Breast Pathology - Benign Flashcards
What are the different ways to take a breast sample?
FNA Fluid nipple discharge nipple scrape needle core biopsy vacuum assisted biopsy skin biopsy inscisional biopsy of mass
What therapeutic measures can be done for breast pathologies?
vacuum assisted excision
excisional biopsy of mass
resection of cancer - wide local inscision or masectomy
What is gynaecomastia?
benign breast growth in males
ductal growth but no lobar development
What causes gynaecomastia?
endogenous hormones
cannabis
prescription drugs
liver disease
What are fibrocystic changes to the breasts?
cysts 1mm->several cm
very common
What age are most affected with cysts?
30-50
How do breast cysts present?
sudden pain
smooth, discrete lumps
cyclical pain
lumpiness
What is the pathology of breast cysts?
blue domed with fluid
thin but may have a fibrocytic wall
surrounded by intervening fibrosis
How are breast cysts managed?
excise if necessary
exclude no malignancy and reassure
How are breast cysts diagnosed?
FNA
What is a Hamartoma?
circumscribed lesion composed of cell types normal to the breast but present in an abnormal proportion or distribution
What populations are affected by fibroadenomas?
African women
30s
How do fibroadenomas present?
painless firm discreet mobile mass 1-3cm
What is the pathology of fibroadenomas?
gray-white in colour
proliferation of intralobular storm
How are fibroadenomas diagnosed?
core biopsy
What are sclerosing lesions?
benign, disorderly proliferation of acini and stroma
may mimic carcinoma or cause mass or calcification
What are two types of sclerosing lesions?
sclerosing adenosis
radial scar
What is sclerosing adenosis?
benign but a neglible risk of subsequent carcinoma
presents with pain, tenderness, lumpiness/thickening
How are radial scars seen pathologically?
stellate architecture
radiating fibrosis + central puckering
epithelial proliferation
What may occur within radial scars?
in situ/invasive carcinoma
How are radial scars picked up?
mammogram
- they mimic carcinoma radiologically
How are radial scars treated?
excised or sampled by vacuum biopsy
What can cause fat necrosis?
local trauma - seat belt injury - or warfarin therapy
What is fat necrosis?
damage and distruption to adiposcytes and infiltration by acute inflammatory cells causing subsequent fibrosis and scarring
What is duct ectasia?
sub aerolar duct and periductal inflammation and fibrosis
How does duct ectasia present?
greenish discharge
nipple retraction and distortion
can mimic breast cancer
bloody/purulent discharge
What is associated with causing duct ectasia?
smoking
How can duct ectasia be managed?
stop smoking
excise duct
treat acute infections
What are the two types/causes of acute mastitis?
duct ectasia
lactation
What organisms cause duct ectasia related mastitis?
mixed organisms and anaerobes
What organisms cause lactation related mastitis?
staph aureus and strep pyogenes
How is mastitis treated?
drainage and antibiotics
What is a Phyllodes tumour?
slow growing unilateral breast lump
3-6cm
What age range do Phyllodes tumours affect?
40-50
What is the pathology of Phyllodes tumour?
pathology predicts tumour behaviour
biphasic tumour prone to local reoccurrence
When can Phyllodes tumour be malignant?
if there is sarcomatous stromal component
What is the presentation of Intraduct papillomas?
age 35-60
nipple discharge +/- blood
often asymptomatic
How are Intraduct papillomas diagnosed?
ultrasound guided biopsy
What is the pathology of Intraduct papillomas?
2-20mm
fibrovascular core covered in mEP and epithelium
epithelium may be proliferative
can occur within a cyst
