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Reproduction & Sexual Health > Benign Breast Pathology > Flashcards

Benign Breast Pathology Flashcards

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1
Q

How is breast disease assessed?

A

Triple Assessment

  • clinical
  • imaging
  • pathology
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2
Q

How can a sample of cytopathology be obtained?

A

Fine needle aspiration
Fluid
Nipple discharge/scrape

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3
Q

Describe the classification of cytopathology findings

A 
C1 - unsatisfactory 
C2 - benign 
C3 - atypia, probably benign 
C4 - suspicious of malignancy 
C5 - malignant
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4
Q

What are the two types of histopathology sampling?

A

Diagnostic

Therapeutic

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5
Q

Name the types of diagnostic histopathology sampling

A

Needle core biopsy
Vacuum assisted biopsy
Skin biopsy
Incisional biopsy of mass

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6
Q

How is a biopsy classified?

A 
B1 - unsatisfactory/normal
B2 - benign 
B3 - atypia
B4 - suspicious of malignancy 
B5a - in situ 
B5b - invasive
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7
Q

Name the therapeutic histopathology sampling

A

Vacuum assisted excision
Excision biopsy of mass
Resection of cancer with margin of clearance

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8
Q

Describe wide local excision

A

Conservation procedure with margin of clearance, sutures - short superior and long lateral for orientation

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9
Q

What is a mastectomy?

A

Full removal of all breast tissue

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10
Q

Name four breast developmental abnormalities

A

Hypoplasia
Juvenile hypertrophy
Accessory breast tissue
Accessory nipple

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11
Q

Name five non-neoplastic breast diseases

A 
Gynaecomastia 
Fibrocystic change 
Hamartoma 
Fibroadenoma 
Sclerosing lesions
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12
Q

What is gynaecomastia?

A

Breast development in male - ductal growth without lobular development

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13
Q

State the causes of gynaecomastia

A

Exogneous/endogenous hormones
Cannabis
Prescription drugs
Liver disease - reduced oestrogen metabolism

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14
Q

How do fibrocystic breast changes usually present?

A

Women aged 20-50 mainly perimenopausal - asymptomatic, smooth discrete lumps or sudden pain, cyclical pain, lumpiness that is ill defined

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15
Q

What is fibrocystic change associated with?

A

Menstrual abnormalities, early/late menarche

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16
Q

Describe the gross appearance of fibrocystic changes

A

Cysts with blue domed appearance and pale fluid, Usually multiple and can be associated with other benign changes

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17
Q

Describe the microscopic appearance of fibrocystic changes

A

Thin walled cysts may have fibrous wall. Lined by apocrine epithelium and can have intervening fibrosis

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18
Q

Define metaplasia

A

Change from one differentiated cell type to another

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19
Q

What metaplasia occurs in fibrocystic change?

A

Ductal - apocrine

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20
Q

How is fibrocystic change managed?

A

Exclude malignancy
Reassure
Excise if necessary

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21
Q

Define a hamartoma

A

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

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22
Q

How does hamartoma present?

A

Pre or peri-menopausal women with a well defined mass

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23
Q

What is a fibroadenoma?

A

Benign proliferation of the epithelium and stroma of the duct lobules

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24
Q

How does a fibroadenoma usually present?

A

Solitary mobile mass, most common in afro-carribean women in 3rd decade. Detected via screening - painless firm discrete mobile mass solid on US

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25
What will imaging of a fibroadenoma show?
Well circumscribed radio-opaque mass lesion with echo-genic area - sharply demarcated
26
What does a fibroadenoma look like pathologically?
Circumscribed, rubbery, grey-white, biphasic tumour with epithelium and surrounding stroma
27
How is fibroadenoma treated?
Diagnose, reassure, excise if patient wishes
28
Name two types of sclerosing lesion
Sclerosing adenomas | Radial scar/complex sclerosing lesion
29
What are sclerosing lesions?
Benign disordered proliferation of the acini and stroma
30
Describe a sclerosing adenosis
Pain, tenderness or lumpiness/thickening - can be asymptomatic often seen with surrounding breast changes
31
Who most commonly gets sclerosing adenosis?
Women aged 20-70 years old
32
What is preserved in sclerosing adenosis?
Myoepithelium
33
How does a radial scar present?
Wide age range, often multi-centric and can be bilateral often detected incidentally or on mammogram
34
What is the difference between a radial scar and complex sclerosing lesion?
1-9mm - radial scar | >10mm complex sclerosing lesion
35
Describe the pathology of a radial scar
Stellate architecture, central puckering and radiating fibrosis
36
Describe the histology of a radial scar
Fibroelastic core with radiating fibrosis containing distorted ductules, fibrocystic changes and epithelial proliferation
37
What can occur within sclerosing lesions?
In situ or invasive carcinoma
38
How are sclerosing lesions treated?
Excise or sample extensively by vacuum biopsy
39
Name three types of inflammatory breast disease
Fat necrosis Duct Ectasia Mastitis
40
What can cause fat necrosis?
Local trauma | Warfarin therapy
41
Describe the pathogenesis behind fat necrosis
Damage and disruption of adipocytes causes leakage into the tissue - inflammation by macrophage attempting to phagocytose/remove fat leading to fibrosis scarring
42
How is fat necrosis managed?
Exclude malignancy and reassure
43
What is duct ectasia?
Dilatation and shortening of the sub-areolar ducts
44
How does duct ectasia present?
Pain, acute episodic inflammation with nipple discharge (bloody or purulent), fistulation, retraction, cosmetic distortion
45
What can duct ectasia cause?
Sub-areolar duct dilation, peri-ductal inflammation, peri-ductal fibrosis, scarring, distortion and mastitis
46
What risk factor is duct ectasia strongly associated with ?
Smoking
47
What will a biopsy of duct ectasia show?
Multiple plasma cells
48
State the two main causes of mastitis
Duct ectasia - anaerobes/mixed organisms | Lactation - staph aureus, strep pyrogens
49
What is mastitis?
Inflammation of breast tissue
50
What does mastitis look like microscopically?
Granulation tissue with florid inflammation of mixed type
51
How is mastitis managed?
Antibiotics Percutanous drainage Incision and drainage Treat underlying cause
52
How will mastitis present?
Pain, tenderness, erythema, warmth, inflammation, discharge and fever
53
Name two benign tumours of breast
Phyllodes tumour | Papillary lesions
54
What is Phyllodes tumour?
Fibroepithelial biphasic tumour
55
How do phyllodes tumours present?
Age 40-50 with a slow unilateral mass
56
What does a phyllodes tumour look like?
Lobulated white mass with cleated architecture
57
Describe the histology of a phyllode tumour
Leaf like structure distorting ductal system. Condensation of cells around epithelial cells. Stromal atypia and loss of circumscription. Different types of sarcoma may be present too
58
How is a phyllode tumour managed?
Local excision - prone to recurrence if not fully excised
59
Name three papillary lesions
- intraduct papilloma - nipple adenoma - encapsulated papillary carcinoma
60
How will an intraduct papilloma present?
35-60 years old with discharge +/- blood or on screening (nodules or calcification)
61
What do intraduct papilloma look like?
2-20mm diameter with papillary fronds and fibrovascular core covered by myoepithelium and epithelium which may show proliferative activity
62
What are the types of hyperplasia?
None - benign Usual type - benign Atypical ductal hyperplasia - IDP with ADH Ductal carcinoma in situ - IDP with DCIS or papillary DCIS
63
What does DCIS stand for?
Ductal carcinoma in situ
64
How are papillary lesions treated?
Benign intraductal papilloma - excised by vacuum biopsy without margins Atypia/in situ - excision with margins

Reproduction & Sexual Health (36 decks)

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