Breast Pathology Flashcards
Clinical features
Physiologic changes must be distinguished from
pathologic changes
Many conditions present as a lump
Always note the characteristics of the lump and the
age of the patient
Discharge from the nipple
Associated skin involvement
Nipple retraction
Below the age of 35 breast cancer is rare but a
histologic diagnosis is mandatory in all breast masses
/ lesions
Diagnostic methods
Imaging – mammography and ultrasound
FNA – needle inserted into the lump, cells
aspirated and stained and examined by
pathologists
Core/trucut biopsy – tissue sample, more
reliable diagnosis, receptor studies can be
performed
Frozen section
Non-neoplastic Conditions
Throphic enlargement
Inflammatory Conditions
Non-neoplastic Conditions:
Throphic Enlargement
- Juvenile hypertrophy
- Gynaecomastia - men
Causes:
➢ Puberty ➢ Liver cirrhosis – increased oestrogen ➢ Drugs - Digitalis ➢ Oestrogen therapy - Rx of prostate ca ➢ Klinefelter syndrome
Non-neoplastic Conditions:
Inflammatory Conditions
Acute mastitis: lactating women, staf aureaus,
cracked nipple
Chronic mastitis: isolated organ tuberculosis
Duct ectasia: nipple discharge with a retroareolar mass
Fat necrosis: can mimic carcinoma, trauma
Non-neoplastic Proliferative Conditions
Vaguely defined conditions representing a single entity with a wide spectrum of clinical and pathological characteristics.
Numerous terms have been used to describe it, including fibroadenosis, fibrocystic disease, fibrocystic change, cystic mastopathy ect.
Cystic change of the breast most likely the best accepted term at this stage
The term ANDI - Abberations of Normal Development and Involution also commonly used.
Cystic Change of the Breast/Fibrocystic disease of the breast
Very common
Causes symptoms and signs in 10% of women between 30 and 55 years.
Histological signs at post mortem in 50% of women in this age group
Clinically present with premenstrual swelling and discomfort, lumpiness and sometimes discrete masses(cysts) in the breasts
Signs and symptoms tend to decrease with onset of menstruation (hormonal relationship)
Etiology and pathogenesis unknown – most likely caused by hormonal factors, possibly oestrogen.
Fibrocystic change of the Breast:
Macroscopy
Solid, firm areas due to increased fibrosis
Fluid containing cysts up to 2cm in diameter
– ’blue domed cysts’ due to blue color
Fibrocystic change of the Breast:
Microscopy
A combination of the following is found:
Adenosis: enlargement of the lobules
Epithelial hyperplasia: proliferation of the epithelium in the ducts, acini and cysts which often leads to the formation of papillary structures (papillomatosis)
Cyst formation: due to dilatation of the acini and small
ducts
Apocrine metaplasia: pink cytoplasm (cells resemble
apocrine glands)
Fibrosis: increase in amount of fibrous connective tissue
Breast Tumours
■ Primary
Benign:
Fibroadenoma
Benign phyllodes tumour
Intraduct papilloma
Malignant:
Carcinoma
Malignant phyllodes tumour
■ Secondary:
Rare, occasionally bronchus or contralateral breast carcinoma
Fibroadenoma
Most common benign breast tumour
15 – 40 years (reproductive years)
Arises from the lobules of the breast
Fibroadenoma:
Macroscopy
Firm, well demarcated mass/es
Mobile, can be multiple
Usually 1 to 5cm in diameter
Sometimes referred to as ‘breast mice’
Lobulated and grey-white in colour
Fibroadenoma:
Microsscopy
Consist of a proliferation of fibrous
connective tissue in which numerous benign
glandular structures are present.
Benign Phyllodes Tumour
Rare
Any age but median of 45 years
Present as a discreet mass whuich may be large
Benign and malignant types
Note: don’t spread to lymph nodes but
hematogenous
Tend to recur / malignant can metastasize
Benign Phyllodes Tumour:
Macroscopy
Well circumscribed macroscopically
Benign Phyllodes Tumour:
Microscopy
Composed of epithelium and stroma
The stroma is more cellular than that of
fibroadenomas
Intraduct Papilloma
Middle aged women (40 to 60 years)
Less common
Causes nipple discharge (oftern bloody): differential diagnosis carcinoma
Intraduct Papilloma:
Macroscopy
Usually small (1cm in diameter)
Found in the larger ducts
Papillary appearance
Intraduct Papilloma:
Microscopy
Papillary (finger-like) structures consisting of
a fibrovascular core covered by epithelial
cells
Screening
In developed countries with a high incidence screening programmes (mammogram) have been introduced
Women whose cancers have been detected by
regular mammography have increased survival rate
because they are detected earlier with less risk of
metastasis
Suspicious mammography – microcalcification,
localised densities
RSA – medical aid patients – mammogram yearly
starting at the age of 40
Breast Carcinoma
Most common malignant tumour in white females
in South Africa
Also common in black South African women(Cervix and esophageal cancer more common)
35 – 70 years
Only 0,5% of breast carcinomas occur in males
Present with a palpable mass in the breast. Initially
mobile, later fixed to the skin or underlying chest
wall.
Numerous other clinical signs including nipple
discharge, oedema of the skin and skin ulceration
Risk Factors Ass. with Breast Carcinoma
Gender, female (increase with age)
Family history of breast cancer-Increases risk
Nulliparous women-Increases risk
First pregnancy after 30-Increaed risk
Early menarche and late menopause
Absence of breast feeding: controversial
Severe epithelial hyperplasia – atypical hyperplasia
Obesity
Radiation
Breast Carcinoma:
Aetiology
Cause still uncertain
Hormones probably oestrogen
Genetic:
- BRCA1 (Chr 17q) and BRCA2 (Chr13q) mutations
- 5-8% breast cancer due to inherited gene mutations
- Lifetime risk of 65% (BRCA1), 45% (BRCA2)
- Also increased risk for development of ovarian and other cancers
Classification of Breast Carcinoma
In-Situ Carcinoma-Limited to the basement membrane(Non-invasive)
Infiltrating/Invasive
