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Reproductive - Breast > Benign Pathology > Flashcards

Benign Pathology Flashcards

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
Q

What are the two main features on gross and microscopic pathology of fibrocystic change?

A

Cysts and intervening fibrosis

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26
Q

How will the cysts of fibrocystic change appear grossly?

A

Blue domed with pale fluid

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27
Q

What is the management of fibrocystic change?

A

Excluding malignancy, reassurance and excision if necessary

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28
Q

What is a hamartoma?

A

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

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29
Q

Hamartomas can occur at any age but are most common in who? What is the presentation?

A

Pre or peri menopausal women presenting with a well defined mass

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30
Q

Fibroadenoma is most common in women from where? When does it usually present?

A

Africa / 3rd decade

31
Q

Are fibroadenomas usually solitary or multiple?

A

Solitary mostly

32
Q

Fibroadenomas can often be picked up on screening. If not, how may they present?

A

Firm, discrete, mobile mass

33
Q

Will the mass of a fibroadenoma be painful?

A

No

34
Q

‘Breast mouse’ may be a presentation of which benign breast condition?

A

Fibroadenoma

35
Q

How would you describe the mass of a fibroadenoma?

A

Well circumscribed, rubbery, grey/white

36
Q

How may a fibroadenoma present on ultrasound?

A

Solid mass (calcification)

37
Q

A fibroadenoma will show microscopic proliferation of what?

A

Intralobular stroma

38
Q

How should a fibroadenoma be treated?

A

Diagnosis and reassurance mostly, excision if growing or changing

39
Q

What are sclerosing lesions?

A

Benign, disorderly proliferations of acini and stroma which can cause the formation of a mass or calcification

40
Q

Why may sclerosing lesions mimic carcinoma?

A

Mass can feel irregular and they are histologically similar

41
Q

What is the relationship between sclerosing adenosis and carcinoma?

A

Negligible risk

42
Q

How may sclerosing adenosis present?

A

Pain, tenderness or lumpiness/thickening (or can be asymptomatic)

43
Q

What is the relationship between radial scar and carcinoma?

A

Not malignant per se but they show epithelial proliferation and in situ or invasive carcinomas may occur within these lesions

44
Q

What is usually the cause of fat necrosis?

A

Local trauma e.g. seatbelt injury

45
Q

What medication can sometimes cause fat necrosis?

A

Warfarin

46
Q

What happens to the adipocytes in fat necrosis?

A

They are damaged and disrupted which leads to acute inflammation, necrosis and scarring

47
Q

How does fat necrosis usually present?

A

A hard lump

48
Q

How should fat necrosis be managed?

A

Confirm the diagnosis and exclude malignancy

49
Q

What happens in duct ectasia?

A

Progressive dilatation of the large or intermediate ducts with surrounding chronic inflammatory change

50
Q

Duct ectasia has an uncertain aetiology, though it does have an association with what?

A

Smoking

51
Q

Which ducts does duct ectasia usually affect?

A

Sub-areolar ducts

52
Q

What are some presentations of duct ecyasia?

A

Pain, blood and or purulent discharge, nipple retraction and distortion

53
Q

What may duct ectasia feel like on palpation?

A

Bag of worms

54
Q

What are the management options for duct ectasia?

A

Treat acute infection, exclude malignancy, stop smoking, excise ducts

55
Q

What are the two main aetiologies of acute mastitis/abscess?

A

Duct ectasia or lactation

56
Q

What type of organisms will be present in acute mastitis/abscess caused by duct ectasia?

A

Mixed organisms, mostly anaerobes

57
Q

What antibiotic should acute mastitis/abscess caused by duct ectasia be treated with?

A

Metronidazole

58
Q

What two organisms are most likely to be responsible for acute mastitis/abscess caused by lactation?

A

Staph Aureus, Strep Pyogenes

59
Q

What are the management options for acute mastitis/abscess?

A

Antibiotics, percutaneous drainage or incision and drainage. Also, treat the underlying cause

60
Q

How should Phyllodes tumour and intraduct papilloma be treated and why?

A

They are usually benign but can become malignant so they should be excised

61
Q

Who does Phyllodes tumour usually present in?

A

Middle aged females (40-50)

62
Q

How does Phyllodes tumour usually present?

A

Slow growing, well defined unilateral breast mass

63
Q

Why is it important that Phyllodes tumours are adequately excised?

A

They are prone to local recurrence

64
Q

Do Phyllodes tumours metastasise?

A

Rarely

65
Q

How does intraduct papilloma present?

A

Nipple discharge +/- blood

66
Q

Patients with intraduct papilloma are often asymptomatic at screening, what may be seen?

A

Nodules and calcification

67
Q

What worrying feature may intraduct papilloma show?

A

Epithelial proliferation

68
Q

What is the relationship between hamartomas and carcinoma? How are these treated?

A

These are completely benign, do not need treated unless for cosmetic reasons

69
Q

What happens to fibroadenomas when approaching the menopause?

A

They usually decrease in size and become non-palpable

70
Q

A Phyllodes tumour may grow relatively fast, causing what symptoms?

A

Unilateral breast enlargement or skin ulceration

71
Q

How may radial scar/CSL be detected?

A

Incidental finding or on a mammogram

72
Q

What is the difference between radial scar and CSL?

A

Size - 1-9mm = radial scar, > 10mm = CSL

73
Q

How are radial scar/CSL treated?

A

Excision or sampled extensively with vacuum biopsy

Reproductive - Breast (10 decks)

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