Breast Pathology (benign) Flashcards
What is FNA?
Fine needle aspiration is a method of analysing the cells in a tissue (cytology)
What are the gradings of cytology in FNA?
C1 = unsatisfactory
C2 = Benign
C3 = atypical but probably benign (requires further investigation)
C4 = probably malignant
C5 = malignant
What are the features looked for on cytology?
The types of cells present, and any abnormalities in the cells e.g. high N:C ratio, open chromatin structure, rouleaux (stacked on top of each other), variation in nuclei
How is histopathology carried out?
Diagnostically = core needle biopsy, vacuum biopsy, incisional biopsy, skin biopsy
Therapeutically = excisional biopsy or resection (wide local excision or mastectomy)
When would vacuum biopsy be preferred?
If need to get a lot of samples - core needle biopsy requires need to be removed every time a sample has been taken
Is histopathology or cytology better?
Histopathology as gives more information regarding the lesion you are investigating
What are some developmental abnormalities that can occur in the breast?
hypoplasia, juvenile hyperplasia, accessory breast tissue/nipple
What is gynaecomastia?
The growth of breast tissue in the male (ducts become enlarged but not the lobules)
What are some causes of gynaecomastia?
exogenous/endogenous steroid use
cannabis
prescription drugs (spironolactone)
liver disease
(anything that causes an increase in the oestrogen:androgen ratio in the male)
What is fibrocytic change?
This is when the breast tissue develops cysts (blue domed and pale fluid filled) that are surrounded by fibrosis. It is very common
Who is affected by fibrocytic change?
Women ages 20-50 (commonly 40)
What is the presentation of fibrocytic change?
may be associated with menstrual change, early menarche or late menopause but is usually asymptomatic and picked up at screening. The breast may feel lumpy or tender (cyclical pain).
How is fibrocystic pain managed?
managed with reassurance as benign, only excise if necessary
Describe the gross pathological findings of fibrocystic change
Cysts (1mm to several cm in diameter) that are blue domed and filled with pale fluid. There will be fibrosis between the cysts
What cells line the fibrocytic cysts?
Apocrine cells
What is a hamartoma?
This is a well circumscribed lesion that is made up of cells local to the breast tissue in abnormal proportion or distribution - benign
Describe the presentation of a fibroadenoma
This will present in the 3rd decade of life with small smooth rubbery lumps in the breast tissue. They will be mobile and can be described as the ‘breast mouse’. Not painful
How are fibroadenomas diagnosed?
solid mass of USS, rubbery, grey in colour
How do you manage a fibroadenoma?
reassure, dont tent to excise but can use vacuum biopsy if <2cm in diameter.
What is sclerosing adenosis?
This is the transformation of stroma to sclerosis that presents in 20-70s. it is benign
What is the architecture like in sclerosis adenosis?
Architecture is normal but distorted due to the sclerosis of stroma causing compression of the lobules
How will sclerosing adenosis present?
Pain, tenderness, lumpiness, thickening of breast tissue, may cause skin retraction
What is a radial scar?
this is a sclerosing lesion that is often found incidentally on mamogram as a radiating lesion of fibrosis.