Reproductive Pathology: Female 1 Flashcards
(60 cards)
What percentage of lesions that occur in the breast are benign?
~ 90%
What sort of shape are benign breast lumps?
Oval/ellipsoid
What is the difference in allignment between benign and malignant breast lumps?
Benign
- Wider than deep; aligned parallel to tissue planes
Malignant
- Deeper than wide
What is the difference like in the margins of malignat and benign lumps?
Benign
- Smooth/thin
- Echogenic pseudocapsule with 2-3 gentle lobulations
Malignant
- Irregular or spiculated; echogenic ‘halo’
Is lateral shadowing present in benign or malignant lumps?
- Present in benign
- Absent in malignant
What does a cyst look like on US vs a malignant tumour?
- Cyst is Hypoechoic, black
- Solid malignant lesion will give out a shadow
What are some concerning features of sample cells from breast tissue which may indicate cancer?
- Small cytoplasm
- Multiple nuclei
- Multiple and large nuclei
- Coarse chromatin
What happens to the ducts in postmenopausal women?
Terminal duct lobular units are absent. The remaining intermediate ducts and larger ducts are commonly dilated
What is a fibrocystic change (FCC)?
- Nonproliferative change that includes gross and microscopic cysts, apocrine metaplasia, mild epithelial hyperplasia, adenosis and an increase in fibrous stoma
- Typically multifocal and bilateral
What happens in apocrine metaplasia/what can be seen on histoligally?
- MAture cell type replaced by another cell type
- Normal 2 cell lining of the ducts and lobules replaced by esinophil granules which resemble apocrine sweat glands
What percentage of women have Fibrocystic change?
1/3 20-50 years old (declines after menopause
Does FCC increase the risk of breast cancer?
NO - but can make potentially cancerous lumps harder to identify
What is the increase in risk of developing carcinoma from proliferative breast disease?
- 2 fold without atypia, (5-15 years)
- 5 fold with atypia (patient requires close clinical monitoring)
Describe the changes that lead to breast cancer?
- Normal epithelium
- Proliferative disease without atypia
- Atypical hyperplasia
- DCIS
- Invasive breast cancer
What substance is used in breast magnetic resonance imaging to see vascularity better?
Gadolinium
What is gynaecomastia?
- Hyperplasia of the male breast stromal and ductal tissue
- Usually caused by a relative increase in the estrogen to androgen ratio in the circulation or breast tissue
What is the most common cause of gynaecomastia?
- Secondary to drugs
- OLder patients: CV and prostate drugs
- Younger patients most likely cannabis, anabolic steroids, anti-ulcer drugs and antidepressants
What ages are physiological gynaecomastia present?
- Neonats
- Pubertal
- Senescence
What can be some pathalogical causes of gynaecomastia?
- Undiagnosed hyperprolactinaemia
- Liver failure
- Alcohol excess
- Obesity
- Malignancy (testes, lung)
What are the different types of benign breast tumours?
- Fibroadenoma
- Duct papilloma
- Adenoma
- Connective tissue tumours
What do fibroadenomas look like?
- Well circumscribed and highly mobile
What do fibroadenomas arise from?
breast lobules and are composed of fibrous epithelial tissue
WHat are fibroadenomas clinically hard to differentiate from?
Phyllodes tumours (distinct pathology, malignant)
What are the differences between fibroadenomas and phyllodes tumour?
- Phyllodes tumours are sarcomas which rapidly enlarge and have variable degress of malignant potential
- They are larger than fibroadenomas and tend to occur in an older age grouop
- Fibroadenomas appear as well-defined, smooth, oval-shaped lump, distinctly mobile and easily identified on US
- Young patients (less than 25yrs) with clearly benign clinical and imaging findings are usually spared a core biopsy
- In older patients we have to rule out occult malignany / Phyllodes tumour
