

A
  • can tell with biopsy if invasive

- ——if so AXILLARY breast is removed

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17
Q

Vacuum assisted biopsy advs?

A
  • needle stays in situ
  • pt doesn’t need to stay in
  • no need local anaesthetic
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18
Q

How does fibrocystic mass present as?

A 
Smooth discrete lumps
Sudden pain (d/t rupture) 
Cyclical pain
Lumpiness
Incidental finding
Screening
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19
Q

What is a red flag for breast tissue gross pathology?

A
  • BLOOD staining is bad on gross pathology
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20
Q

How do the cysts present as?

A

1mm – several cm
blue domed with pale fluid
Usually multiple
Associated with other benign changes

—-intervening fibrosis

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21
Q

What are the cyst walls like?

A

thin walled

  • fibrotic wall
  • lined by aprocrine epithelium
22
Q

Define metaplasia.

A

change from one fully differentiated cell type to another fully differentiated cell type

23
Q

Define hamartoma.

A

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

24
Q

How to manage fibrocystic change?

A

Exclude malignancy
Reassure
Excise if necessary

25
Q

How common is fibroadenoma and in whom?

A
  • common
  • SOLITARY and MOBILE
  • COMMON in african women
  • 30s
26
Q

How does a fibroadenoma present as?

A
  • solid on USG
  • breast “mouse”
  • painless/firm/discretemobile
27
Q

Fibroadenoma are said to biphasic tumors…what does that mean

A

epithlium and stromal content

—also appears gre-white color and rubbey

28
Q

How to treat fibroadenoma?

A

Diagnose
Reassure
Excise

29
Q

How do sclerosing lesions appear?

A
  • mass and calcification

- MIMIC CA

30
Q

How do scleorising lesions appear microscopically?

A

Benign, disorderly proliferation of acini and stroma

31
Q

How and whom does sclerosing adenosis appear in?

A

-breast LUMP
- BREAST PAIN
-Asymptomatic
Age 20-70

32
Q

Does sclerosing adenosis have CA risk?

How to manage?

A
  • no
  • as it is a d.o of INVOLUTION (no malignant risk)
  • lesion should be BIOPSIED (excision not a must)
33
Q

What does a radial scar appear as?

A
  • STELLATE w. Central puckering
  • dense center (fibroelastic)
  • Radiating fibrosis containing distorted ductules
  • Fibrocystic change
  • Epithelial proliferation
34
Q

Are radial scars premalignant?

A
  • probable development of in situ or invasive CA is possible
  • rapid epithelial proliferation
35
Q

How to treat radial scar?

A
  • excise or sample extensively by VACUUM biopsy
36
Q

How may fat necorsis occur of the breast?

A

Local trauma

  • Seat belt injury
  • Frequently no history

Warfarin therapy

37
Q

How to treat Duct ecatsia?

A

Treat acute infections
Exclude malignancy
Stop smoking
Excise ducts

38
Q

What is the etiology of acute mastitis?

A
  1. Duct ecatsia

2. Lactation (S.Aureus/ Strep.pyogenes)

39
Q

How to manage acute mastitis?

A

Antibiotics
Percutaneous drainage
Incision and drainage
Treat underlying cause

40
Q

What is a key ft of phyllodes tumor?

A
  • stromal overgrowth (more than epithelium)
41
Q

How does the phyllodes tumor present clinically?

A
  • in 40s-50s

- slow growing UNILATERAL breast mass

42
Q

The behaviour of the phyllodes tumor (bening/malignant) depends on what fts of the tumor?

A
  • stromal fts
43
Q

What is the risk of an inadequately excised phyllodes tumor?

A
  • prone to LOCAL recurrence

- —-rarely metastasis

44
Q

Name papillary lesions of the breast.

A
  • intraduct papilloma
  • nipple adenoma
  • encapsulated papillary carcinoma
45
Q

intraductal papilloma is commonly seen in which people of what age?

A
  • 35-60
46
Q

What is seen clinically and with imaging in intraductal papilloma?

A
  • Nipple DISCHARGE +/- blood

- nodules and calcification

47
Q

What is seen histologically in intraduct papilloma?

A
  • involves sub-areolar ducts
  • 2-20mm diameter
  • branching fibrovascular cores with an OVERLYING epithelial and myoepithelial layers
48
Q

What is duct ectasia?

A
  • (clogged ducts)
  • subareolar
  • dilated LARGE ducts with fibrous thickening of the walls
  • foamy macrophages in lumen
  • —-eventual ductal obliteration
49
Q

How does ductal ectasia present as?

A
  • inverted nipple
  • redness around nipple and areolar
  • nipple discharge
  • pain in affected nipple
50
Q

In whom is ductal ectasia commonly seen in?

A
  • those approaching menopause or going through menopause

- ducts become shorter and wider with age (easily clogged)

51
Q

Does a breast cyst have a risk of malignancy?

A
  • YES

- SMALL, risk (esp. if younger)

52
Q

How to manage breast cysts?

A
  • aspirate

- –if BLOOD filled or PERSISTENT; mass should be BIOPSIED or EXCISED

repro (55 decks)

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