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Reproduction > Breast Pathology I > Flashcards

Breast Pathology I Flashcards

1
Q

What does the triple assessment of a patient with a breast condition involve?

A 
Clinical = history, examination
Imaging = mammography, US, MRI
Pathology = cytopathology, histopathology
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2
Q

What are the methods of gaining samples for breast cytopathology?

A

Fine needle aspiration, fluid, nipple discharge, nipple scrape

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3
Q

What is the cytology of FNA?

A 
C1 = unsatisfactory       
C2 = benign
C3 = atypia, probably benign
C4 = suspicious of malignancy
C5 = malignant
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4
Q

What are the diagnostic methods used for breast histopathology?

A

Needle core biopsy, vacuum assisted biopsy, incisional biopsy

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5
Q

What are the therapeutic methods used for breast histopathology?

A

Vacuum assisted excision, excisional biopsy, resection of cancer (wide local excision, mastectomy)

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6
Q

What is the cytology of a needle assisted biopsy?

A 
B1 = unsatisfactory/normal        B2 = benign
B3 = Atypia, probably benign
B4 = suspicious of malignancy
B5a = carcinoma in situ             B5b = invasive carcinoma
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7
Q

What are some benign developmental anomalies of the breast?

A

Hypoplasia, juvenile hypertrophy, accessory breast tissue, accessory nipple

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8
Q

What are some non-neoplastic benign breast diseases?

A

Gynaecomastia, fibrocystic change, hamartoma, fibroadenoma, sclerosing adenosis, radial scar (complex sclerosing lesion)

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9
Q

What are some benign inflammatory breast diseases?

A

Fat necrosis, duct ectasia, acute mastitis/abscess

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10
Q

What are some benign tumours of the breast?

A

Phyllodes tumour, intraduct papilloma

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11
Q

What is gynaecomastia?

A

Breast development in males = ductal growth without lobular development

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12
Q

What are some causes of gynaecomastia?

A

Exogenous/endogenous hormones, cannabis, prescription drugs, liver disease

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13
Q

What age group is most affected by fibrocystic changes?

A

Women aged 20-50 = most are aged 40-50

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14
Q

What is the prognosis of fibrocystic changes?

A

Very common = often resolve or diminish after menopause, may be incidental finding at screening

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15
Q

What is the presentation of fibrocystic changes?

A

Smooth discrete lumps, sudden pain, cyclical pain, lumpiness

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16
Q

What is the gross pathology of fibrocystic change?

A

Cysts = blue domed with pale fluid, usually multiple, associated with other benign changes
Intervening fibrosis

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17
Q

What is the microscopic pathology of fibrocystic change?

A

Thin walled but may have fibrotic wall, lined by apocrine epithelium

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18
Q

What is the management of fibrocystic changes?

A

Exclude malignancy, reassure, excise if necessary

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19
Q

What is a hamartoma?

A

Circumscribed lesion composed of all cell types normal to the breast but present in an abnormal proportion

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20
Q

What is the epidemiology of fibroadenomas?

A

Common = more common in African women
Peak incidence in 30s
May need excised

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21
Q

How do fibroadenomas present?

A

Usually solitary but multiple in 10%
Painless, firm and discrete mobile mass
Solid on US

22
Q

What are the features of fibroadenomas?

A

Circumscribed, rubbery and grey/white coloured

Biphasic lesion = epithelium and stroma

23
Q

What causes sclerosing lesions?

A

Benign disorderly proliferation of acini and stroma = can cause mass or calcification that can mimic carcinoma

24
Q

What are some features of sclerosing adenosis?

A

Peak incidence age 20-70
Negligible risk of subsequent carcinoma
Pain, tenderness, lumpiness or asymptomatic

25
Q

What is the epidemiology of radial scars/complex sclerosing lesions?

A

Wide age range and usually incidental finding on mammogram = common, with 67% being multicentric and 43% being bilateral

26
Q

What is the classification of radial scars and complex sclerosing lesions?

A

Radial scar if 1-9mm

Complex sclerosing lesion if >10mm

27
Q

What are the features of radial scars/complex sclerosing lesions?

A

Stellate architecture with central puckering and radiating fibrosis
Often show epithelial proliferation and may mimic carcinoma radiologically

28
Q

What is the histology of radial scars/complex sclerosing lesions?

A

Fibroelastic core, radiating fibrosis containing distorted ductules, fibrocystic change, epithelial proliferation

29
Q

Can radial scars/complex sclerosing lesions be precursor lesions?

A

Yes = in situ or invasive carcinomas may occur within lesions

30
Q

What is the treatment of radial scars/complex sclerosing lesions?

A

Excise or sample extensively by vacuum biopsy

31
Q

What are some causes of fat necrosis?

A

Local trauma or warfarin therapy

32
Q

What occurs in fat necrosis?

A

Damage and disruption of adipocytes

Infiltration of acute inflammatory cells = foamy macrophages subsequent fibrosis and scarring

33
Q

How is fat necrosis managed?

A

Confirm diagnosis and exclude malignancy

34
Q

What part of the breast is affected by duct ectasia?

A

Sub-areolar ducts

35
Q

What is the presentation of duct ectasia?

A

Pain, acute inflammatory changes, bloody discharge and/or purulent discharge, fistulation, nipple retraction and distortion

36
Q

What is duct ectasia associated with?

A

Smoking

37
Q

What occurs in duct ectasia?

A

Sub-areolar duct dilation and periductal inflammation leads to periductal fibrosis and scarring/distortion

38
Q

How is duct ectasia managed?

A

Treat acute infection, stop smoking, excise ducts

39
Q

What are the two main aetiologies of acute mastitis/abscess?

A

Duct ectasia = mixed organisms and anaerobes

Lactation = staph aureus, strep pyogenes

40
Q

What is the management of acute mastitis/abscess?

A

Antibiotics, percutaneous drainage, incision and drainage, treat underlying cause

41
Q

What is a Phyllodes tumour?

A

Biphasic tumour with stromal overgrowth = due to cystosarcoma phyllodes

42
Q

What age group is most commonly affected by Phyllodes tumours?

A

Patients aged 40-50

43
Q

What are some features of Phyllodes tumours?

A

Slow growing unilateral breast mass

Can be benign, borderline or malignant

44
Q

What does the behaviour of Phyllodes tumours depend on?

A

Stromal features and is predicted by pathology

45
Q

Do Phyllodes tumours metastasise commonly?

A

No = prone to local recurrence if not excised adequately but rarely metastasise

46
Q

What are some examples of breast papillary lesions?

A

Intraduct papilloma, nipple adenoma, encapsulated papillary adenoma

47
Q

What age group is most commonly affected by intraduct papillomas?

A

Age 35-60 = affects sub-areolar ducts

48
Q

How do patients with intraduct papillomas present?

A

Nipple discharge +/- blood

Asymptomatic at screening = nodules or calcification seen

49
Q

How do intraduct papillomas present?

A

2-20mm in diameter with papillary fronds containing a fibro-vascular core = covered by myoepithelium and epithelium

50
Q

What may the epithelium of intraduct papillomas show?

A

May show proliferative activity = usual type hyperplasia, atypical ductal hyperplasia, ductal carcinoma in-situ

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