Pathology of the breast Flashcards
What are some benign breast conditions?
- Fibrocystic change
- Fibroadenoma
- Intraduct papilloma - lactiferous ducts, nipple discharge
- Fat necrosis - traumatic/prior surgical intervention
- Duct ectasia - nipple discharge
Give examples of fibrocystic changes to the breast
- Fibrosis - non-cancerous lump
- Adenosis - extra growth of glandular (ducts and lobules) tissue within the breast - often incidental
- Cysts - non-cancerous lump
- Apocrine metaplasia
- Ductal epithelial hyperplasia (usual type, atypical )
What is a friboadenoma?
- A very common benign breast condition - proliferation of epithelial and stromal elements.
- Usually felt as a circumscribed (bounded), mobile, painless lump in the breast which is smooth to the touch.
- They often develop during puberty so are mostly found in young women, but they can occur in all women of reproductive age.
- In most cases you’ll not need any treatment or follow-up if you have a fibroadenoma.
- Most fibroadenomas stay the same size. Some get smaller and some eventually disappear over time.
- Ducts can either be:
- distorted elongated - intracanalicular pattern
- not compressed - pericanalicular growth pattern
Name 2 other adenomas other than fibroadenomas? (2)
Tubular adeonma
- Far less common than fibroadenomas
- Seen in young women
- Disecrete
- Freely movable masses
- Uniform sized ducts
Lactating adenoma
- Enlarging masses during lactation or pregnancy
- Prominent secretory change
Intraduct papilloma
- Usually in middle aged women
- Can cause nipple discharge
- Can show epithelial hyperplasia which might be atypical
Which benign condition of the breast can simulate carcinoma clinically and mammographically?
Fat necrosis
What is fat necrosis of the breast?
Lobules in the breast are surrounded by glandular, fibrous and fatty tissue. Sometimes a lump can form if an area of the fatty breast tissue is damaged. This is called fat necrosis.
Damage to the fatty tissue can occur following:
- A breast biopsy
- Radiotherapy to the breast
- Bruise or injury to the breast.
- Any breast surgery
- breast reconstruction
- breast reduction
- lipomodelling (when fat taken from another part of the body is injected into the breast, for example to improve the appearance of dents following surgery)
- Sometimes it develops without any trauma and many women with it don’t remember any specific injury.
What is Phyllodes tumour?
- Fleshy tumours. Leaf-like pattern and cysts on cut surface
- They have connective fibrous tissue and epithelial elements.
- Make up less than 1% of breast tumours (Rare)
3 main types:
- Benign
- Borderline tumours (between non-cancerous and cancerous)
- Malignant - metastases are haematogenous
What are microcalcifications?
- Tiny deposits of calcium can appear anywhere in the breast and often show up on a mammogram
- Most women have one or more areas of microcalcifications of various sizes
- Majority of calcium deposits are harmless
- A small % may be in precancerous or cancerous tissue
What are 2 of the most important mammographic indicators of breast cancer?
- Masses
- Microcalcifications - look like grains of salt
What should a histology report tell the doctor about the patient?
- Invasive vs non-invasive
- Histological type - ductal vs lobular
- Grade
- Size of tumour
- Margins
- Lymph nodes involved
- Oestogen/progesterone receptor
- Her2
Paget’s disease of the nipple
- It causes pain or itching, scaling and redness (mistaken for eczema) on nipple and the areola
- Also ulceration, crusting, and serous or bloody discharge
- Result of intraepithelial spread of intraductal carcinoma
- Large pale-staining cells within the epidermis of the nipple
