Breast Pathology Flashcards
What is triple assessment of someone with breast disease?
- clinical
- history
- examination
- imaging
- mammography
- ultrasound
- MRI
- pathology
- cytopathology
- histopathology
How are breast cytopathology samples attained?
Fine needle aspiration
Fluid
Nipple discharge
Nipple scrape
What is the staging for breast FNA cytology?
- C1- Unsatisfactory
- C2- benign
- C3- atypia, probably benign
- C4- suspicious of malignancy
- C5- malignant
What procedures are done for diagnostic breast histopathology?
- needle core biopsy
- vacuum assisted biopsy (large volume)
- skin biopsy
- incisional biopsy of mass
What procedures are done for therapeutic breast histopathology?
- vacuum assisted excision
- excisional biopsy of mass
- resection of cancer
- wide local excision
- mastectomy
What are the stagings for needle core biopsy?
B1- Unsatisfactory/normal
B2- benign
B3- atypia, probably benign
B4- suspicious of malignancy
B5- malignant
B5a- carcinoma in situ
B5b- invasive carcinoma
What are the benign developmental anomalies of the breast?
- hypoplasia
- juvenile hypertrophy
- accessory breast tissue
- accessory nipple
What are the benign non-neoplastic pathologies of the breast?
- gynaecomastia
- fibrocystic change
- hamartoma
- fibroadenoma
- sclerosing lesions
- sclerosing adenosis
- radial scar/complex sclerosing lesions
What are the benign inflammatory pathologies of the breast?
- fat necrosis
- duct ectasia
- acute mastitis/abscess
What are the benign tumours of the breast?
Phyllodes tumour
Intraduct papilloma
What is gynaecomastia?
Breast development in the male
Ductal growth without lobular development
What are the causes of gynaecomastia?
Exogenous/endogenous hormones
Cannabis
Prescription drugs
Liver disease
Who is commonly affected by fibrocystic change?
Women aged 20-50
majority 40-50
What can cause fibrocystic change?
Menstrual abnormalities
Early menarche
Late menopause
How does fibrocystic change present?
- smooth discrete lumps
- sudden pain
- cyclical pain
- lumpiness
May pressent as an incidental finding or on breast screening.
What is the gross pathology of fibrocystic change?
Cysts
- 1mm -> several cm*
- blue domed with pale fluid*
- usually multiple*
- associated with other benign changes*
Intervening fibrosis
Describe the microscopic pathology of fibrocystic change
Cysts
- Thin walled- may have fibrotic wall*
- Lined by apocrine epithelium*
Intervening fibrosis
Define metaplasia
Change from one fully differentiated cell type to another fully differentiated cell type
How is fibrocystic change managed?
Exclude malignancy
Reassure
Excise if necessary
What is a hamartoma?
Circumscribed lesion composed of cell types normal to the breast but present in an abnormal proportion or distribution.
Fibroadenomas are usually _______ and are commoner in ______ woman.
Fibroadenomas are usually solitary and are commoner in African woman.
When do fibroadenomas present?
In 3rd decade often at screening
How are fibroadenomas described?
Breast mouse
Painless, firm, discrete, mobile mass
Fibroadenomas are _____ on ultrasound
Fibroadenomas are solid on ultrasound
Describe the gross pathology of fibroadenomas
Circumscribed
Rubbery
Grey-white colour
Biphasic tumour
- epithelium*
- stroma*
What is the treatment of a fibroadenoma?
Diagnose
Reassure
Excise
What are sclerosing lesions?
Benign, disorderly proliferation of acini and stroma
What can sclerosing lesions cause?
Mass or calcification
What may sclerosing lesions mimic?
Carcinoma
Describe the presentation of sclerosing adenosis
Pain, tenderness or lumpiness/thickening
Asymptomatic
What age group gets sclerosing adenosis?
Age 20-70
The risk of carcinoma from sclerosing adenosis is …
Negligible
__% of radial scars are multicentric and __% are bilateral
67% of radial scars are multicentric and 43% are bilateral
How are radial scars detected?
On mammography as incidental finding
What sizes are radial scars (RS) and Complex Sclerosing Lesions (CSL)?
RS= 1-9mm
CSL= >10mm
Describe radial scar pathology
Stellate architecture
Central puckering
Radiating fibrosis
Describe the histology of a radial scar
- fibroelastic core
- radiating fibrosis containing distorted ductules
- fibrocystic change
- epithelial proliferation
What do radial scars mimic?
Carcinoma of radiology
What may occur within a radial scar?
Epithelial proliferation
In situ or invasive carcinoma
What is the treatment of a radial scar?
Excise or sample extensively by vacuum biopsy
What causes fat necrosis?
Local trauma
- seat belt injury
- frequently no history
Warfarin therapy
Describe the growth pathology of fat necrosis?
- damage and disruption of adipocytes
- infiltration by acute inflammatory cells
- ‘foamy’ macrophages
- subsequent fibrosis and scarring
How is fat necrosis managed?
Confirm the diagnosis
Exclude malignancy
What are the clinical features of duct ectasia?
- affects sub-areolar ducts
- pain
- acute episodic inflammatory changes
- bloody and/or purulent discharge
- fistulation
- nipple retraction and distortion
What is associated with duct ectasia?
Smoking
What is the gross pathology of duct ectasia?
- Subareolar duct dilatation
- periductal inflammation
- periductal fibrosis
- scarring and distortion
How can duct ectasia be managed?
- treat acute infections
- exclude malignancy
- stop smoking
- excise ducts
What are the 2 main aetiologies of acute mastitis/abscess?
- duct ectasia
- mixed organisms
- anaerobes
- lactation
- staph aureus
- strep pyogenes
What is the management of acute mastitis/abscess?
Antibiotics
Percutaenous drainage
Incision and drainage
Treat underlying cause
Who gets phyllodes tumours and how are they described?
40-50
Slow growing unilateral breast mass
Describe the morphology of a phylodes tumour?
Biphasic,
Stromal overgowth
Epithelial
What does behaviour of phyllodes tumour depend upon?
Stromal features;
- benign
- borderline
- malignant (sarcomatous)
What is the outcome of phyllodes tumour?
Prone to local recurrence if not adequately excised
Rarely metastasize
How do intraduct papillomas present and who gets them?
Nipple discharge +/- blood
Asymptomatic at screening
- nodules, calcification
Age 35-60
What is the gross pathology of intraduct papilloma?
Found in sub-areolar ducts
2-20mm in diameter
Papillary fronds containing a fibrovascualr core, covered by myoepithelium and epithelium.
What may epithelium show in intraduct papilloma?
Proliferative activity
What does staging of intraduct papilloma depend on?
Epithelial proliferation
- none
- usual type hyperplasia
- atypical ductal hyperplasia
- ductal carcinoma in situ
