Breast Benign Pathology

Question 1

What makes up the triple assessment of breast examination?

Answer 1

Clinical
Imaging
Pathology

Question 2

What are the grades of breast FNA cytology?

Answer 2

C1 - unsatisfactory
C2 - Benign
C3 - Atypia, probably benign
C4 - Suspicious of malignancy
C5 - Malignant

Question 3

What are the grades of breast needle core biopsy?

Answer 3

B1 - unsatisfactory/ normal 
B2 - Benign 
B3 - Atypia, probably benign
B4 - Suspicious of malignancy
B5 - Malignant
B5a - carcinoma in situ
B5b - invasive carcinoma

Question 4

What are some benign developmental abnormalities of breast?

Answer 4

Hypoplasia
Juvenile hypertrophy
Accessory breast tissue
Accessory nipple

Question 5

What are some non-neoplastic breast diseases?

Answer 5

Gynaecomastia
Fibrocystic change
Hamartoma
Fibroadenoma
Sclerosing lesions

Question 6

What are inflammatory benign breast conditions?

Answer 6

Fat necrosis
Duct ectasia
Acute mastitis/ abscess

Question 7

What are 2 benign tumours of the breast?

Answer 7

Phyllodes tumour

Intraduct papilloma

Question 8

What is gynaecomastia?

Answer 8

Breast development in male

Ductal growth without lobular development

Question 9

What are causes of gynaecomastia?

Answer 9

Stimulation of oestrogen
e.g. exogenous/ endogenous hormones
cannabis
prescription drugs
liver disease

Question 10

Age group that get fibrocystic change?

Answer 10

Majority age 40-50

Question 11

Presentation of fibrocystic change?

Answer 11

Smooth discrete lumps
Sudden pain (if cyst ruptures)
Cyclical pain
Lumpiness

Question 12

What other benign condition might fibrocystic change be associated with?

Answer 12

Sclerosing adenosis

Question 13

What is the management of fibrocystic change?

Answer 13

Exclude malignancy

Excise if necessary

Question 14

What is a hamartoma?

Answer 14

Circumscribed lesion

Composed of tissue normally found in breast but in abnormal proportion or distribution

Question 15

What ethnic group more commonly get fibroadenomas?

Answer 15

African women

Question 16

What age group is the peak incidence of fibroadenomas?

Answer 16

3rd decade

Question 17

What are the clinical features of fibroadenoma?

Answer 17

Painless, firm, discrete mobile mass

Breast mouse - moves away from examining fingers

Question 18

What do fibroadenomas look like on ultrasound?

Answer 18

Solid

Question 19

Describe the pathology of a fibroadenoma

Answer 19

Circumscribed and rubbery
Grey-white colour
Biphasic (2 types of tissue) - epithelium and stroma

Question 20

Treatment of fibroadenoma?

Answer 20

Excise

Question 21

What is a sclerosing lesion?

Answer 21

Benign, disorderly proliferation of acini, stroma and myoepithelial cells

Question 22

What is the most common type of sclerosing lesion?

Answer 22

Sclerosing adenosis

Question 23

Describe the pathology of a radial scar?

Answer 23

Stellate architecture
Central puckering
Radiating fibrosis - proliferative epithelium

Question 24

Treatment of radial scar?

Answer 24

Excise or sample extensively by a vacuum biopsy

Question 25

What can cause fat necrosis?

Answer 25

Trauma | Warfarin

Question 26

What is fat necrosis?

Answer 26

Release of adipocytes due to damage and infiltration by acute inflammatory cells

Question 27

What role do macrophages have in fat necrosis?

Answer 27

Foamy macrophages ingest fat droplets leading to fibros

Question 28

Clinical features of duct ectasia?

Answer 28

``` Bloody/ purulent discharge Fistulation Nipple retraction Pain Acute episodic inflammatory changes ```

Question 29

What part of the breast does duct ectasia affect?

Answer 29

Sub-areolar ducts

Question 30

What part of the social history is important in duct ectasia?

Answer 30

SMOKING | strong association

Question 31

Management of duct ectasia?

Answer 31

Treat acute infection Exclude malignancy Stop smoking Excise ducts

Question 32

What are the 2 possible aetiologies of acute mastitis/ abscess?

Answer 32

Duct ectasia | Lactation

Question 33

What organisms cause acute mastitis to develop from duct ectasia?

Answer 33

Anaerobes | Mixed organisms

Question 34

Which antibiotic is sensitive for anaerobes?

Answer 34

Metrondiazole

Question 35

What organisms cause acute mastitis from lactation?

Answer 35

Staph aureus | Strep pyogenes

Question 36

What is the management of acute mastitis?

Answer 36

Antibiotics Percutaneous drainage Incise and drain Treat underlying cause

Question 37

What is a phyllodes tumour?

Answer 37

Slow growing unilateral breast mass

Question 38

At what age do women get phyllodes tumour?

Answer 38

40-50years

Question 39

What are the classes of phyllodes tumour?

Answer 39

Benign Borderline Malignant (sarcomatous)

Question 40

What is the management of phyllodes tumour?

Answer 40

Excise | Prone to recurrence if not fully excised

Question 41

What are the 3 types of papillary lesions?

Answer 41

Encysted papillary carcinoma Nipple adenoma Intraduct papilloma

Question 42

What age of women get intraduct papillomas?

Answer 42

30 - 60 years

Question 43

What are the signs of intraduct papillomas?

Answer 43

Nipple discharge | Bleeding

Question 44

What do intraduct papillomas look like on pathology?

Answer 44

Papillary fronds | Fibrovascular core