Breast Pathology 1

Question 1

triple assessment in breast disease?

Answer 1

clinical (history + examination)
imaging
pathology

Question 2

4 types of breast cytopathology?

Answer 2

fine needle aspiration
fluid
nipple discharge
nipple scrape

Question 3

normal breast epithelial cells on NFA?

Answer 3

honeycomb appearance

Question 4

classification in FNA cytology?

Answer 4

C1-5
1 = unsatisfactory/normal
2 = benign
3 = atypia, probably benign
4 = suspicious of malignancy
5 = malignant

Question 5

drawback of FNA?

Answer 5

cant tell if malignancy is invasive or still in the ducts

Question 6

diagnostic histopathology?

Answer 6

needle core biopsy
vacuum assisted biopsy (large volume)
skin biopsy
incisional biopsy of mass

Question 7

therapeutic histopathology?

Answer 7

vacuum assisted excision
excisional biopsy of mass
resection of cancer (wide local excision or mastectomy)

Question 8

classification of needle core biopsy?

Answer 8

B1-5
1 = unsatisfactory/normal
2 = benign
3 = atypia, probably benign
4 = suspicious of malignancy
5 = malignancy
(5a = in situ, 5b = invasive)

Question 9

advantage of needle core biopsy over FNA?

Answer 9

can show whether invasive or in situ

Question 10

4 examples of developmental anomalies in breast?

Answer 10

hypoplasia
juvenile hypertrophy
accessory breast tissue
accessory nipple

Question 11

non-neoplastic growth in breast?

Answer 11

gynaecomastia
fibrocystic change
hamartoma
fibroadenoma
sclerosing lesions (sclerosing adenosis, radial scar/complex sclerosing lesions)

Question 12

3 benign inflammatory breast diseases?

Answer 12

fat necrosis
duct ectasia
acute mastitis/abscess

Question 13

benign tumours in breast?

Answer 13

phyllodes tumour

intraduct papilloma

Question 14

what is gynaecomastia?

Answer 14

breast growth in male

ductal growth without lobular development

Question 15

what can cause gynaecomastia?

Answer 15

exogenous/endogenous hormones (can have female hormones coming through in breast milk)
cannabis
prescription drugs
liver disease

Question 16

what is associated with fibrocystic change?

Answer 16

menstrual abnormalities
early menarche
late menopause
often resolve in diminish after menopause
in women of child bearing age (usually late reproductive age)

Question 17

how might fibrocystic change present?

Answer 17

smooth discrete lumps or general lumpiness
sudden pain (rupture)
cyclical pain
can be an incidental finding

Question 18

gross pathology in fibrocystic change?

Answer 18

cysts (1mm - several cm)
- blue domed with pale fluid
- usually multiple
- associated with other benign changes
can also have intervening fibrosis

Question 19

describe the cysts seen in fibrocystic change?

Answer 19

thin walled but may have fibrotic wall
lined by apocrine epithelium
abundant pink cytoplasm (low nucleo-cytoplasmic ratio)

Question 20

management of fibrocystic change?

Answer 20

exclude malignancy
reassure
excise if necessary

Question 21

what is a hamartoma?

Answer 21

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

Question 22

clinical features of fibroaenoma?

Answer 22

painless, firm, discrete, mobile mass (“breast mouse”)
solid on US
peak incidence in 3rd decade and usually found on screening

Question 23

physical features of fibroadenoma?

Answer 23

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

Question 24

how is fibroadenoma managed?

Answer 24

diagnose
reassure
excise if needed

Question 25

types of sclerosing lesions?

Answer 25

sclerosing adenosis | radial scar/complex sclerosing leison

Question 26

describe sclerosing leisons

Answer 26

benign disorderly proliferation of acini and stroma can cause a mass or calcification can mimic carcinoma

Question 27

describe sclerosing adenosis

Answer 27

pain, tenderness or lumpiness/thickening can be asymptomatic usually age 20-70 benign with negligible risk of carcinoma

Question 28

how are radial scar usually found?

Answer 28

incidental finding on mammogram | very common

Question 29

features of radial scar?

Answer 29

stellate architecture central puckering radiating fibrosis 1-9mm (>10mm = comples sclerosing lesion)

Question 30

histology of radial scar?

Answer 30

fibroelastic core radiating fibrosis containing distorted ductules fibrocystic change epithelial proliferation

Question 31

are radial scare malignant?

Answer 31

mimic carcinoma radiologically but probably not pre-malignant per se often show epithelial proliferation insitu or invasive carcinoma can occur within the lesion

Question 32

how is radial scar managed?

Answer 32

excise or sample extensively by vacuum biopsy

Question 33

what can cause fat necrosis?

Answer 33

``` local trauma (seat belt injury etc) warfarin therapy ```

Question 34

what happens in fate necrosis?

Answer 34

damage and disruption of adipocytes infiltration by acute inflammatory cells foamy macrophages form subsequent fibrosis and scarring

Question 35

management of fat necrosis?

Answer 35

confirm diagnosis | exclude malignancy

Question 36

clinical features of duct ectasia?

Answer 36

``` in sub-areolar ducts pain acute episodic inflammatory changes bloody and/or purulent D/C fistulation nipple retraction and distortion ```

Question 37

associations in duct ectasia?

Answer 37

``` smoking sub-areolar duct dilation peri-ductal inflammation peri-ductal fibrosis scarring and distortion ```

Question 38

management of duct ectasia?

Answer 38

treat acute infections exclude malignancy stop smoking excise ducts

Question 39

2 main causes of acute mastitis/abscess?

Answer 39

``` duct ectasia (mixed organisms or anaerobes) lactation (staph aureus or strep pyogenes) ```

Question 40

management of acutes mastitis/abscess?

Answer 40

antibiotics percutaneous drainage incision and drainage treat underlying cause

Question 41

clinical features of phyllodes tumour?

Answer 41

40-50 y/o slow growing unilateral biphasic breast mass stromal overgrowth

Question 42

is phyllodes tumour benign or malignant?

Answer 42

depends on stromal features can be benign, borderline or malignant (sarcoma like) rarely metastasise

Question 43

types of papillary lesions in breast?

Answer 43

intraduct papilloma nipple adenoma encapsulated papillary carcinoma

Question 44

clinical features of intraduct papilloma?

Answer 44

usually in age 35-60 nipple discharge +/- blood nodules and calcification seen at screening

Question 45

describe the actual growth in intraduct papilloma?

Answer 45

sub areolar ducts 2-20mm diameter papillary fronds containing a fibrovascular core covered by myoepithelium and epithelium epithelium may show proliferative activity (normal/atypical ductal hyperplasia or ductal carcinoma in situ)

Question 46

types of epithelial proliferation in intraduct papillary leisons?

Answer 46

none usual type hyperplasia atypical ductal hyperplasia (still benign) ductal carcinoma in situ