Breast Pathology 1: Benign Breast Disease

Question 1

Describe the part of the triple assessment

Answer 1

Clinical = history and examination
Imaging= Ultrasound, mammography or MRI
Pathology = cytopathology or histopathology

Question 2

What specimens can be sent for cytopathology

Answer 2

Fine needle aspiration
Fluid
Nipple discharge
Nipple scrape

Question 3

Describe the results that can come back on FNA cytology

Answer 3

C1- unsatisfactory
C2- benign
C3- atypia, probably benign
C4- suspicious of malignancy
C5 - malignant

Question 4

Describe the results that can come back for a needle core biopsy

Answer 4

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

Question 5

Define cynaecomastia

Answer 5

Breast development in the male

Ductal growth without lobular development

Question 6

Causes of gynaecomastia

Answer 6

Exogenous/endogenous hormones
Cannabis
Prescription drugs e.g.rispiredone, spironolactone
Liver disease

Question 7

What age group does fibrocystic change usually occur in

Answer 7

woman aged 40-50 most commonly

can occur in 20-50s group though

Question 8

What usually causes fibrocystic change

Answer 8

menstrual changes/abnormalities
early menarche
late menopause

usually resolves after menopause

Question 9

How does fibrocystic change present

Answer 9

Smooth discrete lumps
Sudden pain
Cyclical pain
Lumpiness
Incidental finding
Can be detected at screening

Question 10

What is a hamartoma

Answer 10

A circumscribed lesion of cell types normal to the breast but present in abnormal proportion or distribution.
It is benign.

Question 11

In what race are fibroadenomas more common

Answer 11

African

Question 12

How common is it to have multiple fibroadenomas

Answer 12

only 10 percent have multiple

usually solitary

Question 13

What are the clinical features of a fibroadenoma

Answer 13

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

Question 14

What is a fibroadenoma

Answer 14

localised hyperplasia

Proliferation of intralobular stroma

Question 15

what are the features of a fibroadenoma

Answer 15

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

Question 16

How are fibroadenomas treated

Answer 16

Rule out malignancy
Reassure
Exise

Question 17

What are sclerosing breast lesions

Answer 17

benign, disorderly proliferation of acini and stroma causing a mass or calcification which may mimic carcinoma

Question 18

What are the main causes of breast sclerosinf lesions

Answer 18

radial scar

sclerosing adenosis

Question 19

When does sclerosis adenosis usually present and how does it usually present

Answer 19

any age between 20-70
pain, tenderness, lump/thickening
asymptomatic sometimes

Question 20

Is there a risk of carcinoma developing from a sclerosing adenosis

Answer 20

yes but it is negligible

Question 21

WHat is a radial scar

Answer 21

is a benign breast lesion that can radiologically mimic malignancy

Question 22

how common are bilateral radial scars

Answer 22

in about 43 percent of cases they are bilateral

Question 23

what is the difference between a radial scar and complex sclerosing lesion

Answer 23

RS is 1-9mm

CSL- more than 10mm

Question 24

what are the histological features of a radial scar

Answer 24

Fibroelastotic core
Radiating fibrosis containing distorted ductules
Fibrocystic change
Epithelial proliferation

Question 25

Is a radial scar pre malignant

Answer 25

No but often show epithelial proliferation | In situ or invasic carcino may occur within these lesions

Question 26

What is fat necrosis of the breast

Answer 26

damage and disruption of adipocytes usually following trauma to the breast infiltration of acute inflammatory cells subsqequent fibrosis and scarring

Question 27

what are the usual causes for fat necrosis

Answer 27

local trauma such as seat belt injury can occur with no history or history of very insignificant/minor trauma warfarin therapy

Question 28

what are the symptoms of duct ectasia

Answer 28

``` Pain Acute episodic inflammatory changes Bloody and/or purulent D/C Fistulation Nipple retraction and distortion ```

Question 29

Where does duct ectasia affect

Answer 29

sub areolar ducts

Question 30

What is the risk factor for duct ectasia

Answer 30

smoking

Question 31

what are the pathological features of duct ectasia

Answer 31

Sub-areolar duct dilatation Periductal inflammation Periductal fibrosis Scarring and distortion

Question 32

What are the two main aetiologies of mastitis or abscess in the breast

Answer 32

duct ectasia | lactation

Question 33

What is usually the causal organism of mastitis/abscess in lactation

Answer 33

Staph aureus | Step pyogenes

Question 34

What usually causes an infection in duct ectasia

Answer 34

mixed organisms | anaerobes

Question 35

How is mastitis/abscesses managed

Answer 35

Antibiotics Percutaneous drainage Incision & drainage Treat underlying cause

Question 36

what is a phyllodes tumour

Answer 36

A tumour of the breast characterised by peri ductal stromal overgrowth. can be benign, borderline or malignant.

Question 37

how do phyllodes tumours behave

Answer 37

they are prone to local recurrence if not excised adequately | rarely metastasize

Question 38

What papillary lesions can occur in the breast

Answer 38

intraductal papilloma nipple adenoma encysted papillary carcinoma

Question 39

what age range do intraductal papillomas usually occur in

Answer 39

35-60

Question 40

What is a common symptom of intraduct papillomas

Answer 40

nipple discharge +/- blood

Question 41

What may be seen on screening with an intraductal papilloma

Answer 41

nodules | calcification

Question 42

what are the features of an intraductal papilloma

Answer 42

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

Question 43

What epithelial proliferation may be seen in intraductal papillomas

Answer 43

None Usual type hyperplasia Atypical ductal hyperplasia Ductal carcinoma in situ