Breast Pathology

Question 1

Describe the normal structure of the breast

Answer 1

Variable amounts of fat and glandular tissue (more fat in old, more gland in young)

Glandular tissue consists of ducts and lobules surrounded by fibrous tissue

Lobules main secretory units and will secrete milk products- lined by epithelial cells with peripheral myoepithelial cells- contractile fxn

Max secretion in lobules => intralobular ducts (1 duct for each unit) => extralobular ducts => lactiferous ducts close to nipple => lactiferous sinus where secretion stored just deep to the nipple

Question 2

Label

Answer 2

Question 3

Label

Answer 3

Question 4

Outline the steps of investigating a breast lump

Answer 4

• Can be normal cyclical changes in the breast
• Need to get good Hx – how/when noticed it, pain, stage of menstrual cycle, previous lumps, Fam Hx
• Clinical Exam - 3S, 3C, 3T
• Radiology – older women mammography (X-ray of breast), younger US more effective
• Needle biopsy – either FNA or core needle biopsy

Question 5

What are the important aspects in the clinical Hx of someone with a breast lump

Answer 5

Change in size of lump – dec size unlikely significant, short time between detection and appointment so may not notice size change

Cyclical or constant – if tracks with menstrual cycle unlikely pathological

Pain – usually innocent finding

Skin changes – inflamm or tethering/dimple may indicate malignancy

Question 6

What are the important aspects of the clinical examination of a breast lump?

Answer 6

Site – benign rarely occur in medial aspect (normally upper outer quadrant)

Size – no indication on malignancy

Consistency – Most cancers usually hard, benign eg fibroadenoma usually firm, lumps usually fatty/soft, cysts can be firm or hard

Character – focal requires further investigation, vague/poorly defined more likely benign, smooth is likely benign, irregular likely malignant

Skin changes – ask patient to raise arms to detect dimpling that’s not apparent

Always examine axilla – many w/o breast cancer will have large palpable glands but in breast cancer may feel large fixed mass of axillary nodal metastases

Question 7

Describe mammography

Answer 7

Mammography – X-Ray of breast between two plates shown from 2 planes cranio-caudal and oblique (30^o) (prevents composite shadowing of overlaying normal tissue)

Difficult to get medial aspect of breast

More effective in older bc more fatty tissue means lumps/masses more apparent

Question 8

Describe the use of ultrasound in breast cancer detection

Answer 8

Ultrasound – useful for known lumps but not screening bc labour intensive and false positives

Can tell if cystic (usually benign) or solid

Outline of lesion (smooth likely benign)

Useful for image guided biopsy