1. Breast pathology Flashcards by Arkie A

What are the rates of breast cancer in males and female

Male 1 in 917

Female 1 in 8

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Breast is a modified

Sweat gland

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What are the basic units of the breast?

Ducts and lobules

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What hormones are the breast tissue responsive to?

Oestrogen and Progesterone

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What are the two layers of epithelium in the breast tissue?

Inner luminal (secretory)
Outer myoepithelial (contractile)

sitting on a basement membrane

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What are the types of stroma in breast tissue?

Loose, cellular intralobular stroma
Dense fibrous interlobular stroma
Scattered inflammatory cells and fibroblasts

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What is the definition of neoplasia?

Uncontrolled growth due to acquired genetic mutation or epigenetic modification

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What often precedes invasive tumour?

Dysplasia

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What is the result of invasion?

stromal reaction, ulceration and/or haemorrhage

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What are the four classes of regulatory genes that play a role in cancer?

Proto-oncogenes
Tumour suppressor genes
Apoptosis-regulating genes
DNA repair genes

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What are the most common sporadic mutation in breast cancer?

Myc (oncogene)
PIK3CA (oncogene)
p53 (tumour-suppressor)
Her2 (growth receptor)

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What are the most common inherited mutations?

BRCA1

- BRCA2

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What is the function of Her2?

It is an epidermal growth factor receptor with normal function in breast tissue during puberty

Branching of terminal ducts
Invasion into stroma
Hyperplasia
Apoptosis

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What is the ligand for Her2?

Amphiregulin

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What is the mechanism of Her2 cancer?

Amplification of the gene

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What is BRCA1 and BRCA2?

Proteins that form a tumour suppressor complex, important for DNA repair and regulating cell cycle following DNA damage

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What is the penetrance of BRCA1/2?

30-90% depending on the mutation

What other cancers predispose people with BRCA1/2 mutations?

Ovarian, prostatic and pancreatic

What is the %age of breast cancers due to single gene familial mutation?

Why is Oestrogen a risk factor for breat cancer?

Promotes cell division hence mutation ability

- Cancers that are hormone responsive can be treated with Anti-oestrogen (Tamoxifen)

What are the risk factors outside of gene mutation for breast cancer?

Young age of menarche (55)
Age at first live birth (>30)
Pregnancy and breastfeeding is protective
Obesity
Hormone replacement therapy

What is the treatment for hormone sensitive breast cancer?

Tamoxifen (anti-oestrogen)

- Bilateral oophorectomy

When does invasion occur?

When tumour grows through the basement membrane and loses the second layer of cells

What happens after invasion of tumour occurs?

Tumours will attempt to recreate ducts/acini, forming ounded structures (called tubules)

What is the grading of invasive carcinoma of breast?

- Tubule formation - Nuclear pleomorphism - Mitotic count

How does E-cadherin play a role in invasive carcinoma?

- E-cadherin is a adhesion molecule - Interacts with epidermal growth factor receptors to suppress cell proliferation - Normally present in epithelium - Loss of this gene promotes motility, invasiveness and metastasis

What is the name of the change associated with sporadic mutations leading to invasive carcinoma without E-cadherin mutation?

Ductal carcinoma (75%)

What is the name of the change associated with sporadic mutations leading to invasive carcinoma + E-cadherin muttion

Lobular carcinoma

What is the change associated with Her2amplification leading to invasive carcinoma?

Her2 amplified

What is the change associated with inherited mutation of BRCA1/2 + sporadic second hit mutation?

Basal-like or Triple negative carcinoma

What is normally found in ductal carcinoma?

Dystrophic calcification within the lumen due to necrosis

What is desmoplastic stroma?

When a tumour invade there is a reactive proliferation of fibroblast and collagen

What does desmoplastic stroma cause macroscopically?

- Formation of palpable mass - Altered breast shape - Retractio no of nipple

What are you looking for in mammogram

Calcification

What are the distant metastatic sites of breast cancer>

Lungs, Liver, Bone, Brain

What is Peau d'orange caused by?

- Skin lymphovascular invasion

What is Paget's disease of the nipple?

Ductal carcinoma in situ spreading from the large ducts to the skin surface causes destruction - Irritation - Pain - Bleeding - Discharge

What is Fibrocystic change?

Clinical = Lumpiness of breast tissue Imaging = Increased density of tissue with possible cysts and calficication Histopatho = Cysts, fibrosis, increased number of acini (adnenosis) and metaplasia No atypia/Dysplasia No increased risk of developing invasive carcinoma

What is Fibroadenoa?

Breast mouse! - Affects 20-30yo Clinical = Mobile, rounded and smooth on palpation Imaging = Rounded density, my show calcification Histopathology = Proliferation of benign intralobular stroma and epithelium with a smooth border. no typia No increased risk of developing invasive carcinoma

What is Papilloma?

Clinical = Bleeding/dischage around nipple and a palpable lump Imaging = Radiodensty, may show calcification Histo = Branching/Treelike proliferation of the epithelium within a large duct, both myoepithelial and epithelial present no atypia Small increase in developing invasive carcinoma (1.5-2%)