Breast Pathology

Question 1

What is triple assessment of someone with breast disease?

Answer 1

• clinical
  
  • history
  • examination
• imaging
  
  • mammography
  • ultrasound
  • MRI
• pathology
  
  • cytopathology
  • histopathology

Question 2

How are breast cytopathology samples attained?

Answer 2

Fine needle aspiration

Fluid

Nipple discharge

Nipple scrape

Question 3

What is the staging for breast FNA cytology?

Answer 3

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

Question 4

What procedures are done for diagnostic breast histopathology?

Answer 4

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

Question 5

What procedures are done for therapeutic breast histopathology?

Answer 5

• vacuum assisted excision
• excisional biopsy of mass
• resection of cancer
  
  • wide local excision
  • mastectomy

Question 6

What are the stagings for needle core biopsy?

Answer 6

B1- Unsatisfactory/normal

B2- benign

B3- atypia, probably benign

B4- suspicious of malignancy

B5- malignant

B5a- carcinoma in situ

B5b- invasive carcinoma

Question 7

What are the benign developmental anomalies of the breast?

Answer 7

• hypoplasia
• juvenile hypertrophy
• accessory breast tissue
• accessory nipple

Question 8

What are the benign non-neoplastic pathologies of the breast?

Answer 8

• gynaecomastia
• fibrocystic change
• hamartoma
• fibroadenoma
• sclerosing lesions
  
  • sclerosing adenosis
  • radial scar/complex sclerosing lesions

Question 9

What are the benign inflammatory pathologies of the breast?

Answer 9

• fat necrosis
• duct ectasia
• acute mastitis/abscess

Question 10

What are the benign tumours of the breast?

Answer 10

Phyllodes tumour

Intraduct papilloma

Question 11

What is gynaecomastia?

Answer 11

Breast development in the male

Ductal growth without lobular development

Question 12

What are the causes of gynaecomastia?

Answer 12

Exogenous/endogenous hormones

Cannabis

Prescription drugs

Liver disease

Question 13

Who is commonly affected by fibrocystic change?

Answer 13

Women aged 20-50

majority 40-50

Question 14

What can cause fibrocystic change?

Answer 14

Menstrual abnormalities

Early menarche

Late menopause

Question 15

How does fibrocystic change present?

Answer 15

• smooth discrete lumps
• sudden pain
• cyclical pain
• lumpiness

May pressent as an incidental finding or on breast screening.

Question 16

What is the gross pathology of fibrocystic change?

Answer 16

Cysts

• 1mm -> several cm*
• blue domed with pale fluid*
• usually multiple*
• associated with other benign changes*

Intervening fibrosis

Question 17

Describe the microscopic pathology of fibrocystic change

Answer 17

Cysts

• Thin walled- may have fibrotic wall*
• Lined by apocrine epithelium*

Intervening fibrosis

Question 18

Define metaplasia

Answer 18

Change from one fully differentiated cell type to another fully differentiated cell type

Question 19

How is fibrocystic change managed?

Answer 19

Exclude malignancy

Reassure

Excise if necessary

Question 20

What is a hamartoma?

Answer 20

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

Question 21

Fibroadenomas are usually _______ and are commoner in ______ woman.

Answer 21

Fibroadenomas are usually solitary and are commoner in African woman.

Question 22

When do fibroadenomas present?

Answer 22

In 3rd decade often at screening

Question 23

How are fibroadenomas described?

Answer 23

Breast mouse

Painless, firm, discrete, mobile mass

Question 24

Fibroadenomas are _____ on ultrasound

Answer 24

Fibroadenomas are solid on ultrasound

Question 25

Describe the gross pathology of fibroadenomas

Answer 25

Circumscribed Rubbery Grey-white colour Biphasic tumour * - epithelium* * - stroma*

Question 26

What is the treatment of a fibroadenoma?

Answer 26

Diagnose Reassure Excise

Question 27

What are sclerosing lesions?

Answer 27

Benign, disorderly proliferation of acini and stroma

Question 28

What can sclerosing lesions cause?

Answer 28

Mass or calcification

Question 29

What may sclerosing lesions mimic?

Answer 29

Carcinoma

Question 30

Describe the presentation of sclerosing adenosis

Answer 30

Pain, tenderness or lumpiness/thickening Asymptomatic

Question 31

What age group gets sclerosing adenosis?

Answer 31

Age 20-70

Question 32

The risk of carcinoma from sclerosing adenosis is ...

Answer 32

Negligible

Question 33

\_\_% of radial scars are multicentric and \_\_% are bilateral

Answer 33

**67**% of radial scars are multicentric and **43**% are bilateral

Question 34

How are radial scars detected?

Answer 34

On mammography as incidental finding

Question 35

What sizes are radial scars (RS) and Complex Sclerosing Lesions (CSL)?

Answer 35

RS= 1-9mm CSL= \>10mm

Question 36

Describe radial scar pathology

Answer 36

Stellate architecture Central puckering Radiating fibrosis

Question 37

Describe the histology of a radial scar

Answer 37

* fibroelastic core * radiating fibrosis containing distorted ductules * fibrocystic change * epithelial proliferation

Question 38

What do radial scars mimic?

Answer 38

Carcinoma of radiology

Question 39

What may occur within a radial scar?

Answer 39

Epithelial proliferation In situ or invasive carcinoma

Question 40

What is the treatment of a radial scar?

Answer 40

Excise or sample extensively by vacuum biopsy

Question 41

What causes fat necrosis?

Answer 41

Local trauma - seat belt injury - frequently no history Warfarin therapy

Question 42

Describe the growth pathology of fat necrosis?

Answer 42

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

Question 43

How is fat necrosis managed?

Answer 43

Confirm the diagnosis Exclude malignancy

Question 44

What are the clinical features of duct ectasia?

Answer 44

* affects sub-areolar ducts * pain * acute episodic inflammatory changes * bloody and/or purulent discharge * fistulation * nipple retraction and distortion

Question 45

What is associated with duct ectasia?

Answer 45

Smoking

Question 46

What is the gross pathology of duct ectasia?

Answer 46

* Subareolar duct dilatation * periductal inflammation * periductal fibrosis * scarring and distortion

Question 47

How can duct ectasia be managed?

Answer 47

* treat acute infections * exclude malignancy * stop smoking * excise ducts

Question 48

What are the 2 main aetiologies of acute mastitis/abscess?

Answer 48

* duct ectasia * mixed organisms * anaerobes * lactation * staph aureus * strep pyogenes

Question 49

What is the management of acute mastitis/abscess?

Answer 49

Antibiotics Percutaenous drainage Incision and drainage Treat underlying cause

Question 50

Who gets phyllodes tumours and how are they described?

Answer 50

40-50 Slow growing unilateral breast mass

Question 51

Describe the morphology of a phylodes tumour?

Answer 51

Biphasic, Stromal overgowth Epithelial

Question 52

What does behaviour of phyllodes tumour depend upon?

Answer 52

Stromal features; - benign - borderline - malignant (sarcomatous)

Question 53

What is the outcome of phyllodes tumour?

Answer 53

Prone to local recurrence if not adequately excised Rarely metastasize

Question 54

How do intraduct papillomas present and who gets them?

Answer 54

Nipple discharge +/- blood Asymptomatic at screening - nodules, calcification Age 35-60

Question 55

What is the gross pathology of intraduct papilloma?

Answer 55

Found in sub-areolar ducts 2-20mm in diameter Papillary fronds containing a fibrovascualr core, covered by myoepithelium and epithelium.

Question 56

What may epithelium show in intraduct papilloma?

Answer 56

Proliferative activity

Question 57

What does staging of intraduct papilloma depend on?

Answer 57

Epithelial proliferation - none - usual type hyperplasia - atypical ductal hyperplasia - ductal carcinoma in situ