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Week 3 - Female GU Pathology > Pathology of Breast 1: Benign Conditions > Flashcards

Pathology of Breast 1: Benign Conditions Flashcards

1
Q

Name and describe the structures that the breast epithelium forms [4]

A
  1. lobules = clusters of glands that make up milk during lactation
  2. ducts = the plumbing that takes the milk from the lobules to the nipple
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2
Q

What is the TDLS? [2]

A
  • terminal duct lobular system
    • (where most breast pathology lies)
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3
Q

Name and describe the 2 types of epithelial cells present in the breast [4]

A
  1. luminal cells
    • produce milk in the TDLS only
  2. myoepithelial cells
    • helps produce and maintain the basement membrane
    • inhibits angiogenesis
    • contracts for milk ejection during lactation
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4
Q

How does the breast tissue change during puberty? [2]

A
  1. the ducts sprout from the breast bud
  2. in females, further development occurs establishing the adult mammary gland
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5
Q

How does the breast tissue change during pregnancy/lactation? [3]

A
  1. increase in the number and size of lobular epithelial cells
  2. vaculoated epithelium
  3. secretions in lactation
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6
Q

How does the breast tissue change during menopause? [2]

A
  1. lobules undergo atrophy
  2. less fibrous stroma
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7
Q

Define inflammatory conditions [1]

A

pathologies caused by the result of the body’s reaction to an antigen (i.e. an infection)

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8
Q

Define hyperplasia [1]

A

pathologies caused by an increase in the number of cells that will cease when stimulus is removed

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9
Q

Define neoplasia [3]

A
  1. pathologies caused by an increase in the amount of cells
  2. will not cease when the stimulus is removed
  3. can be benign or malignant
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10
Q

Define dysplasia [2]

A
  1. tissue which is not normal but not invasive
  2. dysplasia, carcinoma in-situ and neoplasia in-situ all describe the same process but in different sites
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11
Q

Define ectopic breast tissue [2]

A
  1. breast tissue (sometimes only glandular tissue) lying outside of the breast
  2. e.g. in the nipple or the milk line between the axilla and breast
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12
Q

Name 4 conditions associated with breast hypoplasia [4]

A
  1. ulnar-mammary syndrome
  2. Poland’s syndrome
  3. Turner’s syndrome
  4. congenital adrenal hyperplasia
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13
Q

Is congenital nipple inversion a sign of cancer? Why/why not? [2]

A
  1. nipple inversion from birth is not a sign of cancer, it’s a benign congenital anomaly
  2. BUT new nipple inversion may be a sign of cancer
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14
Q

Describe the cause/pathogenesis of acute mastitis [3]

A
  1. fissuring of skin in breast-feeding women (often due to problems with suckling)
  2. this leads to access to microorganisms esp. S. aureus
  3. stagnant milk allows the growth of bacteria leading to acute mastitis
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15
Q

What are the 2 main signs/symptoms of acute mastitis? [2]

A
  1. cellulitis = bacterial infection
  2. abscess = localised collection of pus and necrotic tissue
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16
Q

What does a patient with acute mastitis usually present with? [2]

A
  1. unilateral breast discomfort
  2. after breast-feeding problems
17
Q

Name the 3 causes of Granulomatous Conditions [3]

A
  1. systemic granulomatous disease (e.g. TB/sarcoidosis)
  2. idiopathic granulomatous mastitis
  3. reaction to ruptured implants
18
Q

Describe the pathogenesis of periductal mastitis/mammary duct ectasia [2]

A
  1. central ducts become inflamed, blocked and dilated
  2. associated with chronic inflammation and scarring
19
Q

List the symptoms of periductal mastitis/mammary duct ectasia and who gets it? [7]

A
  1. redness
  2. swelling and tenderness around the nipple
  3. mass beneath the nipple
  4. nipple retraction
  5. thick, cheesy nipple discharge
  6. occurs in post-menopausal women
20
Q

What can periductal mastitis/mammary duct ectasia lead to (complications)? [2]

A
  1. breast abscess
  2. acute (lactational) mastitis
21
Q

What are the causes of fat necrosis? [4]

A
  1. damage to breast fat:
  2. any type of trauma such as:
    • external trauma
    • previous surgery
    • other inflammatory conditions
22
Q

How can fat necrosis be mistaken for cancer? [1]

A

can present as a lump

23
Q

How does fat necrosis present histologically? [3]

A
  1. necrotic fat (no nuclei)
  2. chronic inflammation
  3. multinucleate giant cells
24
Q

What is the cause of fibrocystic change in breast? [1]

A

probably an aberrant response of breast tissue to fluctuations in cyclical hormones (not a disease as such)

25
Q

How does fibrocystic change of breast present clinically and who gets it? [4]

A
  1. common in women of reproductive age (20-40yrs)
  2. presents as:
    • lumpy/bumpy
    • often multiple
    • worst before menstruation
26
Q

Name the microscopic abnormalities associated with fibrocystic change [7]

A
  1. small and large cysts
  2. apocrine metaplasia
  3. adenosis/sclerosing adenosis
  4. more fibrous stroma
  5. epithelial hyperplasia
  6. micro-calcification
27
Q

What is apocrine metaplasia? [1]

A

where the epithelial cells of cysts changes to look like apocrine sweat glands

28
Q

What is adenosis and sclerosing adenosis? [2]

A
  1. adenosis = increased amount of glands/lobular tissue
  2. sclerosing adenosis = where the glands are small and squashed
29
Q

What is epithelial hyperplasia? [2]

A
  1. where the duct or lobular epithelium gets thicker and forms unusual shapes
  2. this increases risk of cancer
30
Q

Describe the columnar cell changes associated with fibrocystic change of the breast [3]

A
  1. tall cells with apical snouts line cysts
  2. associated with calcification
  3. some variants of columnar cell changes increases cancer risk
31
Q

List the features to look out for when identifying a radial scar [4]

A
  1. fibrosis and elastic material in the centre
  2. star-shaped/flower-head appearance
  3. trapped glands only “pseudo-infiltrative”
  4. myoepithelial cells present in a way that is not seen in cancer
32
Q

What are the symptoms of fibroadenoma and who typically gets it? [3]

A
  1. common in young women (20-40 yrs)
  2. often asymptomatic
  3. but can cause lump, which is firm but not hard and mobile (i.e. NOT CYSTIC)
33
Q

Describe the features of fibroadenoma seen in microscopy [3]

A
  1. looks like a “giant lobule”
  2. all the TDLU tissue is expanded and distorted
  3. contains ducts, glands and lots of variably cellular fibrous tissue
34
Q

Phyllodes tumour is very similar to fibroadenoma. Is it more common in young people or old people? [1]

A

older people

35
Q

What are the microscopic differences between the phyllodes tumour and fibroadenoma? [4]

A
  1. more cellular
  2. more mitotic
  3. more atypical
  4. often larger
36
Q

What is intraductal papilloma? [2]

A
  1. a frond-like growth usually in large ducts below the nipple
  2. it’s benign but often excised to ensure nothing worse is lurking
37
Q

How does a patient with intraductal papilloma usually present? [3]

A
  1. serous/bloody nipple discharge
  2. usually unilateral
  3. increases risk of breast cancer
38
Q

How is intraductal papilloma different from papillomatosis? [1]

A

papillomas are found in small ducts at the periphery of the breast and is NOT dysplasia (but may slightly increase cancer risk)

Week 3 - Female GU Pathology (7 decks)

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