Breast pathology - benign Flashcards
What assessment is done in a women with suspected breast disease ?
Triple assessment
- Clinical - History & Examination
- Imaging - Mammography, Ultrasound, MRI
- Pathology - Cytopathology or Histopathology done (histopathology more commonly now as it allows you to see the cells in context of the whole tissue)
What is the main technique used for obtaining breast cytopathology samples ?
Fine need aspiration (FNA)
What do the 5 different gradings mean for cystopathology breast results ?
- C1 - Unsatisfactory
- C2 - Benign
- C3 - Atypia, probably benign
- C4 - Suspicious of malignancy
- C5 - Malignant
What are the different diagnostic and theraputic options for obtaining breast histopathology samples ?
Diagnostic:
- (Needle) core biopsy
- Vacuum assisted biopsy (large volume)
- Skin biopsy
- Incisional biopsy of mass
Therapeutic:
- Vacuum assisted excision
- Excisional biopsy of mass
- Resection of cancer
- Wide local excision (WLE)
- Mastectomy
What do the 5 gradings of breast histopathology mean ?
- B1 - Unsatisfactory / normal
- B2 - Benign
- B3 - Atypia, probably benign
- B4 - Suspicious of malignancy
- B5 - Malignant - B5a - carcinoma in situ or B5b - invasive carcinoma
List the 4 main developmental (congenital) breast anomalies
- Hypoplasia
- Juvenile hypertrophy
- Acessory breast tissue (polymastia)
- Acessory nipple
List the 4 main non-neoplastic breast conditions
- Gynaecomastia
- Fibrocystic change
- Hamartoma
- Sclerosing lesions - sclerosing adenosis, radial scar/complex sclerosing lesions
List the 3 main inflammatory breast conditions
- Fat necrosis
- Duct ectasia
- Acute mastitis/abscess
List the 2 main benign breast tumours
- Phyllodes tumour
- Intraduct papilloma
Define what breast hypoplasia (micromastia) is
This is postpubertal underdevelopment of a womans breast tissue
Define what juvenile hypertrophy is
- At the onset of puberty the breast grow rapidly & out of proportion, they become a severe physical & psychological burden
- Microscopically there is no abnormality seen, the enlargement is simply due to overgrowth of adipose & connective tissue
Think kenna
What is the treatment of juvenile hypertrophy?
Surgical reduction
Define what acessory breast tissue (polymastia) is
- This is where abnormal breast tissue is seen in addition to the presence of normal breast tissue.
- This can present as a mass anywhere along the course of the embryological mammary streak (axilla to inguinal region)
Describe what gynaecomastia is
- This is breast development in males, occuring in response to high oestrogen levels
- Ductal growth occurs without lobular development
What are the causes of gynaecomastia ?
- Exogenous/endogenous hormones e.g. hormonal therapy for prostate cancer
- Cannabis
- Chronic liver disease
- Drugs e.g. digoxin, sprinolocatone
What condition causes breast enlargement like gynaecomastia but histologically the breasts are similar to female breasts with lobules seen ?
Kleinfelters syndrome (47 XXY)
What is the most common breast lesion in women ?
Fibrocystic change
What age range of women does fibrocystic change affect ?
Any between 20-50 but esp premenopausal women 40-50
What causes fibrocystic change to occur ?
Occurs due to changes in hormone levels/sensitivity hence often associated with menstrual abnormalities, early menarche & late menopause
What results in a sharp delcine in symptomatic cases of fibrocystic change ?
Having been through menopause
What are the presenting features of fibrocystic change ?
- Smooth discrete lumps
- Sudden pain
- Cyclical pain
- Lumpiness/thickening
- Breast changes similar in both breasts
- Incidental finding or on screening
What is the gross pathological appearance of fibrocystic change ?
- Cysts which are blue domed with pale fluid and usually multiple
- Fibrosis - increased fibrous stroma
Note - stroma of the breast is the supporting framework of the gland, it is partly fibrous & partly fatty. Fatty stroma = the main bulk of the breast, fibrous stroma forms the suspensory ligaments
What is the microscopic appearance of fibrocystic change ?
- Cysts - thin walled fibrotic, lined with apocrine epithelium (apocrine metaplasia)
- Fibrosis - increased fibrous stoma
What is the management of fibrocystic change ?
- Exclude malignancy
- Reassure
- Excise if necessary
Define what a hamartoma is
This is a ‘circumscribed (has boundries) lesion composed of cell types normal to the breast but present in an abnormal proportion or distribution’ - disordered collection of lobules, stroma & fat
Who is fibroadenomas more common in ?
African women
Describe the presenting features of a fibroadenoma
- Well-defined mobile solitary lump (1-3cm)
- Painless & rubber-firm & smooth
What age range is fibroadenomas most common in ?
Most common in 20-30’s
What is the gross pathological appearance of a fibroadenoma ?
A well-circumscribed, rubbery, grey-white lump
What is the microscopic appearance of a fibroadenoma ?
- There is proliferation of the intralobular stroma with interspread epithelial tubules or clefts.
- It is a biphasic tumour/lesion (consists of epithelial tissue & mesenchymal tissue)
What is the management of fibroadenomas ?
- Diagnose & reasure (no increased risk of malignancy)
- Excise usually if > 3cm
What does sclerosing lesions ecompass ?
Sclerosing adenosis & radial scar/ complex sclerosing lesions