Breast Pathology - Benign

Question 1

What are the different ways to take a breast sample?

Answer 1

FNA
Fluid
nipple discharge
nipple scrape
needle core biopsy
vacuum assisted biopsy 
skin biopsy
inscisional biopsy of mass

Question 2

What therapeutic measures can be done for breast pathologies?

Answer 2

vacuum assisted excision
excisional biopsy of mass
resection of cancer - wide local inscision or masectomy

Question 3

What is gynaecomastia?

Answer 3

benign breast growth in males

ductal growth but no lobar development

Question 4

What causes gynaecomastia?

Answer 4

endogenous hormones
cannabis
prescription drugs
liver disease

Question 5

What are fibrocystic changes to the breasts?

Answer 5

cysts 1mm->several cm

very common

Question 6

What age are most affected with cysts?

Answer 6

30-50

Question 7

How do breast cysts present?

Answer 7

sudden pain
smooth, discrete lumps
cyclical pain
lumpiness

Question 8

What is the pathology of breast cysts?

Answer 8

blue domed with fluid
thin but may have a fibrocytic wall
surrounded by intervening fibrosis

Question 9

How are breast cysts managed?

Answer 9

excise if necessary

exclude no malignancy and reassure

Question 10

How are breast cysts diagnosed?

Answer 10

FNA

Question 11

What is a Hamartoma?

Answer 11

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

Question 12

What populations are affected by fibroadenomas?

Answer 12

African women

30s

Question 13

How do fibroadenomas present?

Answer 13

painless 
firm
discreet
mobile mass
1-3cm

Question 14

What is the pathology of fibroadenomas?

Answer 14

gray-white in colour

proliferation of intralobular storm

Question 15

How are fibroadenomas diagnosed?

Answer 15

core biopsy

Question 16

What are sclerosing lesions?

Answer 16

benign, disorderly proliferation of acini and stroma

may mimic carcinoma or cause mass or calcification

Question 17

What are two types of sclerosing lesions?

Answer 17

sclerosing adenosis

radial scar

Question 18

What is sclerosing adenosis?

Answer 18

benign but a neglible risk of subsequent carcinoma

presents with pain, tenderness, lumpiness/thickening

Question 19

How are radial scars seen pathologically?

Answer 19

stellate architecture
radiating fibrosis + central puckering
epithelial proliferation

Question 20

What may occur within radial scars?

Answer 20

in situ/invasive carcinoma

Question 21

How are radial scars picked up?

Answer 21

mammogram

- they mimic carcinoma radiologically

Question 22

How are radial scars treated?

Answer 22

excised or sampled by vacuum biopsy

Question 23

What can cause fat necrosis?

Answer 23

local trauma - seat belt injury - or warfarin therapy

Question 24

What is fat necrosis?

Answer 24

damage and distruption to adiposcytes and infiltration by acute inflammatory cells causing subsequent fibrosis and scarring

Question 25

What is duct ectasia?

Answer 25

sub aerolar duct and periductal inflammation and fibrosis

Question 26

How does duct ectasia present?

Answer 26

greenish discharge nipple retraction and distortion can mimic breast cancer bloody/purulent discharge

Question 27

What is associated with causing duct ectasia?

Answer 27

smoking

Question 28

How can duct ectasia be managed?

Answer 28

stop smoking excise duct treat acute infections

Question 29

What are the two types/causes of acute mastitis?

Answer 29

duct ectasia | lactation

Question 30

What organisms cause duct ectasia related mastitis?

Answer 30

mixed organisms and anaerobes

Question 31

What organisms cause lactation related mastitis?

Answer 31

staph aureus and strep pyogenes

Question 32

How is mastitis treated?

Answer 32

drainage and antibiotics

Question 33

What is a Phyllodes tumour?

Answer 33

slow growing unilateral breast lump | 3-6cm

Question 34

What age range do Phyllodes tumours affect?

Answer 34

40-50

Question 35

What is the pathology of Phyllodes tumour?

Answer 35

pathology predicts tumour behaviour | biphasic tumour prone to local reoccurrence

Question 36

When can Phyllodes tumour be malignant?

Answer 36

if there is sarcomatous stromal component

Question 37

What is the presentation of Intraduct papillomas?

Answer 37

age 35-60 nipple discharge +/- blood often asymptomatic

Question 38

How are Intraduct papillomas diagnosed?

Answer 38

ultrasound guided biopsy

Question 39

What is the pathology of Intraduct papillomas?

Answer 39

2-20mm fibrovascular core covered in mEP and epithelium epithelium may be proliferative can occur within a cyst