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MD1 - Intersystems > 1. Breast pathology > Flashcards

1. Breast pathology Flashcards

1
Q

What are the rates of breast cancer in males and female

A

Male 1 in 917

Female 1 in 8

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2
Q

Breast is a modified

A

Sweat gland

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3
Q

What are the basic units of the breast?

A

Ducts and lobules

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4
Q

What hormones are the breast tissue responsive to?

A

Oestrogen and Progesterone

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5
Q

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

A
  1. Inner luminal (secretory)
  2. Outer myoepithelial (contractile)

sitting on a basement membrane

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6
Q

What are the types of stroma in breast tissue?

A
  • Loose, cellular intralobular stroma
  • Dense fibrous interlobular stroma
  • Scattered inflammatory cells and fibroblasts
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7
Q

What is the definition of neoplasia?

A

Uncontrolled growth due to acquired genetic mutation or epigenetic modification

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8
Q

What often precedes invasive tumour?

A

Dysplasia

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9
Q

What is the result of invasion?

A

stromal reaction, ulceration and/or haemorrhage

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10
Q

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

A
  1. Proto-oncogenes
  2. Tumour suppressor genes
  3. Apoptosis-regulating genes
  4. DNA repair genes
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11
Q

What are the most common sporadic mutation in breast cancer?

A
  1. Myc (oncogene)
  2. PIK3CA (oncogene)
  3. p53 (tumour-suppressor)
  4. Her2 (growth receptor)
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12
Q

What are the most common inherited mutations?

A
  • BRCA1

- BRCA2

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13
Q

What is the function of Her2?

A

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

  1. Branching of terminal ducts
  2. Invasion into stroma
  3. Hyperplasia
  4. Apoptosis
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14
Q

What is the ligand for Her2?

A

Amphiregulin

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15
Q

What is the mechanism of Her2 cancer?

A

Amplification of the gene

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16
Q

What is BRCA1 and BRCA2?

A

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

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17
Q

What is the penetrance of BRCA1/2?

A

30-90% depending on the mutation

18
Q

What other cancers predispose people with BRCA1/2 mutations?

A

Ovarian, prostatic and pancreatic

19
Q

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

A

3%

20
Q

Why is Oestrogen a risk factor for breat cancer?

A
  • Promotes cell division hence mutation ability

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

21
Q

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

A
  • Young age of menarche (55)
  • Age at first live birth (>30)
  • Pregnancy and breastfeeding is protective
  • Obesity
  • Hormone replacement therapy
22
Q

What is the treatment for hormone sensitive breast cancer?

A
  • Tamoxifen (anti-oestrogen)

- Bilateral oophorectomy

23
Q

When does invasion occur?

A

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

24
Q

What happens after invasion of tumour occurs?

A

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

25
Q

What is the grading of invasive carcinoma of breast?

A
  • Tubule formation
  • Nuclear pleomorphism
  • Mitotic count
26
Q

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

A
  • 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
27
Q

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

A

Ductal carcinoma (75%)

28
Q

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

A

Lobular carcinoma

29
Q

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

A

Her2 amplified

30
Q

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

A

Basal-like or Triple negative carcinoma

31
Q

What is normally found in ductal carcinoma?

A

Dystrophic calcification within the lumen due to necrosis

32
Q

What is desmoplastic stroma?

A

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

33
Q

What does desmoplastic stroma cause macroscopically?

A
  • Formation of palpable mass
  • Altered breast shape
  • Retractio no of nipple
34
Q

What are you looking for in mammogram

A

Calcification

35
Q

What are the distant metastatic sites of breast cancer>

A

Lungs, Liver, Bone, Brain

36
Q

What is Peau d’orange caused by?

A
  • Skin lymphovascular invasion
37
Q

What is Paget’s disease of the nipple?

A

Ductal carcinoma in situ spreading from the large ducts to the skin surface causes destruction

  • Irritation
  • Pain
  • Bleeding
  • Discharge
38
Q

What is Fibrocystic change?

A

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

39
Q

What is Fibroadenoa?

A

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

40
Q

What is Papilloma?

A

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%)

MD1 - Intersystems (7 decks)

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