Breast Pathology Flashcards by Megan McLaren

what is the assessment method for a patient with breast disease

TRIPLE ASSESSMENT

clinical history + examination
Imaging- mammography/USS/MRI
Pathology- cytopathology/histopathology

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how is breast cytopathology obtained

NNA
Nipple discharge
Nipple scrape

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5 stages of breast FNA cytology

C1- Unsatisfactory
C2- Benign
C3- Atypical 
C4- Suspicious
C5- Malignant

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5 stages of a needle core biopsy

B1- Normal 
B2- Benign 
B3- Atypical 
B4- Suspicious 
B5- Malignant

B5a = carcinoma in situ 
B5b =  invasive carcinoma

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developmental benign breast diseases

hypoplasia- one of both breasts don’t develop properly during puberty
Juvenile hypertrophy - breasts continue to grow
Accessory breast tissue / accessory nipple

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Examples of non-neoplastic benign breast disease

Gynaecomastia 
fibrocystic change
Hamartoma
Fibroadenoma
Sclerosing lesions

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Inflammatory benign breast disease

Fat necrosis
Duct ectasia
Acute mastitis/abscess

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benign breast tumours

phyllodes tumour

intra-duct papilloma

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what is gynaecomastia

breast development in males

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pathology of gynaecomastia

ductal growth without lobular development

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causes of gynaecomastia

Exogenous/endogenous hormones
cannabis
liver disease
prescription drugs (e.g. spironolactone)

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what age range are fibrocystic changes seen in

majority aged 40-50

also seen as early as 20s

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how does a breast with fibrocystic change appear

lumpy, cobblestone appearance

Lumps are smooth with defined edges and are usually free moving

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what is fibrocystic change associated with

menstrual abnormalities
early menarche
late menopause

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what happens with fibrocystic changes after menopause

resolves/diminishes

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pathology of fibrocystic change

cysts- 1mm to several cm
Blue domed with pale fluid
usually multiple

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what are fibrocystic cysts lined with

apocrine epithelium

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presentation of fibrocystic change

smooth discrete lumps
sudden pain
cyclical pain
lumpiness

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what is a hamartoma

circumscribed lesion composed of normal cell types but in an abnormal distribution/proportion

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features of a fibroadenoma

Common- usually African women, peak incidence in 30s

Solitary lesion- painless, firm, mobile mass

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presentation of fibroadenoma on USS

Solid

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pathology of fibroadenoma

circumscribed
rubbery
grey-white colour

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what often co-exists with fibrocystic change

sclerosing adenosis

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what is sclerosing adenosis

benign proliferative condition of the terminal duct lobular units
increase number of stroma, acini and their glands

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what can sclerosisng adenosis cause

mass or calcification | may mimic carcinoma

presentation of sclerosing adenosis

pain, tenderness, lumpiness, thickening may be asymptomatic age 20-70

pathology of a radial scar

central fibrous core with central puckering

how is a radial scar diagnosed

incidental finding not palpable detected by mammogram

histology of radial scar

fibro-elastic core radiating fibrosis containing distorted ductules fibrocystic change epithelial proliferation

differential of a radial scar

carcinomas- can mimic them radiologically

causes of fat necrosis

local trauma | warfarin therapy

pathology of fat necrosis

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

what is duct ectasia

lactiferous duct becomes blocked or clogged | can cause greenish discharge

what is duct ectasia associated with

smoking

features of duct ectasia

``` affects sub-areolar ducts pain acute episodic/inflammatory changes discharge can be bloody/green nipple retraction and distortion ```

pathology of duct ectasia

sub-areolar duct dilatation periductal inflammation + fibrosis scarring + distortion

management of duct ectasia

treat acute infections exclude malignancy stop smoking excise ducts

management of acute mastitis/abscess

antibiotics percutaneous drainage incision &amp treat underlying cause

features of a phyllodes tumour

age 40-50 slow growing unilateral breast mass

examples of papillary lesions

intraduct papilloma nipple adenoma encysted papillary carcinoma

features of a intra-duct papilloma

age 35-60 | nipple discharge +/- blood

what is an intra-duct papilloma

benign breast lesions

classifications of intra-duct papilloma

central | peripheral

where are peripheral intra-duct papillomas found

terminal duct lobular unit

potential complications of intra-duct papillomas

if they are big enough they may block ducts and cause cysts

what is a ductal carcinoma in situ

breast carcinoma limited to the ducts no extension beyond the basement membrane cancer has not infiltrated the parenchyma/lymphatics -> cannot metastasise

what tumours often metastasise to the breast

bronchial ovarian serous carcinoma clear cell carcinoma of the kidney melanoma

definition of breast carcinoma

a malignant tumour of breast epithelial cells

where does breast carcinoma arise from

glandular epithelium of the terminal duct lobular unit

2 types of breast carcinoma

ductal carcinoma | lobular carcinoma

pre-cursors of ductal carcinoma

epithelial hyperplasia columnar cell change atypical ductal hyperplasia ductal carcinoma in situ

pre-cursors of lobular carcinoma

atypical lobular hyperplasia | lobular carcinoma in situ

what is meant by in situ carcinoma

confined within basement membrane | malignant but non invasive

atypical lobular hyperplasia

<50% of lobule involved

lobular carcinoma in situ

>50% of lobule involved

features of lobular carcinoma in situ (LCIS)

ER positive incidence decreases after menopause may calcify

which intra-ductal pre-cursor has the highest risk of progressing to cancer

DCIS

Features of DCIS

Arises in terminal ductal lobular unit | typically affects a single duct system

what is DCIS that invades the nipple called

pagets disease

what is pagets disease of the nipple

high grade DCIS extending along ducts to reach the epidermis of the nipple Still in situ- non invasive

management of DCIS

Surgery + radiotherapy

definition of invasive

malignant cells have invaded the basement membrane | infiltration of normal tissues

what factors affect prognosis of breast cancer

ER | HER2

treatment if tumour is HER 2 positive

trastuzumab

Breast Pathology Flashcards

(64 cards)