Benign breast lesions Flashcards
(79 cards)
1
Q
What is the embryological origin of benign breast lesions?
A
Ectodermal mammary ridge (groin to axilla)
2
Q
What is the surface anatomy of the breasts?
A
2nd to 6th rib MCL
3
Q
How many lobes does the breast consist of?
A
15-20 lobes
4
Q
Name the breast nerves
A
Pectoralis
Long thoracic
Thoracodorsal
5
Q
What is the function of the Montgomery glands?
A
Lubrication at the nipple area
6
Q
Discuss the microscopy of the breast
A
A network of thousands of terminal ductal lobular units per lobe which lead to the lactiferous sinus and drain to the nipple
7
Q
Name the cells of the breast
A
Ductal epithelial Acinar milk Secreting cells Myoepithelial cells Stem cells
8
Q
What are the interpectoral lymph nodes also known as?
A
Rotter’s lymph nodes
9
Q
Name the 5 groups of axillary breast lymph nodes
A
Apical (subclavicular) Central Anterior (pectoral/external mammary) Lateral (brachial) Posterior (subscapular)
10
Q
Name the non-axillary breast lymph nodes
A
Parasternal (internal mammary)
Infraclavicular (deltopectoral)
11
Q
Where is the sentinel lymph node usually located in the breast?
A
External mammary group
12
Q
How is the lobule different to the interlobular stroma?
A
Interlobular stroma contains larger breast ducts, blood vessels and fat
13
Q
Describe normal breast development
A
- Prepubertal
- Pubertal (9-12yo)
- Menarche (12-13yo)
- Post-pubertal
- Pregnancy
- Menopause (40-55yo)
14
Q
Describe normal prepubertal breast development
A
- dense fibrous tissue with scattered epithelial lined ducts
15
Q
Describe normal pubertal breast development
A
- develop pubic hairs
16
Q
Describe normal breast development in menarche
A
- menstruation begins under pituitary gonadotropins -> increased oestrogen
- oestrogen causes new ducts to elongate and branch (thelarche)
- visible breast buds
17
Q
Describe normal postpubertal breast development
A
- mature breast that undergoes cyclical changes under hormonal stimulation
- hypertrophy predominates
18
Q
Describe normal breast development in pregnancy
A
- formation of new TDLU
- breast enlargement
- less fibrous tissue
- increased blood flow
- milk production
- areolar pigmentation
19
Q
Describe normal breast development in menopause
A
- ovarian function ceases
- breast involution and decreased epithelial elements
- increased fat
- TLDUs disappear
20
Q
Define ANDI
A
Aberration in the Normal Development and Involution of breasts
21
Q
When can ANDI occur?
A
- Development
- Cyclical change
- Epithelial activity
- Pregnancy
- Lactation
- Involution
22
Q
Define fibrocystic breast disease
A
A spectrum of clinical, mammographic and histological findings due to exaggerated stromal and epithelial response to circulating hormones and local growth factors
23
Q
What is the pathology in fibrocystic breast disease?
A
Microcysts
Macrocysts
Solid elements (adenosis, sclerosis, epithelial metaplasia, hyperplasia)
24
Q
Classify hyperplasia in fibrocystic breast disease
A
- Non-proliferative
- Proliferative without atypia
- Proliferative with atypia
- Combination
25
What is the pathogenesis of breast cysts?
Destruction and dilation of lobules and terminal ducts influenced by ovarian hormones (vary with menstrual phase and decline with menopause)
26
Name the clinical features of breast cysts
Palpable mass
27
Discuss the management of breast cysts
U/S
| Aspiration for cytology
28
Define a fibroadenoma
A benign, solid stromal and epithelial tumour
29
How are fibroadenomas classified?
```
<5cm = juvenile fibroadenoma
>5cm = giant fibroadenoma
```
30
Name the clinical features of breast fibroadenoma
<30yo (common in teenagers)
| Firm, mobile mass (breast mouse)
31
Discuss the management of fibroadenomas
Reassure
Excise if
- increasing size
- patient request
32
Define a phyllodes tumour
Biphasic proliferation of stromal connective tissue and mammary epithelium
33
What was the historical name of phyllodes tumour and why did it change?
Cystosarcoma phyllodes
- 90% are benign
- 10% are malignant
34
Discuss the classification of phyllodes tumour
Based on increased cellularity, margin invasion and sarcomatous appearance
1. Benign phyllodes
2. Intermediate/borderline phyllodes
3. Frankly malignant phyllodes
35
Describe a benign phyllodes tumour under the classification
Firm, lobulated mass usually >5cm
Similar histology to fibroadenoma but whorled stroma have larger clefts lined with epithelium and resemble leaf-like structures
Increased cellularity than fibroadenoma
Very few mitosis
36
Discuss the management of a benign phyllodes tumour
Triple assessment
Mammogram
Biopsy (Trucut preferred over FNAB)
Excise and F/U for >2 years
37
Describe an intermediate phyllodes tumour under the classification
> cellularity
| > mitosis
38
Discuss the management of an intermediate phyllodes tumour
Wide excision with 1cm margin
| Strict F/U
39
Describe a malignant phyllodes tumour under the classification
Pronounced cellular atypia
Higher mitotic rate
Stromal overgrowth
Hematogenous metastases
40
Where do malignant phyllodes tumors metastasize to?
Lung
Mediastinum
Abdominal viscera
Bone
41
Discuss the management of a malignant phyllodes tumour
```
Mammogram
U/S
Biopsy (Trucut preferred)
Metastatic workup
Mastectomy
Radiotherapy
Chemotherapy
- cyclophosphamide
- vincristine
- dacarbazin
- imatinib (in trials)
```
42
How does a malignant phyllodes tumour appear on U/S?
Discrete structure with cystic spaces
43
What do you need to establish concerning nipple discharge?
1. Unilateral vs bilateral
2. Single vs multiple duct
3. Colour (bloody, milky, purulent)
44
Define a galactocele
A milk-filled cyst due to obstruction by inspissated milk usually 6-10m after breastfeeding
45
Discuss management of galactoceles
Aspiration
| Excision
46
Give the aetiology of traumatic fat necrosis
Trauma
Surgery
Radiotherapy
47
Name the two types of traumatic fat necrosis
Type 1: Elderly ecchymosis
| Type 2: Young, cystic and tender
48
How does a type 1 traumatic fat necrosis appear on mammography?
Resembles a carcinoma
49
How does a type 2 traumatic fat necrosis appear on mammography?
Translucent cystic masses
50
Discuss the management of type 1 traumatic fat necrosis
Biopsy
51
Discuss the management of type 2 traumatic fat necrosis
Triple assessment
| Excision w/wo histology
52
Which micro-organism is common in lactational abscess?
Staphylococcus aureus
53
Name the clinical features of lactational abscess
Swollen
Tender
Erythematous
54
Discuss the management of a lactational abscess
Nipple hygiene
Flucloxacillin
I&D
55
Which micro-organism is commonly involved in non-lactational abscess
Mixed aerobic and anaerobic
56
Name the clinical features of non-lactational abscess
Smoker/diabetic
Skin/nipple retraction (chronic)
Subareolar fistula
Mass due to infection
57
Discuss the management of non-lactational breast abscess
Antibiotics
Emotional/psychological support
I&D
Biopsy/excise abscess wall
58
Name the types of TB breast and their cause
```
Primary
Secondary
- retrograde lymphatic spread from the lungs
- infant suckling with infected tonsils
- rarely from bones and joints
```
59
Name the clinical features of TB breast
Breast abscess
Nipple discharge
May mimic breast carcinoma
60
Discuss the management of TB breast
U/S guided needle biopsy
| RIPE treatment
61
Name the types of mastalagia
Cyclical
| Non-cyclical
62
Discuss the aetiology of cyclical mastalgia
Ovarian hormones 3-7d before and with menstruation
| Relieved by menopause
63
Discuss the aetiology of non-cyclical mastalgia
Complex hormonal
| Caffeine
64
Discuss the management of non-cyclical mastalgia
```
Pain chart
NSAIDs
Evening primrose oil
If severe
- Danazol
- Bromocriptine
- Tamoxifen
```
65
Name causes of gynecomastia
Idiopathic
Physiological
Pathological
66
What is the pathology of gynecomastia?
Ductal and stromal hyperplasia
67
Name pathological causes of gynecomastia
1. Endocrine tumours
- adrenal
- leydig cell
- pituitary
2. Non-endocrine tumours
- bronchial carcinoma
- lymphoma
3. Hepatic disease
- cirrhosis
- haemochromatosis
4. Drugs
- oestrogen
- ARVs
- cimetidine
5. Primary testicular failure
- anorchia
- cryptorchidism
- mumps orchitis
6. Secondary testicular failure
- hypopituitarism
- GnRH
68
Discuss the triple assessment
1. Clinical
2. Imaging
3. Biopsy
69
Name receptors found on breast biopsy
ER
PR
HER2
Ki67
70
Define solitary papillomas
Polyps of epithelial lined breast ducts
71
Describe the locations of solitary papillomas
Close to areola
Usually <1cm but can grow to 5cm
Lining cysts
Lining expanded ducts
72
Is there an increased risk of cancer in solitary papillomas?
No
73
What clinical feature of solitary papillomas is noteworthy?
Bloody nipple discharge
74
Discuss the management of solitary papillomas
Microdochectors
75
In which population group does papillomatosis usually occur?
Younger women
76
Define papillomatosis
Hyperplastic epithelium in ducts w/o stalk-like polyps
77
Define sclerosing adenosis
Increased TDLUs associated with stromal proliferation
78
Discuss the appearance of sclerosing adenosis on mammography
Calcium deposition similar to cancer due to irregular speculation in surrounding stroma
But no significant cancer risk!
79
Define a radial scar
A group of complex sclerosing lesions with moderate risk of breast cancer
- microcysts
- hyperplasia
- adenosis
- central sclerosis
