Breast Pathology 1

Question 1

What is the triple assessment of the breast?

Answer 1

Clinical examination
Imaging
Pathology

Question 2

What are ways to assess Breast cytopathology?

Answer 2

Fine needle aspiration
Fluid
Nipple discharge
Nipple scrape

Question 3

What are the breast FNA cytology?

Answer 3

C1 - Unsatisfactory
C2 - Benign
C3 - Atypia, probs benign
C4 - Suspicious of malignancy
C5 - Malignant

Question 4

What are diagnostic measures of breast histopathology?

Answer 4

Core biopsy
Vacuum assisted biopsy
Skin biopsy
Incisional biopsy of mass

Question 5

What are therapeutic measures of breast histopathology?

Answer 5

Excisional biopsy of mass
Resection of cancer - Wide local excision
- Mastectomy

Question 6

What are the results of a core biopsy?

Answer 6

B1 - Unsatisfactory/Normal
B2 - Benign
B3 - Atypia, probs benign
B4 - Suspicious
B5 - Malignant
B5a - Carcinoma in situ
B5b - Invasive carcinoma

Question 7

Name developmental anomalies of benign breast disease? (4)

Answer 7

Hypoplasia
Juvenile hypertrophy
Accessory breast tissue
Accessory nipple

Question 8

What are non-neoplastic pathologies of benign breast disease? (5)

Answer 8

Gynaecomastia
Fibrocystic change
hamartoma
Fibroadenoma
Sclerosing lesions
- Sclerosing adenosis 
- Radial scar/complex sclerosing lesions

Question 9

What are inflammatory pathologies of benign breast disease? (3)

Answer 9

Fat necrosis
Duct ectasia
Acute mastitis/abscess

Question 10

What are tumour pathologies of benign breast disease? (2)

Answer 10

Phyllodes tumour

Intraduct papilloma

Question 11

What is Gynaecomastia?

Answer 11

Breast development in males

Ductal growth without lobular development

Question 12

What can cause gynaecomastia?

Answer 12

Exogenous/endogenous hormones
Cannabis
Prescription drugs
Liver disease

Question 13

Who are more likely to get fibrocystic change?

Answer 13

Women aged 20-50

Mainly 40-50

Question 14

What are causes of fibrocystic change?

Answer 14

Menstrual abnormalities
Early menarche
late menopause

Question 15

When is fibrocystic change usually resolved or diminished?

Answer 15

After menopause

Question 16

How does fibrocystic change present?

Answer 16

Smooth discrete lumps
Sudden pain 
Cyclical pain
Lumpiness
Incidental finding
Screening

Question 17

What are the cysts like in fibrocystic change with regards to gross pathology?

Answer 17

1mm - several cm's
Blue domed with pale fluid
usually multiple
Assoc. with other benign changes
Intervening fibrosis

Question 18

What are the cysts like in fibrocystic change with regards to microscopic pathology?

Answer 18

Thin walled but may have fibrotic wall
Lined by apocrine epithelium
Intervening fibrosis

Question 19

What is the management of fibrocystic change?

Answer 19

Exclude malignancy
Reassure
Excise of necessary

Question 20

What is a Hamartoma?

Answer 20

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

Question 21

Who are more likely to get a fibroadenoma?

Answer 21

African women

Question 22

What are the clinical features of fibroadenoma?

Answer 22

Peak incidence in 3rd decade
Screening
Painless, firm, discrete, mobile mass
“Breast mouse”

Question 23

How does a fibroadenoma appear on USS?

Answer 23

Solid

Question 24

Describe a fibroadenoma?

Answer 24

Circumscribed
Rubbery
Grey-white colour
Biphasic tumour/lesion
- Epithelium
- Stroma

Question 25

How do you manage a fibroadenoma?

Answer 25

Diagnose Reassure Excise

Question 26

Describe sclerosing lesions?

Answer 26

``` Sclerosing adenosis Radial scar/ complex sclerosing lesion Benign, disorderly proliferation of acini and storma Can cause a mass or calcification May mimic carcinoma ```

Question 27

What are the signs/symptoms of sclerosing adenosis?

Answer 27

``` Pain Tenderness Lumpiness/thickening Asymptomatic Age 20-70 ```

Question 28

Is sclerosing adenosis benign or malignant?

Answer 28

Benign

Question 29

Describe a radial scar?

Answer 29

``` Stellate architecture Central punching Radiating fibrosis RS =1-9mm CSL=>10mm ```

Question 30

What is the histology of a radial scar?

Answer 30

Fibroelastotic core Radiating fibrosis containing distorted ductules Fibrocystic change Epithelial proliferation

Question 31

What does a radial scar often show?

Answer 31

Epithelial proliferation

Question 32

How do you manage a radial scar?

Answer 32

Excise or sample via vacuum biopsy

Question 33

What cancers may arise from a radial scar?

Answer 33

In situ carcinoma | Invasive carcinoma

Question 34

What can cause fat necrosis?

Answer 34

Seat belt trauma | Warfarin therapy

Question 35

What happens in fat necrosis?

Answer 35

Damage and disruption of adipocytes Infiltration by acute inflammatory cells "foamy" macrophages Subsequent fibrosis and scarring

Question 36

How do you manage fat necrosis?

Answer 36

Confirm diagnosis and exclude malignancy

Question 37

What are clinical features of duct ectasia?

Answer 37

``` It affects the sub-areolar ducts Pain Acute episodic inflam changes Bloody and or purelent discharge Fistulation Nipple retraction and distortion ```

Question 38

What happens in duct ectasia and what is it associated with?

Answer 38

``` Assoc. with smoking Sub-areolar duct dilatation Periductal inflammation Periductal fibrosis Scarring and distortion ```

Question 39

How do you manage duct ectasia?

Answer 39

Treat acute infections Exclude malignancy Stop smoking Excise ducts

Question 40

What are the 2 causes of acute mastitis/ an abscess?

Answer 40

Duct ectasia - mixed organisms and anaerobes | Lactation - Staph.aureus, Strep pyogenes

Question 41

How do you manage Acute mastitis / Abscess?

Answer 41

Antibiotics Percutaneous drainage Incision and drainage Treat underlying cause

Question 42

What are clinical features of Phyllodes tumour?

Answer 42

40-50 y/o | Slow growing unilateral breast mass

Question 43

Describe a Phyllodes tumour?

Answer 43

``` Cystosarcoma phyllodes Biphasic tumour Stromal overgrowth Behaviour depends on stromal features Benign borderline, malignant (sacromatous) ```

Question 44

What are 3 papillary lesions?

Answer 44

Intraduct papilloma Nipple adenoma Encysted papillary carcinoma

Question 45

What are the clinical features of Intraduct papilloma?

Answer 45

``` Age 35-60 Nipple discharge +/- blood Asymptomatic at screening - nodules - calcification ```

Question 46

Describe intraduct papilloma?

Answer 46

Sub-areolar ducts 2-20mm diameter Papillary fronds containing a fibrovascular core Covered by myoepithelium and epithelium Epithelium may show proliferative activity

Question 47

What type of epithelial proliferation occurs in intraduct papilloma?

Answer 47

Usual type is hyperplasia Atypical ductal hyperplasia Ductal carcinoma in situ