Breast Pathology/Benign Breast Conditions Flashcards
Assessment of patient with breast disease?
Triple assessment
- Clinical
- Imaging
- Pathology (cytopathology, histopathology)
Breast cytopathology?
(Rarely undertaken these days)
- Fine needle aspiration
- Fluid
- Nipple discharge
- Nipple scrape
Grades of breast FNA cytology?
C1: Unsatisfactory C2: Benign C3: Atypia, probably benign C4: Suspicious of malignancy C5: Malignant
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
What is WLE?
Wide local excision
Types of developmental abnormalities?
Hyperplasia
Juvenile hypertrophy
Accessory breast tissue
Accessory nipple
Non-neoplastic pathology of benign breast disease?
Gynaecomastia Fibrocystic change Hamartoma Fibroadenoma Sclerosing lesions
Inflammatory pathology of benign breast disease?
Fat necrosis
Duct ectasia
Acute mastitis/abscess
Benign tumours of breast?
Phyllodes tumour
Intraduct papilloma
What is gynaecomastia?
Breast development in males
-Ductal growth without lobular development
Causes of gynaecomastia?
- Exogenous/endogenous hormones
- Cannabis
- Prescription drugs
- Liver disease
What is cause of fibrocystic change?
Abnormal and exaggerated responses of breast tissue to cyclical physiological menstrual hormonal stimuli
What age group does fibrocystic change occur in?
Pre-menopausal women age 20-50
Very common
Resolution of fibrocystic change?
Often resolves or diminishes after menopause
Presnetation of fibrocystic change?
Lump or lumpiness of breast in pre-menopausal women
- Smooth discrete lumps
- Sudden pain
- Cyclical pain
- Lumpiness
- Incidental finding (asymptomatic)
Microscopic and macroscopic appearance of fibrocystic change?
Cysts with intervening fibrosis
Management of fibrocystic change?
Exclude malignancy, reassure, excise if necessary
What is hamartoma?
Circumscribed lesion composed of cell types normal to breast but present in an abnormal proportion or distribution
What is the commonest benign tumour of the breast?
Fibroadenoma
Presentation of fibroadenoma?
Usually solitary single lump which is small, firm and mobile.
Usually painless
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
