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Reproductive Pathology > Benign and Malignant Breast Diseases > Flashcards

Benign and Malignant Breast Diseases Flashcards

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?

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?

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?

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

Describe cyst formation in NPBD?

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

Describe fibrosis in NPBD?

A

Secondary to cyst rupture with subsequent inflammation and fibrosis

24
Q

Describe adenosis in NPBD?

A
  • Increase in number of acini per lobule

- Acini not distorted, no epithelial hyperplasia

25
Q

Proliferative breast disease without atypia is characterised by?

A
  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
Q

What is the microscopic morphology of proliferative breast disease without atypia?

A
  1. Epithelial hyperplasia: moderate or florid
  2. Sclerosing adenosis
  3. Complex sclerosing lesion (radial scar)
  4. papillomas
27
Q

Compare normal breast tissue vs breast with epithelial hyperplasia?

A
  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
Q

Describe epithelial hyperplasia in PBDW/A?

A
  • There is proliferation of epithelial and myoepithelial cells and basement membrane is intact.
  • Cells fill and distend ducts and lobules
29
Q

Describe sclerosing adenosis?

A
  • 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
Q

Describe complex sclerosing lesions?

A
  • 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
Q

Describe papillomas?

A
  • 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
Q

Proliferative breast disease with atypia includes?

A
  1. Atypical duct hyperplasia (ADH)

2. Atypical lobular hyperplasia (ALH)

33
Q

What is proliferative breast disease with atypia?

A

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
Q

Describe benign tumours?

A
  • 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
Q

Describe the epidemiology of benign tumours?

A

Seen in young females: adolescents and early reproductive age group

36
Q

Describe the macroscopic morphology of fibroadenoma?

A
  • Sharply circumscribed and encapsulated

- Freely movable in the breast: breast mice

37
Q

Describe the microscopic morphology of fibroadenoma?

A

proliferation of stroma and epithelial components (ducts)

38
Q

What is breast cancer?

A

Carcinoma of the breast is most common form of breast cancer

- Common problem worldwide and in Malawi

39
Q

What are the major risk factors of breast cancer?

A
  1. hormonal

2. genetic (family history BRCA 1 and 2 mutations)

40
Q

Describe the role of oestrogen in causing breast cancer?

A

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
Q

How to treat hormonal breast cancer causes by oestrogen?

A

giving anti-oestrogen drugs eg Tamoxifen

42
Q

Describe age a risk factor for breast cancer?

A
  • rarely found before age 25 except in familial cases

- Common in older women

43
Q

Describe how age at menarche is a risk factor?

A

young age at menarche have increased risk compared to late menarche

44
Q

Describe how first live birth is a risk factor for breast cancer?

A

Full term pregnancy at young age < 20 have half the risk of nulliparous women

45
Q

Describe risk factors of breast cancer?

A

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
Q

Describe the progression of cancer?

A
  • 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
Q

Name other types of breast cancer?

A
  1. Lobular carcinoma
  2. Mucinous carcinoma
  3. Medullary carcinoma

Reproductive Pathology (8 decks)

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