breast pathology Flashcards
Breasth microanatomy
from inner to outer:
terminal duct, lobular unit, large ducts and lactiferou sinuses
Myoepithelium on the outside squeeze the milk out
Interlobular stroma between the lobules, intralo
life cycle changes of breast
pre-pregnancy- neonatal, pubertal, menstrual cycle
Pregnancy- lactational change
Post menopausal- atrophy and adipose replacement
suspiciouus imaging finidns
mass, asymmetry or archidectural distortion, microcalcifications (can be seen in both benign and malignant lesion), BIRADS (level of suspicion by radiologist
Mammogram vs Ultrasound vs MRI
Mammogram- Microcalcifications, Asymmetry/Architectural distortion, mass-like lesions
Ultrasound- masses, microcalcification
MRI- Asymmetry/architectural distrotion, mass like lesions, dense breast
Common causes of mass lesions by age/group
15-35 fibroadenoma
35-50 fibrocystic changes, fibroademoa, cancer
over 50 cancer until proven otherwise
pregnant or lactating- lactating adenoma, fibroadenoma, fibrocystic changes, mastitis, cancer
Triple test
Combination of: Clinical (physical examination), radiology (imaging studies), pathology (biopsy)
If all three point to a benign diagnosis, it is likely that the process is benign and can be followed without requiring surgical removal (95% sensitive)
If there is any discodance, further studies are indicated
common benign breast lesions
Non-proliferative changes- Fibrocystic changes, apocrine metaplasia
Proliferative changes without atypia- usual ductal epithelial hyperplasia, intraductal papilloma, sclerosing adenosis, columnar cell change, radial scar complex sclerosing lesions
Fibroepithlial lesions- fibroadenoma, benign phyllodes tumor
Inflammatory lesion- mastitis, fat necrosis
Gynecomastia
Fibrocystic changes
Younger women, common, lumpy breasts, tenderness, may fluctuate, can present with density and or calcifications
Gross examination- blue domed cysts
Usual ductal hyperplasia
slit like peripheral lumina, streaming/overlapping heterogenous epithelial cells
non precancerous, no atypia
Intraductal papilloma
present with nipple discharge often bloody, obstruction and dilation of large ducts, often infarct
calcification, fibrovascular core
Can become sclerotic
Fibroadenoma
Younger women, most common benign tumor, hormonally responsive, often palpable, multiple, bilateral well circumscribed mass on ultrasound
become sclerotic and calcified over time
Phyllodes tumor
On the same spectrum as fibroadenomas- often have similar clinical and gross findings circumscribed oval mass, have overlapping histologic features
Diagnostic features favoring phyllodes, areas of stromal overgrowth and leaf like architecture
Can be benign , boderline, malignant, borderline and malignant have increased stromal atypia, mitoses, are more aggressive, and can met
Looks like a maple leaf
Mastitis
Acute- Clinically (red, warm and/fever chills), most common during breast feeding, usually staphylococcus aureus, pr streptococcous, acute inflammation neutrophils, treatment (antibiotic may require Iand D)
Peri- ductal- smoking- associated, periductal chronic inflammation (lymphocytes, plasma cells)
Fat necrosis
Usually due to prior trauma/procedure, can be concerning for malignancy radiographically (stellare appearing scar), microcaclcifications
Histiocytes are macrophages
Gynecomastia
Most common abnormality of male breast
Nodular or diffuse enlargement
2 groups- newborn, adolescent, adult, etiology hormone imbalance, meds, mecahincal
early proliferative, fibrotic
