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Flashcards in Breast pathology 1 Deck (51):
1

what is the triple assessment of a patient

clinical - history and exam
imaging - mammography, USS, MRI
pathology - cytopathology, histopathology

2

how is breast cytopathology taken

fluid needle aspiration
fluid
nipple discharge
nipple scrape

3

how is FNA staged from C1-5

C1 unsatisfactory
C2 benign
C3 atypia, probs benign
C4 suspicious of malignancy
C5 malignancy

4

what are the two types of breast histopathology and how is each one done

diagnostic - needle core biopsy, vacuum assisted biopsy, skin biopsy, incisional biopsy

therapeutic - excision biopsy of mass, resection of cancer (wide local excision of mastectomy)

5

how is a needle core biopsy graded from B1-5

B1A unstisfactory/normal
B2 benign
B3 atypia, probs benign
B4 suspicious of malignancy
B5 malignant
B5a carcinoma in situ
B5b invasive carcinoma

6

what are some developmental anomalies of breasts

hypoplasia
juvenile hypertrophy - usually one but can be both
accessory breast tissue - commonly at the axilla and becomes evident when hormonal state changes
accessory nipple

7

inflammatory benign breast disease (3)

fat necrosis
duct ectasia
acute mastitis/abscess

8

what is gynaecomastia
what kind of growth

breast develop,emt in the male
ductal growth without lobular development

9

what are some causes of gynaecomastia

exogenous/endogenous hormone
cannabis
prescription drugs
liver disease

10

who does fibrocystic change occur in

women aged 20-50 but commonest in women aged 40-50

11

risk factors for fibrocystic change

menstrual abnormalities
early menarche
late menopause
often resolve or diminish after menopause

12

link between breast cancer and fibrocystic change

same risk factors
can have co existing breast cancer

13

fibrocystic change presentation

smooth discrete lumps
sudden pain form rupture of cysts
cyclic pain which changes with menstrual cycle
lumpiness
incidental finding
screening

14

gross pathology of fibrocystic change of the cysts

1mm- several cm
blue domes with pale fluid
usually multiple
associated with other benign changes

15

microscopic pathology of cysts with fibrocystic change

thin walled but may have fibrotic wall
lined by apocrine epithelium

16

management of fibrocystic change

exclude malignancy
reassure
excise if necessary

17

what is hamartoma

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

18

treatment of hamartoma

left alone as it does not cause issues

19

how common is fibroadenoma

common
commoner in african women
usually solitary (10% multiple)

doesn't invade the tissue like cancer does

20

fibroadenoma age
presentation

peak incidence in 30s
can be picked up on screening
painless, firm, discrete mobile mass
"breast mouse"

21

US of fibroadenoma

solid on USS

22

description of a fibroadenoma

circumscribed
rubbery
grey-white colour
biphasic tumour/lesion - epithelium, stroma

23

treatment of fibroadenoma

diagnose
reassure
excise

24

when can a fibroadenoma grow rapidly

during pregnancy

25

what are the types of scelrosing lesions

sclerosis adenomas
radial scar/complex sceloring lesion (CSL)

26

what are sclerosising lesions
what can they cause
what can they mimic

benign
disorderly proliferation of acini and stroma

mass or calcification

carcinoma

27

sclerosising adenosis presentation

pain, tenderness, lumpiness/thickening
often asymp
age 20-70

28

risk of carcinoma + sclerosising adenosis

its benign and there is no risk of subsequent carcinoma

29

radial scar age
is it common
how is it found
ix

wide age range
common - 67% multi centric, 43% bilateral
incidental finding
mamographically detected

30

different between a radial scar and CSL

RS 1-9mm
CSL >10mm

31

pathology of a radial scar

stellate architecture
central puckering
radiating fibrosis

32

histology of radial scar

fibroelastic core
radiating fibrosis contains distorted ductules
fibrocystic change
epithelial proliferation

33

what does a radial scar mimic
is it premalignant
what it often show and what can happen in these

mimic carcinoma radiologically

not exactly

epitelial proliferation - in situ or invasive carcinoma may occur within these lesions

34

treatment of radial scar

excise or sample extensively by vacuum biopsy
now biopsy done more

35

causes for fat necrosis
what is it associated with

local trauma e.g. seat belt injury

associated with warfarin therapy - minor trauma can cause bleeding and damage to the fat

36

what happen during fat necrosis and what does it lead to

damage and disruption of adipocytes
infiltration by acute inflam cells
fibrosis and scarring - can cause contraction and a mass - can be month after initial injury

37

management of fat necrosis

confirm diagnosis
exclude malignancy
reassure

38

duct ectasia clinicas features

affect sub areolar ducts leading to dilatation
pain
acute episodic inflam changes - periductal inflam
bloody and or purulent discharge
fistulation
nipple retraction and distortion
periductal fibrosis

39

why does duct ectasia occur

keratin plugging causing stasis of secretion which can lead to infection

40

what is associated with duct ectasia

smoking

41

management of duct eurasia

treat acute infections
exclude malignancy
stop smoking
excise ducts

42

two main causes for acute mastitis/abscess

duct ectasia - mixed organisms, anaerobes
lactation - SA, strep pyogenes

43

management of acute mastitis/abscess

antibiotics
percutaneous drainage under USS guidance
incision and drainage
treat underlying cause - correct way for breastfeeding

44

what does phyllodes tumour look like
clinical features

cut surface looks like a leaf
40-50
slow growing unilateral breast mass

45

what kind of tumour is phyllodes
what does its behaviour depend on
graded how

biphasic - stromal overgrowth

behaviour depends on stromal features

benign, borderline, malignant (sarcomatous)

46

behaviour of phyllodes tumour

prone to local recurrence if not adequately excised
rarely metastasise

47

3 types of papillary lesions

introduct papilloma
nipple adenoma
encysted papillary carcinoma

48

age intraduct
signs/symp

35-60
nipple discharge +/or blood
asymp at screening - nodules and calcifications

49

description of intraduct papilloma

sub areolar ducts
2-20 mm diameter
papillary fronds containing a fibrovascular core
covered by my-epithelium and epithelium
epithelium may show proliferative activity

50

grading of epithelial proliferation in intraduct papilloma

none (benign)
usually type hyperplasia (benign)
atypical ductal hyperplasia - IDP with ADH
ductal carcinoma in situ - IDP with DCIS

51

treatment for intraduct papilloma

mostly excise other than the in situ carcinoma with is treated like an in situ carcinoma