Non-Neoplastic Breast Pathology Flashcards
Normal breast histolgy
see adipose, extralobular ducts, terminal ducts, and lobules,
normal anatomy of breast
What is this an image of?
Terminal Ductal Lobular Unit :
ducts in breast tissue if normal should awys have
2 cell layers:
Myoepithelium on outside
Epithelial cell on inside
Clinical presentation of breast disease that is cancer is usually:
Palpable mass
Concerns of breast that are likely Benign
Pain is IG bening
lumpiness is IG benign
discharge liekly benig
Gold standard for diagnosis and eval of breast lesion
core biopsy
Screening guidelines for women to get mammogram
40-50 yrs; get one every year or every other
>50 get one every year
1st degree relative w/ breast cancer start 10 years early for screening
Interesting findings in mammograms
Density: carcinomas are 1⁄2 the size of palpable ones
Microcalcifications Picks up even smaller lesions May herald an in situ carcinoma
Magnification or compression views may aid in the evaluation of mammographic abnormalities
used in women younger than 35 years especially if the lesion is clinically benign
Can differentiate solid from cystic masses
ultrasound
***oval masses often benign
Indications for Breast MRI
Pre operative evaluation of extent of malignant disease/ contralateral process adjuvant
Axillary lymph node positive for metastatic carcinoma with unknown primary
Evaluate integrity silicone breast implant High risk screening
Evaluate tumor response to neo chemotherapy
Cannot distinguish between in situ and invasive lesions
Safe, accurate and well tolerated , Higher rate of false negative results
Fine needle aspiration
Can be obtained using radiologic guidance if the mass is small, deep, mobile, vaguely palpable or multiple
False negatives are usually due to sampling error
Core needle biopsy; get several samples
Combination of physical examination, imaging studies and biopsy :if all three tests point to a benign diagnosis, it is likely that the process is benign and can be followed without requiring surgical removal (95% sensitive)
Triple test
Most common masses found ages 15-35
fibroadenoma
Mass or lesion in breast over 50
cancertill proven otherwise
Common masses seen from 35-50
fibrocystic change, cancer, cyst
Periductal mastitis, Mammary duct ectasia ,Fat necrosis , acute mastitis all examples of
Inflammatory conditions
Proliferative breast disease without atypia or with atyppia
Nonproliferative breast changes :(fibrocystic changes)
Benign epithelial lesions
NOn-proliferative breast changes or _______ seen more in premopausal women from 35-50 and is most common benign lesion of breast
fibrocystic change
May present as lumpy breast, mass, calcifications, nipple discharge
Pain, tenderness, pain may occur in the premenstrual phase of the cycle
Masses may be multiple and/or bilateral and may fluctuate in size
Non- proliferative Breast Change
Fibrocystic
Cysts
Fibrosis
Apocrine metaplasia
are all examples of:
non-proliferative breast lesion
(fibrocystic)
What is this?
Blue domed cysts; non-proliferative fibrocystic breast change
What is this? is it malignant?
Apocrine cyst: a non-proliferative breast thing
see blue calcificaitons in middle and some hyperplasia but its BENIGN
Moderate, florid hyperplasia
Sclerosing adenosis
complex sclerosing lesions
Papillomas
all examples of:
Proliferative breast disease w/out Atypia
Moderate, florid hyperplasia, Sclerosing adenosis, complex sclerosing lesions, Papillomas
How do we detect these things?
Proliferative Breast Disease Without Atypia :RARELY form mass
thus incidental findings and from Calcficaitons
Lumen filled by heterogeneous population of cells
Different morphologies myoepithelial and epithelial
Irregular slit like fenestrations, prominent at periphery
Ductal hyperplasia
Enlarged lobule, circumscribed edge, Preserved background lobular architecture, Compressed and distorted acini, Dense stroma, calcifications
Sclerosing Adenosis
(proliferative w/out atypia)
Complex Sclerosing Lesion
Most common between ____and ____years of age
rarely palpable and detected on mammograpy
40 and 60
Mammography shows a stellate or spiculated lesion with a central core
Complex scerosing lesion
**need to get biopsy to confim and then EXCISION
Stellate lesions with central hyalinized stroma and entrapped glands
RAdial scar
see dialted ducts at the periphery
how old are people that get benign Papilloma of breast?
Where is it usually located?
What is our pirmary symptom?
any age
central breast
nipple discharge (often bloody)
Pt has recently notice blood in her sportbra after seh works out. She is 30, with no significant history for breast cancer. ON physical exam you palpate a subareolar mass. Dx
likely papilloma dt central location and nipple discharge
has branching fibrovascular core within duct and see epithelial hyperplasia
Dx and what symptom would pt likely have?
Papilloma (bening)
nipple discharge
What kind of atypical proliferative breast disease is there?
atypical ductal or lobar hyperplasia
resembles in situ carcinoma but lacks qualitative or quantitative features of dx
image is atypical ductal hyperplasia;
can have lobule too
What causes significant increase risk for invasive carcinoma
DCIS or LCIS
Moderate is atypia in duct or lobule
Fibroadenoma, Phyllodes tumor and Sarcomas are examples of what type of tumor?
Stromal Tumor
Most common tumor in young adults (peak at 3rd dec)
solitary, well circumbscribed, movable, painless
Fibroadenoma: stromal cell tumor
histology see lots of stroma, compressed myoeplithilium or compressed ducts
Fibroepithelial tumor that is benign or malignant seen in the 5th and 6th decade, only
Discreate palpable mass with RAPID growth
Phyllodes Tumor
Interlacing clefts, not encapsulated but circumscribed: cysts/neocrosis or hemorrhage inside
Phyllodes tumor
leaf like or epithelium lined clefts, cyts, with increased stromal activity and stromal overgrowth
PHyllodes turmor or cystosarcoma phyllodes
Malignant features of Phyllodes tumor
high stromal cellularity, increased midosis (>2-5 per field is low grade) (>5-10 per field is High)
cellular pleomorphism, infiltrating border, necrosis
Prognosis of Phyllodes tumor
Benign: may recur
Low grade: may recur, rarely mets
High grade: aggressive, distant mets 1/3 cases and Axillary nodes common
