11.2 Breast Disease Flashcards
What is the breast made up of made up of?
15-24 lobulated masses
Lobules are stroma with many acini. The acini are made up of cuboidal cells surrounded by myoepithelium which can contract.
How does the breast change at puberty?
Increased number of lobules
Increased stroma
How does the breast change within a menstrual cycle?
Follicular phase- lobules inactive
After ovulation- cell proliferation and stromal oedema
Menstruation- decreased size of lobules
How does the breast change in pregnancy?
Increased size
Increased number of lobules
Decrease in stroma
Secretory changes
How does the breast change postmenopause?
Decreased size
Decreased number of lobules
Intralobular stroma replaced with adipose tissue
What type of mass is worrying to find in the breast?
Craggy, fixed, hard
What may milky breast discharge be a symptom of?
Endocrine disorder
Side effect of medication
What may bloody breast discharge be a symptom of?
Benign lesions
Duct ectasia
What is a worrying mammogram finding?
Calcifications
Densities
What is the most common benign breast tumour?
Fibroadenoma
What is polythelia?
More than 2 nipples
Can appear anywhere in milk line
What is acute mastitis?
Occurs during lactation
Usually S. aureus infection from nipple cracks
How does acute mastitis present?
Painful breast
Pyrexia
Breast abscesses
Who is at risk of fat necrosis presenting in the breast?
Recent trauma or surgery
How does a benign epithelial lesion present?
Presents as a mass or mammographic abnormality
How does a fibroadenoma present?
Mobile, elusive mass (breast mouse)
What does a fibroadenoma look like macroscopically?
Rubbery, greyish-white, well-circumcised
What does a phyllodes tumour look like?
Nodule of proliferating stroma covered by epithelium
What is gynaecomastia?
Enlargement of male breast
What causes gynaecomastia?
Puberty- oestrogen levels peak before testosterone
Oestrogen excess- liver cirrhosis
Gonadotrophin excess- testicular tumour
Drug-related- spironolactone, alcohol
Klinefelter syndrome- XXY not enough testosterone
What are some risk factors of breast cancer?
Female Long oestrogen exposure Exogenous oestrogen Previous breast cancer Geography
What is an in situ carcinoma?
Neoplastic population of cells limited to ducts and lobules by the basement membrane.
Myoepithelial cells of acini are maintained.
Vessels not invaded.
No metastases
How does DCIS present?
Mammographic calcifications or a mass
What does DCIS look like histologically?
Central necrosis with calcification
How does Paget’s disease present?
Neoplastic cells spread to nipple skin without crossing basement membrane. Presents with unilateral red and crusting nipple.
What is an invasive carcinoma?
Neoplastic cells invade beyond basement membrane and into stroma.
Can invade vessels
Metastasise to other sites
What is peau d’orange?
Lymphatic drainage of the skin of the breast is compromised so hairs retract and skin turns orange colour
How does invasive ductal carcinoma present histologically?
Atypical cells lining tubules
Poorly-differentiated
Where does invasive lobular carcinoma spread to?
Peritoneum Retroperitoneum GI Tract Ovaries Uterus
Where do breast cancers often spread to?
Lymph nodes Bones Liver Lungs Brain
What are the aims of mammographic screening?
Detect small impalpable tumours and pre-invasive cancers
Looks for densities, calcifications and parenchymal abnormalities
Who is eligible for mammographcic screening?
Women aged 47-73
Done every 3 years
What surgery can be done to eliminate breast cancer?
Massectomy
Breast-conserving surgery
Axillary dissection
Sentinel lymph node biopsy
What is Herceptin?
Drug containing antibodies against the Her2 protein
How can survival rates of breast cancer be improved?
Early detection Neoadjuvent chemotherapy New therapies- herceptin Gene expression profiling Prevent familial cases
