Breast Pathology Flashcards
(52 cards)
How to assess a patient with breast disease?
By TRIPLE assessment
- Clinical (hx and exam)
- Imaging (Mammography/USG/MRI)
- Pathology (cyto-/histo-pathology)
How is cytopathology assessed?
- by: Fine needle aspiration/ fluid/ nipple discharge/ nipple scrape
- easy extraction of epithelial cells
What may the FNA cytology indicate in classification?
- helps classify the breast lump to:
1. C1: unsatisfactory/ normal
2. C2: benign
3. C3: atypia, probably benign
4. suspicious malignancy (surgery not done yet)
5. C5: malignant (don’t know if INVASIVE or IS) > SURGERY
How is breast histopathology assessed?
dx by core biopsy
- vacuum assisted biopsy
- skin biopsy
- incisional biopsy of mass
What can be performed in response to the breast histopathology results?
- vacuum assisted excision
- excisional biopsy of mass
- resection of CANCER
(wide local excision/ mastectomy- if disease is too extensive)
Classification of the lesion by the needle core biopsy is…
B1: normal/unsatis. B2: Benign B3: Atypia (probably benign) B4: suspicious malignancy B5: Malignant - B5a (CA in situ) ....- B5b: invasive CA
Name 4 developmental anomalies of breast tissue.
- hypoplasia
- juvenile hypertrophy (one or both grow MASSIVELy)
- accessory breast tissue
- accessory nipple (anywhere along the milk line)
What are non-neoplastic conditions of the breast?
- gynaecomastia
- fibrocystic change
- hamartoma
- fibroadenoma
- sclerosing lesions (sclerosing adenosis/ radial scars)
Name 3 inflammatory conditions of the breast.
- fat necrosis (with trauma and seat belt injurieS)
- duct ectasia
- acute mastitis/ abscess
What are some benign tumors of the breast tissue?
- intraduct papilloma
- phyllodes tumor (benign—-> malign.)
What occurs in gynaecomastia?
- ductal growth without lobar develop.
- don’t see acini
- hyperplastic epithelium
- ductal proliferation
What causes gynaecomastia?
- cannabis
- prescription drugs
- liver disease
- exogenous/endogenous hormones (estrogenic hormones)
Fibrocystic change commonly occur at what age?
- age 40-50
(seen 20-50y.o)
—very common
What causes these changes?
- menstrual abnormalities
(early menarche-late menopause) –esp. ANOVULATORY cycle (prolonged estrogenic stimulation)
—–RESOLVES after menopause
Hisyopathology and cytopathology diff.
HISTO= looks at biopsy specimens
Cytopathology= fluid specimens (V. QUICK process; done in a day)
DIff. with needle core biopsy vs FNA?
- can tell with biopsy if invasive
- ——if so AXILLARY breast is removed
Vacuum assisted biopsy advs?
- needle stays in situ
- pt doesn’t need to stay in
- no need local anaesthetic
How does fibrocystic mass present as?
Smooth discrete lumps Sudden pain (d/t rupture) Cyclical pain Lumpiness Incidental finding Screening
What is a red flag for breast tissue gross pathology?
- BLOOD staining is bad on gross pathology
How do the cysts present as?
1mm – several cm
blue domed with pale fluid
Usually multiple
Associated with other benign changes
—-intervening fibrosis
What are the cyst walls like?
thin walled
- fibrotic wall
- lined by aprocrine epithelium
Define metaplasia.
change from one fully differentiated cell type to another fully differentiated cell type
Define hamartoma.
Circumscribed lesion composed of cell types normal to the breast but present in an abnormal proportion or distribution
How to manage fibrocystic change?
Exclude malignancy
Reassure
Excise if necessary
