Breast Pathology I Flashcards
What does the triple assessment of a patient with a breast condition involve?
Clinical = history, examination Imaging = mammography, US, MRI Pathology = cytopathology, histopathology
What are the methods of gaining samples for breast cytopathology?
Fine needle aspiration, fluid, nipple discharge, nipple scrape
What is the cytology of FNA?
C1 = unsatisfactory C2 = benign C3 = atypia, probably benign C4 = suspicious of malignancy C5 = malignant
What are the diagnostic methods used for breast histopathology?
Needle core biopsy, vacuum assisted biopsy, incisional biopsy
What are the therapeutic methods used for breast histopathology?
Vacuum assisted excision, excisional biopsy, resection of cancer (wide local excision, mastectomy)
What is the cytology of a needle assisted biopsy?
B1 = unsatisfactory/normal B2 = benign B3 = Atypia, probably benign B4 = suspicious of malignancy B5a = carcinoma in situ B5b = invasive carcinoma
What are some benign developmental anomalies of the breast?
Hypoplasia, juvenile hypertrophy, accessory breast tissue, accessory nipple
What are some non-neoplastic benign breast diseases?
Gynaecomastia, fibrocystic change, hamartoma, fibroadenoma, sclerosing adenosis, radial scar (complex sclerosing lesion)
What are some benign inflammatory breast diseases?
Fat necrosis, duct ectasia, acute mastitis/abscess
What are some benign tumours of the breast?
Phyllodes tumour, intraduct papilloma
What is gynaecomastia?
Breast development in males = ductal growth without lobular development
What are some causes of gynaecomastia?
Exogenous/endogenous hormones, cannabis, prescription drugs, liver disease
What age group is most affected by fibrocystic changes?
Women aged 20-50 = most are aged 40-50
What is the prognosis of fibrocystic changes?
Very common = often resolve or diminish after menopause, may be incidental finding at screening
What is the presentation of fibrocystic changes?
Smooth discrete lumps, sudden pain, cyclical pain, lumpiness
What is the gross pathology of fibrocystic change?
Cysts = blue domed with pale fluid, usually multiple, associated with other benign changes
Intervening fibrosis
What is the microscopic pathology of fibrocystic change?
Thin walled but may have fibrotic wall, lined by apocrine epithelium
What is the management of fibrocystic changes?
Exclude malignancy, reassure, excise if necessary
What is a hamartoma?
Circumscribed lesion composed of all cell types normal to the breast but present in an abnormal proportion
What is the epidemiology of fibroadenomas?
Common = more common in African women
Peak incidence in 30s
May need excised
How do fibroadenomas present?
Usually solitary but multiple in 10%
Painless, firm and discrete mobile mass
Solid on US
What are the features of fibroadenomas?
Circumscribed, rubbery and grey/white coloured
Biphasic lesion = epithelium and stroma
What causes sclerosing lesions?
Benign disorderly proliferation of acini and stroma = can cause mass or calcification that can mimic carcinoma
What are some features of sclerosing adenosis?
Peak incidence age 20-70
Negligible risk of subsequent carcinoma
Pain, tenderness, lumpiness or asymptomatic
What is the epidemiology of radial scars/complex sclerosing lesions?
Wide age range and usually incidental finding on mammogram = common, with 67% being multicentric and 43% being bilateral
What is the classification of radial scars and complex sclerosing lesions?
Radial scar if 1-9mm
Complex sclerosing lesion if >10mm
What are the features of radial scars/complex sclerosing lesions?
Stellate architecture with central puckering and radiating fibrosis
Often show epithelial proliferation and may mimic carcinoma radiologically
What is the histology of radial scars/complex sclerosing lesions?
Fibroelastic core, radiating fibrosis containing distorted ductules, fibrocystic change, epithelial proliferation
Can radial scars/complex sclerosing lesions be precursor lesions?
Yes = in situ or invasive carcinomas may occur within lesions
What is the treatment of radial scars/complex sclerosing lesions?
Excise or sample extensively by vacuum biopsy
What are some causes of fat necrosis?
Local trauma or warfarin therapy
What occurs in fat necrosis?
Damage and disruption of adipocytes
Infiltration of acute inflammatory cells = foamy macrophages subsequent fibrosis and scarring
How is fat necrosis managed?
Confirm diagnosis and exclude malignancy
What part of the breast is affected by duct ectasia?
Sub-areolar ducts
What is the presentation of duct ectasia?
Pain, acute inflammatory changes, bloody discharge and/or purulent discharge, fistulation, nipple retraction and distortion
What is duct ectasia associated with?
Smoking
What occurs in duct ectasia?
Sub-areolar duct dilation and periductal inflammation leads to periductal fibrosis and scarring/distortion
How is duct ectasia managed?
Treat acute infection, stop smoking, excise ducts
What are the two main aetiologies of acute mastitis/abscess?
Duct ectasia = mixed organisms and anaerobes
Lactation = staph aureus, strep pyogenes
What is the management of acute mastitis/abscess?
Antibiotics, percutaneous drainage, incision and drainage, treat underlying cause
What is a Phyllodes tumour?
Biphasic tumour with stromal overgrowth = due to cystosarcoma phyllodes
What age group is most commonly affected by Phyllodes tumours?
Patients aged 40-50
What are some features of Phyllodes tumours?
Slow growing unilateral breast mass
Can be benign, borderline or malignant
What does the behaviour of Phyllodes tumours depend on?
Stromal features and is predicted by pathology
Do Phyllodes tumours metastasise commonly?
No = prone to local recurrence if not excised adequately but rarely metastasise
What are some examples of breast papillary lesions?
Intraduct papilloma, nipple adenoma, encapsulated papillary adenoma
What age group is most commonly affected by intraduct papillomas?
Age 35-60 = affects sub-areolar ducts
How do patients with intraduct papillomas present?
Nipple discharge +/- blood
Asymptomatic at screening = nodules or calcification seen
How do intraduct papillomas present?
2-20mm in diameter with papillary fronds containing a fibro-vascular core = covered by myoepithelium and epithelium
What may the epithelium of intraduct papillomas show?
May show proliferative activity = usual type hyperplasia, atypical ductal hyperplasia, ductal carcinoma in-situ
