Breast pathology 1

Question 1

what is the triple assessment of a patient

Answer 1

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

Question 2

how is breast cytopathology taken

Answer 2

fluid needle aspiration
fluid
nipple discharge
nipple scrape

Question 3

how is FNA staged from C1-5

Answer 3

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

Question 4

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

Answer 4

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

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

Question 5

how is a needle core biopsy graded from B1-5

Answer 5

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

Question 6

what are some developmental anomalies of breasts

Answer 6

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

Question 7

inflammatory benign breast disease (3)

Answer 7

fat necrosis
duct ectasia
acute mastitis/abscess

Question 8

what is gynaecomastia

what kind of growth

Answer 8

breast develop,emt in the male

ductal growth without lobular development

Question 9

what are some causes of gynaecomastia

Answer 9

exogenous/endogenous hormone
cannabis
prescription drugs
liver disease

Question 10

who does fibrocystic change occur in

Answer 10

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

Question 11

risk factors for fibrocystic change

Answer 11

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

Question 12

link between breast cancer and fibrocystic change

Answer 12

same risk factors

can have co existing breast cancer

Question 13

fibrocystic change presentation

Answer 13

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

Question 14

gross pathology of fibrocystic change of the cysts

Answer 14

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

Question 15

microscopic pathology of cysts with fibrocystic change

Answer 15

thin walled but may have fibrotic wall

lined by apocrine epithelium

Question 16

management of fibrocystic change

Answer 16

exclude malignancy
reassure
excise if necessary

Question 17

what is hamartoma

Answer 17

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

Question 18

treatment of hamartoma

Answer 18

left alone as it does not cause issues

Question 19

how common is fibroadenoma

Answer 19

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

doesn’t invade the tissue like cancer does

Question 20

fibroadenoma age

presentation

Answer 20

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

Question 21

US of fibroadenoma

Answer 21

solid on USS

Question 22

description of a fibroadenoma

Answer 22

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

Question 23

treatment of fibroadenoma

Answer 23

diagnose
reassure
excise

Question 24

when can a fibroadenoma grow rapidly

Answer 24

during pregnancy

Question 25

what are the types of scelrosing lesions

Answer 25

sclerosis adenomas | radial scar/complex sceloring lesion (CSL)

Question 26

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

Answer 26

benign disorderly proliferation of acini and stroma mass or calcification carcinoma

Question 27

sclerosising adenosis presentation

Answer 27

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

Question 28

risk of carcinoma + sclerosising adenosis

Answer 28

its benign and there is no risk of subsequent carcinoma

Question 29

radial scar age is it common how is it found ix

Answer 29

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

Question 30

different between a radial scar and CSL

Answer 30

RS 1-9mm | CSL >10mm

Question 31

pathology of a radial scar

Answer 31

stellate architecture central puckering radiating fibrosis

Question 32

histology of radial scar

Answer 32

fibroelastic core radiating fibrosis contains distorted ductules fibrocystic change epithelial proliferation

Question 33

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

Answer 33

mimic carcinoma radiologically not exactly epitelial proliferation - in situ or invasive carcinoma may occur within these lesions

Question 34

treatment of radial scar

Answer 34

excise or sample extensively by vacuum biopsy | now biopsy done more

Question 35

causes for fat necrosis | what is it associated with

Answer 35

local trauma e.g. seat belt injury associated with warfarin therapy - minor trauma can cause bleeding and damage to the fat

Question 36

what happen during fat necrosis and what does it lead to

Answer 36

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

Question 37

management of fat necrosis

Answer 37

confirm diagnosis exclude malignancy reassure

Question 38

duct ectasia clinicas features

Answer 38

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

Question 39

why does duct ectasia occur

Answer 39

keratin plugging causing stasis of secretion which can lead to infection

Question 40

what is associated with duct ectasia

Answer 40

smoking

Question 41

management of duct eurasia

Answer 41

treat acute infections exclude malignancy stop smoking excise ducts

Question 42

two main causes for acute mastitis/abscess

Answer 42

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

Question 43

management of acute mastitis/abscess

Answer 43

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

Question 44

what does phyllodes tumour look like | clinical features

Answer 44

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

Question 45

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

Answer 45

biphasic - stromal overgrowth behaviour depends on stromal features benign, borderline, malignant (sarcomatous)

Question 46

behaviour of phyllodes tumour

Answer 46

prone to local recurrence if not adequately excised | rarely metastasise

Question 47

3 types of papillary lesions

Answer 47

introduct papilloma nipple adenoma encysted papillary carcinoma

Question 48

age intraduct | signs/symp

Answer 48

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

Question 49

description of intraduct papilloma

Answer 49

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

Question 50

grading of epithelial proliferation in intraduct papilloma

Answer 50

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

Question 51

treatment for intraduct papilloma

Answer 51

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