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Reproductive Pathology > Benign and Malignant Breast Diseases > Flashcards

Benign and Malignant Breast Diseases Flashcards

(47 cards)

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1
Q

What are the 5 major groups of benign breast disease?

A
  1. Inflammatory conditions
  2. Non - proliferative breast changes
  3. Proliferative breast disease without atypia
  4. Proliferative breast disease with atypia
  5. Benign neoplastic lesions/tumours
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2
Q

What is the clinical presentation of benign breast disease?

A
  1. Pain
  2. Palpable mass
  3. Nipple discharge or skin changes
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3
Q

What are the 2 categories of inflammatory conditions?

A
  1. Infectious - uncommon, usually seen with lactation
    e. g. acute pyogenic mastitis
  2. Non - infectious
    e. g. mammary duct ectasia and fat necrosis
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4
Q

What is acute pyogenic mastitis?

A
  • Acute inflammatory condition
  • Very painful
  • Usually occurs first few weeks after delivery
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5
Q

Describe the clinical presentation of acute pyogenic mastitis?

A
  • There is rubor, calor, tumor and dolor
  • Purulent nipple discharge in severe cases
  • If untreated can progress to abscess formation
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6
Q

What causes mastitis?

A
  • S. aureus, common

- S. pyrogens

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7
Q

Describe the aetiopathogenesis of acute pyogenic mastitis?

A
  • Portal of entry = crack in nipple with lymphatic spread
  • bacteria causes widespread inflammation with systemic effects
  • Duct obstruction by a keratotic plug (hair follicles get clogged with dead skin cells and keratin) contributes
  • Usually localised to one segment with spread to others in some cases
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8
Q

What other infections can cause acute pyogenic mastitis?

A

tuberculosis

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9
Q

How does TB cause APM?

A

Usually haematogenous spread from a focus in the lung

- Can occur as part of miliary TB

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10
Q

What is the clinical presentation for APM caused by TB?

A
  • Caseous mass in the breast
  • Complicated cases can form sinuses
  • Clinically can mimick cancer hence need for a biopsy
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11
Q

Name the oppurtunistic infections of immunocompromised patients that can lead to APM?

A

Localised or as part of systemic infection

  1. histoplasmosis, cryptococcus, mucormycosis - fungal
  2. Atypical mycobacteria
  3. Actinomycosis
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12
Q

What is mammary duct ectasia?

A

subareolar periductal inflammation with dilated mammary glands

  • Involves larger ducts
  • Severe cases can extend to smaller ducts
  • Common in perimenopause and menopause
  • has no relationship to malignancy
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13
Q

What is the clinical presentation of MDE?

A
  1. nipple discharge : when blood stained can mimick cancer
  2. nipple retraction due to fibrosis around ducts
  3. mass
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14
Q

What is the pathology of MDE?

A
  • Dilated ducts filled with sticky/viscous material
  • Periductal chronic inflammation: lymphocytes, plasma cells, macrophages
  • Periductal fibrosis
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15
Q

What is fat necrosis?

A

a benign condition that most commonly develops after an injury or trauma to the breast tissue
- Frequently seen in obese people and after menopause

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16
Q

Describe the clinical presentation of fat necrosis?

A

Presents as a discrete lump therefore mimicking cancer

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17
Q

Describe the macroscopic presentation of fat necrosis?

A

yellow haemorrhagic tissue with calcifications

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18
Q

Describe the microscopic morphology of fat necrosis?

A
  • necrotic adipocytes,
  • chronic inflammation,
  • foamy macrophages
  • fibrosis
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19
Q

What are non-proliferative breast changes?

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A

breast fibrocystic change characterized by the absence of epithelial cell hyperplasia
- No increase in risk of cancer compared to the proliferative diseases

20
Q

Non proliferative breast changes can present with?

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A
  1. Palpable mass
  2. Nipple discharge
  3. Mammographic densities or calcifications
21
Q

What are the 3 principal patterns of morphologic change in non proliferative breast disease?

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A
  1. cyst formation
  2. fibrosis
  3. adenosis
22
Q

Describe cyst formation in NPBD?

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A
  • Small to large cysts (blue-dome cysts)
  • Aprocrine metaplasia present
  • Calcifications
23
Q

Describe fibrosis in NPBD?

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A

Secondary to cyst rupture with subsequent inflammation and fibrosis

24
Q

Describe adenosis in NPBD?

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A
  • Increase in number of acini per lobule

- Acini not distorted, no epithelial hyperplasia

25
Proliferative breast disease without atypia is characterised by?
1. Proliferation of ductal epithelium and/stroma 2. No epithelial atypia - Can form palpable masses, majority of cases do not - Commonly detected as mammographic densities
26
What is the microscopic morphology of proliferative breast disease without atypia?
1. Epithelial hyperplasia: moderate or florid 2. Sclerosing adenosis 3. Complex sclerosing lesion (radial scar) 4. papillomas
27
Compare normal breast tissue vs breast with epithelial hyperplasia?
1. In normal breast: one epithelial cell layer and one myoepithelial cell layer 2. In EP: presence of more than 2 cell layers - Referred to as moderate to florid when there are more than 4 cell layers
28
Describe epithelial hyperplasia in PBDW/A?
- There is proliferation of epithelial and myoepithelial cells and basement membrane is intact. - Cells fill and distend ducts and lobules
29
Describe sclerosing adenosis?
- Increase in number of acini - Variable cellular hyperplasia with prominence of myoepithelial cells. - Acini in the centre are compressed and distorted, those at periphery are dilated - Fibrosis - Calcifications
30
Describe complex sclerosing lesions?
- Also called stellate lesions - Contain central area of hyalinised stroma with entrapped glands - Great mimic of cancer both radiologically or morphologically - No cellular atypia
31
Describe papillomas?
- Commonly present as palpable masses - Can involve large or small ducts - Composed of multiple fibrovascular cores lined by proliferating epithelial and myoepithelial cells. - Apocrine metapasia is present - Expands and dilates a duct
32
Proliferative breast disease with atypia includes?
1. Atypical duct hyperplasia (ADH) | 2. Atypical lobular hyperplasia (ALH)
33
What is proliferative breast disease with atypia?
Atypical cellular proliferation/ hyperplasia but lacking sufficient features for duct carcinoma in situ (DCIS) or lobular carcinoma in situ (LCIS) - DCIS and LCIS are pre-invasive lesions for breast cancer
34
Describe benign tumours?
- Common is the fibroadenoma - No malignant potential - Present as a palpable mass - Lesions are hormonally responsive and lesions may increase in late menstrual cycle.
35
Describe the epidemiology of benign tumours?
Seen in young females: adolescents and early reproductive age group
36
Describe the macroscopic morphology of fibroadenoma?
- Sharply circumscribed and encapsulated | - Freely movable in the breast: breast mice
37
Describe the microscopic morphology of fibroadenoma?
proliferation of stroma and epithelial components (ducts)
38
What is breast cancer?
Carcinoma of the breast is most common form of breast cancer | - Common problem worldwide and in Malawi
39
What are the major risk factors of breast cancer?
1. hormonal | 2. genetic (family history BRCA 1 and 2 mutations)
40
Describe the role of oestrogen in causing breast cancer?
Metabolites of oestrogen causes 1. Mutations 2. Generate DNA damaging free radicals 3. Via its hormonal actions, oestrogen drives the proliferation of premalignant lesions and the cancer itself
41
How to treat hormonal breast cancer causes by oestrogen?
giving anti-oestrogen drugs eg Tamoxifen
42
Describe age a risk factor for breast cancer?
- rarely found before age 25 except in familial cases | - Common in older women
43
Describe how age at menarche is a risk factor?
young age at menarche have increased risk compared to late menarche
44
Describe how first live birth is a risk factor for breast cancer?
Full term pregnancy at young age < 20 have half the risk of nulliparous women
45
Describe risk factors of breast cancer?
First degree relative with breast cancer portends an increased risk Previous atypical hyperplasia Race: Younger black women (40) at more risk than whites Oestrogen exposure Radiation exposure Obesity Carcinoma of contralateral breast and endometrium Diet: rich in fat; controversial though Breast feeding: longer durations of breast feeding reduces risk Environmental toxins with oestrogenic effects on humans eg organochlorine pesticides
46
Describe the progression of cancer?
- Starts with pre-malignant lesions and progress to invasive cancer - Common premalignant lesion is DCIS precursor of infiltrating duct carcinoma (IDC) - IDC is the most common carcinoma (70-80%)
47
Name other types of breast cancer?
1. Lobular carcinoma 2. Mucinous carcinoma 3. Medullary carcinoma

Reproductive Pathology (8 decks)

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