Repro 11.2 pathology of the breast Flashcards
What symptoms may signify breast pathology?
tenderness
nipple changes (inversion, dimpling, secretions)
palpable mass
skin changes (dimples, darkening)
lumpiness
Other than symptoms, how else might breast pathology be suspected?
By use of mammography
With regards to breast pain, what features are more likely to mean the cause is benign?
- cyclical
- diffuse
Eg due to menstruation. (higher progesterone levels cause changes to the ductular-lobuar system which can cause pain)
With regards to a palpable mass, what features mean it is more likely to be due to a malignant cause?
- hard
- craggy
- fixed
Give some features of the different kinds of nipple discharge.
- milky, white (eg due to endocrine disorders)
- bilateral/unilateral (unilateral is more worrying)
- bloody
- serous
When is mammography used to screen women, and why at this time?
Ages 47-73.
Before this age you cant really see anything, there is lots of stroma and tissue. AS you get older, more stroma is replaced by adipose tissue which makes screening easier.
What may be picked up by mammography?
- densities (eg fibroadenomas, invasive carcinomas, cysts)
- calcifications (DCIS or benign changes)
How can breast pathology by classified?
- inflammatory
- benign epithelial lesions
- stomal tumours
- male breast conditions
- breast carcinomas
Give examples of some inflammatory conditions causing breast pathology.
- mastitis
- Duct ectasia
- fat necrosis
Discuss features of acute mastitis.
almost always occurs when lactating
often caused by S. Aureus,
Can cause breast abscess
What is duct ectasia?
dilation or chronic inflammation of the ducts, can cause peri-areolar masses or nipple discharge.
What might cause fat necrosis in the breast?
Why is it worrying?
Commonly by trauma, or due to breast surgery.
Mimics carcinomas clinically and on mammography.
Give some examples of benign epithelial lesions.
- fibrocystic change
- papilloma
- epithelial hyperplasia
What is meant by fibrocystic change?
- common in increasing age
- present as a mass or on mammography
- the mass can be aspirated and will often disappear
- histologically shows cyst formation, fibrosis and apocrine metaplasia.
Give examples of stromal tumours of the breast.
- fibroadenomas
- phyllodes tumour
What is a fibroadenoma?
- a mobile mass which may be picked up on mammography
- ‘breast mouse’ because freely moving and elusive
- common in younger women, often present before 30.
- can grow large to take over whole breast