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Reproductive & Sexual Health > Breast Pathology > Flashcards

Breast Pathology Flashcards

1
Q

What is triple assessment of someone with breast disease?

A
  • clinical
    • history
    • examination
  • imaging
    • mammography
    • ultrasound
    • MRI
  • pathology
    • cytopathology
    • histopathology
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2
Q

How are breast cytopathology samples attained?

A

Fine needle aspiration

Fluid

Nipple discharge

Nipple scrape

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3
Q

What is the staging for breast FNA cytology?

A
  • C1- Unsatisfactory
  • C2- benign
  • C3- atypia, probably benign
  • C4- suspicious of malignancy
  • C5- malignant
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4
Q

What procedures are done for diagnostic breast histopathology?

A
  • needle core biopsy
  • vacuum assisted biopsy (large volume)
  • skin biopsy
  • incisional biopsy of mass
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5
Q

What procedures are done for therapeutic breast histopathology?

A
  • vacuum assisted excision
  • excisional biopsy of mass
  • resection of cancer
    • wide local excision
    • mastectomy
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6
Q

What are the stagings for needle core biopsy?

A

B1- Unsatisfactory/normal

B2- benign

B3- atypia, probably benign

B4- suspicious of malignancy

B5- malignant

B5a- carcinoma in situ

B5b- invasive carcinoma

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7
Q

What are the benign developmental anomalies of the breast?

A
  • hypoplasia
  • juvenile hypertrophy
  • accessory breast tissue
  • accessory nipple
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8
Q

What are the benign non-neoplastic pathologies of the breast?

A
  • gynaecomastia
  • fibrocystic change
  • hamartoma
  • fibroadenoma
  • sclerosing lesions
    • sclerosing adenosis
    • radial scar/complex sclerosing lesions
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9
Q

What are the benign inflammatory pathologies of the breast?

A
  • fat necrosis
  • duct ectasia
  • acute mastitis/abscess
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10
Q

What are the benign tumours of the breast?

A

Phyllodes tumour

Intraduct papilloma

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11
Q

What is gynaecomastia?

A

Breast development in the male

Ductal growth without lobular development

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12
Q

What are the causes of gynaecomastia?

A

Exogenous/endogenous hormones

Cannabis

Prescription drugs

Liver disease

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13
Q

Who is commonly affected by fibrocystic change?

A

Women aged 20-50

majority 40-50

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14
Q

What can cause fibrocystic change?

A

Menstrual abnormalities

Early menarche

Late menopause

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15
Q

How does fibrocystic change present?

A
  • smooth discrete lumps
  • sudden pain
  • cyclical pain
  • lumpiness

May pressent as an incidental finding or on breast screening.

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16
Q

What is the gross pathology of fibrocystic change?

A

Cysts

  • 1mm -> several cm*
  • blue domed with pale fluid*
  • usually multiple*
  • associated with other benign changes*

Intervening fibrosis

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17
Q

Describe the microscopic pathology of fibrocystic change

A

Cysts

  • Thin walled- may have fibrotic wall*
  • Lined by apocrine epithelium*

Intervening fibrosis

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18
Q

Define metaplasia

A

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

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19
Q

How is fibrocystic change managed?

A

Exclude malignancy

Reassure

Excise if necessary

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20
Q

What is a hamartoma?

A

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

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21
Q

Fibroadenomas are usually _______ and are commoner in ______ woman.

A

Fibroadenomas are usually solitary and are commoner in African woman.

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22
Q

When do fibroadenomas present?

A

In 3rd decade often at screening

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23
Q

How are fibroadenomas described?

A

Breast mouse

Painless, firm, discrete, mobile mass

24
Q

Fibroadenomas are _____ on ultrasound

A

Fibroadenomas are solid on ultrasound

25
Q

Describe the gross pathology of fibroadenomas

A

Circumscribed

Rubbery

Grey-white colour

Biphasic tumour

    • epithelium*
    • stroma*
26
Q

What is the treatment of a fibroadenoma?

A

Diagnose

Reassure

Excise

27
Q

What are sclerosing lesions?

A

Benign, disorderly proliferation of acini and stroma

28
Q

What can sclerosing lesions cause?

A

Mass or calcification

29
Q

What may sclerosing lesions mimic?

A

Carcinoma

30
Q

Describe the presentation of sclerosing adenosis

A

Pain, tenderness or lumpiness/thickening

Asymptomatic

31
Q

What age group gets sclerosing adenosis?

A

Age 20-70

32
Q

The risk of carcinoma from sclerosing adenosis is …

A

Negligible

33
Q

__% of radial scars are multicentric and __% are bilateral

A

67% of radial scars are multicentric and 43% are bilateral

34
Q

How are radial scars detected?

A

On mammography as incidental finding

35
Q

What sizes are radial scars (RS) and Complex Sclerosing Lesions (CSL)?

A

RS= 1-9mm

CSL= >10mm

36
Q

Describe radial scar pathology

A

Stellate architecture

Central puckering

Radiating fibrosis

37
Q

Describe the histology of a radial scar

A
  • fibroelastic core
  • radiating fibrosis containing distorted ductules
  • fibrocystic change
  • epithelial proliferation
38
Q

What do radial scars mimic?

A

Carcinoma of radiology

39
Q

What may occur within a radial scar?

A

Epithelial proliferation

In situ or invasive carcinoma

40
Q

What is the treatment of a radial scar?

A

Excise or sample extensively by vacuum biopsy

41
Q

What causes fat necrosis?

A

Local trauma

  • seat belt injury
  • frequently no history

Warfarin therapy

42
Q

Describe the growth pathology of fat necrosis?

A
  • damage and disruption of adipocytes
  • infiltration by acute inflammatory cells
  • ‘foamy’ macrophages
  • subsequent fibrosis and scarring
43
Q

How is fat necrosis managed?

A

Confirm the diagnosis

Exclude malignancy

44
Q

What are the clinical features of duct ectasia?

A
  • affects sub-areolar ducts
  • pain
  • acute episodic inflammatory changes
  • bloody and/or purulent discharge
  • fistulation
  • nipple retraction and distortion
45
Q

What is associated with duct ectasia?

A

Smoking

46
Q

What is the gross pathology of duct ectasia?

A
  • Subareolar duct dilatation
  • periductal inflammation
  • periductal fibrosis
  • scarring and distortion
47
Q

How can duct ectasia be managed?

A
  • treat acute infections
  • exclude malignancy
  • stop smoking
  • excise ducts
48
Q

What are the 2 main aetiologies of acute mastitis/abscess?

A
  • duct ectasia
    • mixed organisms
    • anaerobes
  • lactation
    • staph aureus
    • strep pyogenes
49
Q

What is the management of acute mastitis/abscess?

A

Antibiotics

Percutaenous drainage

Incision and drainage

Treat underlying cause

50
Q

Who gets phyllodes tumours and how are they described?

A

40-50

Slow growing unilateral breast mass

51
Q

Describe the morphology of a phylodes tumour?

A

Biphasic,

Stromal overgowth

Epithelial

52
Q

What does behaviour of phyllodes tumour depend upon?

A

Stromal features;

  • benign
  • borderline
  • malignant (sarcomatous)
53
Q

What is the outcome of phyllodes tumour?

A

Prone to local recurrence if not adequately excised

Rarely metastasize

54
Q

How do intraduct papillomas present and who gets them?

A

Nipple discharge +/- blood

Asymptomatic at screening

  • nodules, calcification

Age 35-60

55
Q

What is the gross pathology of intraduct papilloma?

A

Found in sub-areolar ducts

2-20mm in diameter

Papillary fronds containing a fibrovascualr core, covered by myoepithelium and epithelium.

56
Q

What may epithelium show in intraduct papilloma?

A

Proliferative activity

57
Q

What does staging of intraduct papilloma depend on?

A

Epithelial proliferation

  • none
  • usual type hyperplasia
  • atypical ductal hyperplasia
  • ductal carcinoma in situ

Reproductive & Sexual Health (54 decks)

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