Breast Pathology/Benign Breast Conditions Flashcards by Charis Gibson

Assessment of patient with breast disease?

Triple assessment

Clinical
Imaging
Pathology (cytopathology, histopathology)

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Breast cytopathology?

(Rarely undertaken these days)

Fine needle aspiration
Fluid
Nipple discharge
Nipple scrape

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Grades of breast FNA cytology?

C1: Unsatisfactory 
C2: Benign 
C3: Atypia, probably benign 
C4: Suspicious of malignancy 
C5: Malignant

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Grading of needle core biopsy?

B1: Unsatisfactory/normal 
B2: Benign 
B3: Atypia, probably benign 
B4: Sus of malignancy 
B5: Malignant
   a= Carcinoma in situ 
   b= Invasive carcinoma

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What is WLE?

Wide local excision

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Types of developmental abnormalities?

Hyperplasia
Juvenile hypertrophy
Accessory breast tissue
Accessory nipple

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Non-neoplastic pathology of benign breast disease?

Gynaecomastia 
Fibrocystic change 
Hamartoma 
Fibroadenoma 
Sclerosing lesions

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Inflammatory pathology of benign breast disease?

Fat necrosis
Duct ectasia
Acute mastitis/abscess

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Benign tumours of breast?

Phyllodes tumour

Intraduct papilloma

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What is gynaecomastia?

Breast development in males

-Ductal growth without lobular development

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Causes of gynaecomastia?

Exogenous/endogenous hormones
Cannabis
Prescription drugs
Liver disease

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What is cause of fibrocystic change?

Abnormal and exaggerated responses of breast tissue to cyclical physiological menstrual hormonal stimuli

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What age group does fibrocystic change occur in?

Pre-menopausal women age 20-50

Very common

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Resolution of fibrocystic change?

Often resolves or diminishes after menopause

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Presnetation of fibrocystic change?

Lump or lumpiness of breast in pre-menopausal women

Smooth discrete lumps
Sudden pain
Cyclical pain
Lumpiness
Incidental finding (asymptomatic)

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Microscopic and macroscopic appearance of fibrocystic change?

Cysts with intervening fibrosis

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Management of fibrocystic change?

Exclude malignancy, reassure, excise if necessary

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What is hamartoma?

Circumscribed lesion composed of cell types normal to breast but present in an abnormal proportion or distribution

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What is the commonest benign tumour of the breast?

Fibroadenoma

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Presentation of fibroadenoma?

Usually solitary single lump which is small, firm and mobile.
Usually painless

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Who do fibroadenomas usually occur in?

Young women

Afro-carribean

How does a fibroadenoma appear on US?

Solid

Gross appearance of fibroadenoma?

Well circumscribed
Rounded
Elastic
Greyish cut surface

Clinical description of fibroadenoma?

Painless, discrete, mobile mass

Microscopic fibroadenoma?

Composed of connective tissue (stroma) and epithelium

Management of fibroadenoma?

- Reassure that it is benign | - Excise if causing symptoms

Difference between fibrocystic change and fibroadenoma?

Fibrocystic= Painful, irregular lumpiness Fibroadenoma= Painful, solid single lump

What are sclerosing lesions?

Benign, disorderly proliferation of acini and stroma

What mimics carcinoma?

Sclerosing lesions

Presentation of scleroing adenosis?

- Pain, tenderness or lumpiness/thickening | - Asymptomatic

Age for presentation of scleroising adenosis?

20-70 years old

What is a radial scar?

Small firm lesion with dense fibrous core with radiating fingers of fibrosis entrapping and distorting glandular elements

What may occur in radial scars?

In situ or invasive carcinoma

Management of radial scars?

Excised or vacuumed

Radial scars can be confused with?

Carcinoma

Cause of fat necrosis?

Local trauma - Seat belt injury - Surgery OR Warfarin therapy

What is fat necrosis?

Necrotic fat with lipid rich macrophages, giant cells and later, fibrosis

What can fat necrosis present as?

Mass mimicking carcinoma

Management of fat necrosis?

Exclude malignancy and reassure -Lumps generally go away Surgery can be done if they become big/uncomfy

What is duct ectasia?

Chronic inflammatory condition assoc with ectasia of ducts/cystic dilation

What is duct ectasia associated with?

Ageing and smoking

Clinical features of duct ectasia?

- Affects sub-areolar ducts - Pain - Acute episodic inflammatory changes - Blood/purulent discharge - Fistulation - Nipple retraction and distortion

Management of duct ectasia?

- Treat acute infections - Exclude malignancy - Smoking cessation - If bad can do surgery

2 main aetiologies of acute mastitis and breast abscess?

Duct ectasia > involves organisms and anaerobes | Lactation > staph A, strep pyogenes

Clinical presentation of acute mastitis/abscess?

Signs of infection and painful swollen breast

Management of acute mastitis/abscess?

- AB's - Percutaneous drainage - Incision and drainage

Age range for phyllodes tumour?

40-50

Cut surface of phyllodes tumour looks like?

Leaves- Phyllodes= greek for leaf)

Where can duct papilloma develop?

This benign tumour can develop in any part of duct system of breast but is most common in lacteal sinuses at nipple

Age for intraduct papilloma?

Age 35-60

Presnetation of intraduct papilloma?

Nipple discharge +/- blood

Management of duct papilloma?

Surgical removal and histology examined as small risk of cancer