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Reproductive - Breast > Benign Pathology > Flashcards

Benign Pathology Flashcards

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1
Q

What are the three main components of triple assessment?

A

Clinical, imaging and pathology

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2
Q

What imaging techniques may be used for someone presenting with breast pathology?

A

Mammography, ultrasound, MRI

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3
Q

What are the two main methods of pathology sampling and what is the difference between the two?

A

Cytopathology (cells only) and histopathology (tissue sample)

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4
Q

What are the 4 ways in which you can get breast cytopathology?

A

FNA, fluid, nipple discharge, nipple scrape

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5
Q

What is the advantage of using FNA for pathological testing?

A

It is quick and easy - can get results the same day

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6
Q

What are the five rankings of FNA results and what do they mean?

A

C1-C5: unsatisfactory, benign, atypia probably benign, suspicious of malignancy, malignant

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7
Q

What are the diagnostic ways of obtaining breast histopathology?

A

Needle core biospy, vacuum assisted biopsy, skin biopsy, incisional biopsy of mass

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8
Q

What are the therapeutic ways of obtaining breast histopathology?

A

Excision biopsy, resection of cancer

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9
Q

What are the five rankings of core needle biopsy results and what do they mean?

A

B1-B5: unsatisfactory, benign, atypia probably benign, suspicious of malignancy, malignant

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10
Q

Only which type of pathology samples will be able to differentiate between carcinoma in situ and invasive carcinoma?

A

Histopathology

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11
Q

What does a B5a core needle biopsy result mean?

A

Carcinoma in situ

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12
Q

What does a B5b core needle biopsy result mean?

A

Invasive carcinoma

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13
Q

Where may accessory breast tissue or accessory nipple occur?

A

Anywhere along the milk line from the axilla to the groin

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14
Q

Failure of development of the breast at puberty is uncommon and usually related to what?

A

Turner’s syndrome

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15
Q

What is juvenile hypertrophy?

A

When, at the onset of puberty, the breasts grow rapidly and out of proportion

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16
Q

What is gynaecomastia?

A

Breast development in males - ductal growth without lobular involvement

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17
Q

What are some causes of gynaecomastia?

A

Exogenous or endogenous hormones, cannabis or prescribed drugs, liver disease

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18
Q

What is the most common breast lesion, occurring in 1/3rd of women?

A

Fibrocystic change

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19
Q

Does fibrocystic change always cause symptoms?

A

No

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20
Q

At what age does fibrocystic change occur?

A

During the reproductive decades i.e. 20-50 but most common aged 40-50

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21
Q

What are some symptoms of fibrocystic change?

A

Smooth, discrete lumps, sudden and cyclical pain

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22
Q

Fibrocystic change occurs due to changes in what?

A

Hormone levels/sensitivity

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23
Q

Because of the hormonal aspect of fibrocystic change, what are some things it can be associated with?

A

Menstrual abnormalities, early menarche, late menopause

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24
Q

What often happens to symptoms of fibrocystic change after the menopause?

A

They resolve or diminish

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25
What are the two main features on gross and microscopic pathology of fibrocystic change?
Cysts and intervening fibrosis
26
How will the cysts of fibrocystic change appear grossly?
Blue domed with pale fluid
27
What is the management of fibrocystic change?
Excluding malignancy, reassurance and excision if necessary
28
What is a hamartoma?
A circumscribed lesion composed of cell types normal to the breast but present in an abnormal proportion or distribution
29
Hamartomas can occur at any age but are most common in who? What is the presentation?
Pre or peri menopausal women presenting with a well defined mass
30
Fibroadenoma is most common in women from where? When does it usually present?
Africa / 3rd decade
31
Are fibroadenomas usually solitary or multiple?
Solitary mostly
32
Fibroadenomas can often be picked up on screening. If not, how may they present?
Firm, discrete, mobile mass
33
Will the mass of a fibroadenoma be painful?
No
34
'Breast mouse' may be a presentation of which benign breast condition?
Fibroadenoma
35
How would you describe the mass of a fibroadenoma?
Well circumscribed, rubbery, grey/white
36
How may a fibroadenoma present on ultrasound?
Solid mass (calcification)
37
A fibroadenoma will show microscopic proliferation of what?
Intralobular stroma
38
How should a fibroadenoma be treated?
Diagnosis and reassurance mostly, excision if growing or changing
39
What are sclerosing lesions?
Benign, disorderly proliferations of acini and stroma which can cause the formation of a mass or calcification
40
Why may sclerosing lesions mimic carcinoma?
Mass can feel irregular and they are histologically similar
41
What is the relationship between sclerosing adenosis and carcinoma?
Negligible risk
42
How may sclerosing adenosis present?
Pain, tenderness or lumpiness/thickening (or can be asymptomatic)
43
What is the relationship between radial scar and carcinoma?
Not malignant per se but they show epithelial proliferation and in situ or invasive carcinomas may occur within these lesions
44
What is usually the cause of fat necrosis?
Local trauma e.g. seatbelt injury
45
What medication can sometimes cause fat necrosis?
Warfarin
46
What happens to the adipocytes in fat necrosis?
They are damaged and disrupted which leads to acute inflammation, necrosis and scarring
47
How does fat necrosis usually present?
A hard lump
48
How should fat necrosis be managed?
Confirm the diagnosis and exclude malignancy
49
What happens in duct ectasia?
Progressive dilatation of the large or intermediate ducts with surrounding chronic inflammatory change
50
Duct ectasia has an uncertain aetiology, though it does have an association with what?
Smoking
51
Which ducts does duct ectasia usually affect?
Sub-areolar ducts
52
What are some presentations of duct ecyasia?
Pain, blood and or purulent discharge, nipple retraction and distortion
53
What may duct ectasia feel like on palpation?
Bag of worms
54
What are the management options for duct ectasia?
Treat acute infection, exclude malignancy, stop smoking, excise ducts
55
What are the two main aetiologies of acute mastitis/abscess?
Duct ectasia or lactation
56
What type of organisms will be present in acute mastitis/abscess caused by duct ectasia?
Mixed organisms, mostly anaerobes
57
What antibiotic should acute mastitis/abscess caused by duct ectasia be treated with?
Metronidazole
58
What two organisms are most likely to be responsible for acute mastitis/abscess caused by lactation?
Staph Aureus, Strep Pyogenes
59
What are the management options for acute mastitis/abscess?
Antibiotics, percutaneous drainage or incision and drainage. Also, treat the underlying cause
60
How should Phyllodes tumour and intraduct papilloma be treated and why?
They are usually benign but can become malignant so they should be excised
61
Who does Phyllodes tumour usually present in?
Middle aged females (40-50)
62
How does Phyllodes tumour usually present?
Slow growing, well defined unilateral breast mass
63
Why is it important that Phyllodes tumours are adequately excised?
They are prone to local recurrence
64
Do Phyllodes tumours metastasise?
Rarely
65
How does intraduct papilloma present?
Nipple discharge +/- blood
66
Patients with intraduct papilloma are often asymptomatic at screening, what may be seen?
Nodules and calcification
67
What worrying feature may intraduct papilloma show?
Epithelial proliferation
68
What is the relationship between hamartomas and carcinoma? How are these treated?
These are completely benign, do not need treated unless for cosmetic reasons
69
What happens to fibroadenomas when approaching the menopause?
They usually decrease in size and become non-palpable
70
A Phyllodes tumour may grow relatively fast, causing what symptoms?
Unilateral breast enlargement or skin ulceration
71
How may radial scar/CSL be detected?
Incidental finding or on a mammogram
72
What is the difference between radial scar and CSL?
Size - 1-9mm = radial scar, > 10mm = CSL
73
How are radial scar/CSL treated?
Excision or sampled extensively with vacuum biopsy

Reproductive - Breast (10 decks)

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