Histo: Breast pathology Flashcards
What are the three components of investigating breast disease?
- Clinical examination
- Imaging (ultrasound, mammography or MRI)
- Pathology (cytopathology and/or histopathology)
Outline the coding used by cytopathologists when assessing breast aspirates.
- C1 = inadequate
- C2 = benign
- C3 = atypia, probably benign
- C4 = suspicious of malignancy
- C5 = malignant
What is the gold standard for diagnosing breast cancer?
Histopathology
NOTE: 24-hour turnaround time
Describe the appearance of normal breast histology.
- Glandular tissue will be stained purple with pink stroma around it
- The duct and extralobular terminal duct are together referred to as the terminal duct lobular unit (TDLU)
- Myoepithelial cells will be seen around the outside of the epithelial cells - they help pump milk
Define duct ectasia. Describe its presentation.
- Inflammation and dilatation of large breast ducts.
- Typically presents with a breast lump and nipple discharge.
Describe the histology of duct ectasia.
- The duct will be distended and full of proteinaceous material
- Foamy macrophages will also be present
Define acute mastitis.
Acute inflammation of the breast.
Which group of women tend to be affected by acute mastitis?
Often seen in lactating women due to cracked skin and stasis of breast milk.
Which organism is usually responsible for acute mastitis?
Staphylococci
Describe the cytological appearance of acute mastitis.
Lots of neutrophils
Define fat necrosis.
Inflammatory reaction to damaged adipose tissue
Describe the cytological appearance of fat necrosis.
Fat cells surrounded by macrophages.
Define fibrocystic disease.
- A group of alterations in the breast which reflect normal, albeit exaggerated, responses to hormonal influences
- On histology, the ducts are usually dilated and calcified
Define fibroadenoma.
Benign fibroepithelial neoplasm of the breast.
Describe the histology of fibroadenoma.
Consists of lots of glandular and stromal cells.
Define Phyllodes tumour.
A group of potentially aggressive fibroepithelial neoplasms of the breast.
NOTE: the majority are benign
Describe the histology of Phyllodes tumours.
- Cells do not form uniform layers
- Whether it is benign or malignant depends on the cellularity of the stroma
Define intraductal papilloma.
A benign papillary tumour arising within the duct system of the breast.
What are the two different types of intraductal papilloma?
- Peripheral papilloma - arises in small terminal ductules
- Central papilloma - arises in large lactiferous ductules
How do intraductal papillomas present?
- Central papillomas present with nipple discharge
- Peripheral papillomas usually remain clinically silent
Describe the histology of intraductal papillomas.
- Histology will show a large dilated duct with a polypoid mass in the middle
- The mass tends to have a fibrovascular core
What is a radial scar?
A benign sclerosing lesion characterised by a central zone of scarring surrounded by a radiating zone of proliferating glandular tissue
What pathological phenomenon is thought to be responsible for the formation of radial scars?
Exuberant reparative phenomenon in response to areas of tissue damage in the breast
How do radial scars present?
Seen as stellate masses on mammograms
