Breast Pathology 1 Flashcards

1
Q

triple assessment in breast disease?

A

clinical (history + examination)
imaging
pathology

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2
Q

4 types of breast cytopathology?

A

fine needle aspiration
fluid
nipple discharge
nipple scrape

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3
Q

normal breast epithelial cells on NFA?

A

honeycomb appearance

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4
Q

classification in FNA cytology?

A
C1-5
1 = unsatisfactory/normal
2 = benign
3 = atypia, probably benign
4 = suspicious of malignancy
5 = malignant
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5
Q

drawback of FNA?

A

cant tell if malignancy is invasive or still in the ducts

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6
Q

diagnostic histopathology?

A

needle core biopsy
vacuum assisted biopsy (large volume)
skin biopsy
incisional biopsy of mass

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7
Q

therapeutic histopathology?

A

vacuum assisted excision
excisional biopsy of mass
resection of cancer (wide local excision or mastectomy)

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8
Q

classification of needle core biopsy?

A
B1-5
1 = unsatisfactory/normal
2 = benign
3 = atypia, probably benign
4 = suspicious of malignancy
5 = malignancy
(5a = in situ, 5b = invasive)
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9
Q

advantage of needle core biopsy over FNA?

A

can show whether invasive or in situ

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10
Q

4 examples of developmental anomalies in breast?

A

hypoplasia
juvenile hypertrophy
accessory breast tissue
accessory nipple

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11
Q

non-neoplastic growth in breast?

A
gynaecomastia
fibrocystic change
hamartoma
fibroadenoma
sclerosing lesions (sclerosing adenosis, radial scar/complex sclerosing lesions)
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12
Q

3 benign inflammatory breast diseases?

A

fat necrosis
duct ectasia
acute mastitis/abscess

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13
Q

benign tumours in breast?

A

phyllodes tumour

intraduct papilloma

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14
Q

what is gynaecomastia?

A

breast growth in male

ductal growth without lobular development

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15
Q

what can cause gynaecomastia?

A

exogenous/endogenous hormones (can have female hormones coming through in breast milk)
cannabis
prescription drugs
liver disease

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16
Q

what is associated with fibrocystic change?

A

menstrual abnormalities
early menarche
late menopause
often resolve in diminish after menopause
in women of child bearing age (usually late reproductive age)

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17
Q

how might fibrocystic change present?

A

smooth discrete lumps or general lumpiness
sudden pain (rupture)
cyclical pain
can be an incidental finding

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18
Q

gross pathology in fibrocystic change?

A
cysts (1mm - several cm)
- blue domed with pale fluid
- usually multiple
- associated with other benign changes
can also have intervening fibrosis
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19
Q

describe the cysts seen in fibrocystic change?

A

thin walled but may have fibrotic wall
lined by apocrine epithelium
abundant pink cytoplasm (low nucleo-cytoplasmic ratio)

20
Q

management of fibrocystic change?

A

exclude malignancy
reassure
excise if necessary

21
Q

what is a hamartoma?

A

circumscribed lesion composed of cell types normal to the breast but present in an abnormal proportion or distribution

22
Q

clinical features of fibroaenoma?

A

painless, firm, discrete, mobile mass (“breast mouse”)
solid on US
peak incidence in 3rd decade and usually found on screening

23
Q

physical features of fibroadenoma?

A

circumscribed
rubbery
grey-white colour
biphasic tumour/lesion (epithelium/stroma)

24
Q

how is fibroadenoma managed?

A

diagnose
reassure
excise if needed

25
Q

types of sclerosing lesions?

A

sclerosing adenosis

radial scar/complex sclerosing leison

26
Q

describe sclerosing leisons

A

benign disorderly proliferation of acini and stroma
can cause a mass or calcification
can mimic carcinoma

27
Q

describe sclerosing adenosis

A

pain, tenderness or lumpiness/thickening
can be asymptomatic
usually age 20-70
benign with negligible risk of carcinoma

28
Q

how are radial scar usually found?

A

incidental finding on mammogram

very common

29
Q

features of radial scar?

A

stellate architecture
central puckering
radiating fibrosis
1-9mm (>10mm = comples sclerosing lesion)

30
Q

histology of radial scar?

A

fibroelastic core
radiating fibrosis containing distorted ductules
fibrocystic change
epithelial proliferation

31
Q

are radial scare malignant?

A

mimic carcinoma radiologically but probably not pre-malignant per se
often show epithelial proliferation
insitu or invasive carcinoma can occur within the lesion

32
Q

how is radial scar managed?

A

excise or sample extensively by vacuum biopsy

33
Q

what can cause fat necrosis?

A
local trauma (seat belt injury etc)
warfarin therapy
34
Q

what happens in fate necrosis?

A

damage and disruption of adipocytes
infiltration by acute inflammatory cells
foamy macrophages form
subsequent fibrosis and scarring

35
Q

management of fat necrosis?

A

confirm diagnosis

exclude malignancy

36
Q

clinical features of duct ectasia?

A
in sub-areolar ducts
pain
acute episodic inflammatory changes
bloody and/or purulent D/C
fistulation
nipple retraction and distortion
37
Q

associations in duct ectasia?

A
smoking
sub-areolar duct dilation
peri-ductal inflammation
peri-ductal fibrosis
scarring and distortion
38
Q

management of duct ectasia?

A

treat acute infections
exclude malignancy
stop smoking
excise ducts

39
Q

2 main causes of acute mastitis/abscess?

A
duct ectasia (mixed organisms or anaerobes)
lactation (staph aureus or strep pyogenes)
40
Q

management of acutes mastitis/abscess?

A

antibiotics
percutaneous drainage
incision and drainage
treat underlying cause

41
Q

clinical features of phyllodes tumour?

A

40-50 y/o
slow growing unilateral biphasic breast mass
stromal overgrowth

42
Q

is phyllodes tumour benign or malignant?

A

depends on stromal features
can be benign, borderline or malignant (sarcoma like)
rarely metastasise

43
Q

types of papillary lesions in breast?

A

intraduct papilloma
nipple adenoma
encapsulated papillary carcinoma

44
Q

clinical features of intraduct papilloma?

A

usually in age 35-60
nipple discharge +/- blood
nodules and calcification seen at screening

45
Q

describe the actual growth in intraduct papilloma?

A

sub areolar ducts
2-20mm diameter
papillary fronds containing a fibrovascular core
covered by myoepithelium and epithelium
epithelium may show proliferative activity (normal/atypical ductal hyperplasia or ductal carcinoma in situ)

46
Q

types of epithelial proliferation in intraduct papillary leisons?

A

none
usual type hyperplasia
atypical ductal hyperplasia (still benign)
ductal carcinoma in situ