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3rd Year - Reproductive Diseases > 15.3. Breasts - Pathology of Breast Disease > Flashcards

15.3. Breasts - Pathology of Breast Disease Flashcards

1
Q

What are the Benign Breast Conditions?

A
  1. Fibrocystic Change
  2. Fibroadenoma
  3. Intraduct Papilloma
  4. Fat Necrosis
  5. Duct Ectasia
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2
Q

What occurs in Fibrocystic Change?

A
  1. Fibrosis
  2. Adenosis
  3. Cysts
  4. Apocrine Metaplasia
  5. Duct Epithelial Hyperplasia
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3
Q

What is the pathology of Fibroadenoma?

A
  1. Proliferation of Epithelial and Stromal Elements
  2. Ducts Distorted / Elongated
  3. Slit-Like Structures - Intracanalicular Pattern (Ducts not Compressed)
  4. Pericanlicular Growth Pattern
    Note - This is the most common breast Tumour in Adolescent and Young Adult Women
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4
Q

How is a Fibroadenoma described?

A
  1. Well-Circumscribed
  2. Freely Mobile
  3. Non-painful
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5
Q

Other than Fibroadenoma, What other Adenomas can be found in the Breast?

A
  1. Tubular Adenoma - Discrete, Freely Movable Mass (Uniform Size Ducts)
  2. Lactating Adenoma - Enlarging Masses during Lactation / Pregnancy (Prominent Secretory Change)
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6
Q

How does Intraduct Papilloma normally present?

A
  1. Middle Aged Women
  2. Nipple Discharge
  3. Can show Atypia
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7
Q

How does Fat Necrosis of the Breast normally present?

A
  1. Simulate Carcinoma Clinically and Mammographically
  2. History of Antecedent Trauma / Prior Surgical Intervention
  3. Histiocytes with Foamy Cytoplasm
  4. Lipid Filled Cysts
  5. Fibrosis. Calcifications, Egg Shell on Mammography
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8
Q

What is a Phyllodes Tumour?

A

A Benign (Borderline Malignant) Fleshy, Circumscribed, Connective Tissue and Epithelial Tumour with a Leaf-Like Pattern and Cysts on Cut Surface
Note - < 1% of breast tumours
Note - Metastases are Haematogenous

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9
Q

What is the Aetiology / Risk Factors of Breast Cancer?

A
  1. Affects 1 in 8 women (22%) - commonest cause of female cancer death worldwide
  2. Age
  3. Menstrual History / Menarche
  4. Radiation / Hormonal Treatment
  5. Family / Personal History / Genetic Factors
  6. Obesity / Smoking / Alcohol
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10
Q

What genes are related to Breast Cancer?

A
  1. BRCA1 - 20-40%
  2. BRCA2 - 10-30%
  3. TP53 - < 1%
  4. PTEN - < 1%
  5. Other Genes - 30-70%
    Note - 5-10% of breast cancers can be attributed to inherited factors
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11
Q

What are the Histological Types of Non-Invasive Breast Cancer?

A
  1. Ductal Carcinoma in Situ (DCIS)

2. Lobular Carcinoma in Situ (LCIS / LISN)

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12
Q

What are the Histological Types of Invasive Breast Cancer?

A
  1. Invasive Ductal Carcinoma - 85%
  2. Invasive Lobular Carcinoma - 10%
  3. Special Type - 5%
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13
Q

What are the features of an “In Situ” Carcinoma?

A
  1. Pre-Invasive - Does not form a Palpable Tumour
  2. Not detected Clinically - Only X-Rays in DCIS Screening
  3. Multicentricity and Bilaterally - LCIS
  4. No Metastatic Spread (Basement Membrane)
  5. Risk of Invasion depending on Grade:
  6. a) Low Grade DCIS - 30% in 15 years
  7. b) High Grade DCIS - 50% in 8 years
  8. c) LCIS - 19% in 25 Years
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14
Q

What are the Histological Classification of the Special Types (5%) of Invasive Cancers?

A
  1. Tubular Carcinoma
  2. Mucinous Carcinoma
  3. Medullary Carcinoma
    Note - there are others
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15
Q

What are the Diagnostic Procedures for Breast Cancer?

A
  1. Clinical Examination
  2. Radiology
  3. Fine Needle Aspiration (FNA) Cytology
  4. Needle Core Biopsy
  5. Wide Local Excision with Adequate Margins
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16
Q

What is the Screening Procedure for Breast Cancer?

A

Mammogram every 3 years for women 50-70 years old

Note - 30% reduction in mortality

17
Q

What are Microcalcifications?

A

Tiny deposits of Calcium which can appear anywhere in the Breast and often show up on a Mammogram
Note - Most women have 1+ areas and majority are harmless

18
Q

What are the 2 important Mammographic Indicators of Breast Cancers?

A
  1. Masses

2. Microcalcifications - Tiny flecks of Calcium like Grains of Salt

19
Q

What will a Histology Report include?

A
  1. Invasive vs Non-Invasive
  2. Histological Type - Ductal (85%) vs Lobular
  3. Grade - Estimate of aggression under the Microscope
  4. Size
  5. Margins
  6. Lymph Nodes
  7. Oestrogen / Progesterone Receptor (2/3 Positive)
  8. HER-2 / NEU
20
Q

How can Breast Cancer Spread?

A
  1. Local - To Skin / Pectoral Muscles
  2. Lymphatic - Axillary and Internal Mammary Nodes
  3. Haematologically - Bone / Liver / Lungs / Brain
21
Q

What are the indicators of Prognosis?

A
  1. Nottingham Prognostic Index (NPI) - Based on Size / Grade / Nodal Status
  2. Type
  3. Age
  4. Lymphovascular Space Invasion
  5. Oestrogen / Progesterone Receptors / HER-2
    Note - Overall 64% 5-Year Survival
22
Q

What are the Oestrogen / Progesterone Receptors indicate in Breast Cancer?

A

Response to Hormonal Therapies - ER/PR Negative Tumours do not respond

23
Q

What does HER-2 indicate in Breast Cancer?

A

Predicts Response to Trastuzumab (about 20-30% positive)

24
Q

What are the Molecular Classifications of Breast Cancer?

A

Gene Expression, with 5 Subtypes:

  1. Luminal A - Oestrogen Receptor Positive
  2. Luminal B
  3. Basal-Like - Triple Negative
  4. HER-2 Positive
  5. Normal Breast-Like
25
Q

What are the Features / Prevalence of Luminal A Subtype of Breast Cancer?

A 
1. Oestrogen Receptor -
Positive (+/- Progesterone Receptor -
Positive)
2. HER-2 - Negative
3. Low Ki67
Prevalence = 30-70%
26
Q

What are the Features / Prevalence of Luminal B Subtype of Breast Cancer?

A 
1. Oestrogen Receptor - Positive (+/- Progesterone Receptor -
 Positive)
2. a) HER-2 - Positive
2. b) HER-2 - Negative with High Ki67
Prevalence = 10-20%
27
Q

What are the Features / Prevalence of Basal-Like Subtype of Breast Cancer?

A
  1. Oestrogen Receptor Negative
  2. Progesterone Receptor Negative
  3. HER-2 - Negative
    Prevalence = 15-20%
28
Q

What are the Features / Prevalence of HER-2 Subtype of Breast Cancer?

A
  1. Oestrogen Receptor - Negative
  2. Progesterone Receptor - Negative
  3. HER-2 - Positive
    Prevalence - 5-15%
29
Q

How is Breast Cancer managed?

A
  1. Staging
  2. Surgery - Radical Mastectomy / Conserving Surgery / Wide Local Excision (WLE) - +/- Lymph Nodes
  3. Radiotherapy
  4. Anti-Hormone Therapy (Tamoxifen)
  5. Chemotherapy
30
Q

What is the cause of Paget’s Disease of the Nipple?

A

It is a Result of Intraepithelial Spread of Intraductal Carcinoma

31
Q

How does Paget’s Disease present?

A
  1. Large Pale-Staining Cells within the Epidermis
  2. Limited to the Nipple / Extend to the Areola
  3. Pain / Itching
  4. Scaling and Redness
  5. Ulceration / Crusting and Serous / Bloody Discharge if severe
    Note - often mistaken for Eczema
32
Q

What are the 2 Male Pathology’s of the Breast?

A
  1. Gynecomastia - most common Clinical and Pathological Abnormality of the Male Breast
  2. Carcinoma of the Male Breast - <1% of all breast Cancers
33
Q

What is Gynecomastia?

A

Increase in Subareolar Tissue

34
Q

What is Gynecomastia associated with?

A
  1. Hyperthyroidism
  2. Cirrhosis of the Liver
  3. Chronic Renal Failure
  4. Chronic Pulmonary Disease
  5. Hypogonadism
  6. Use of Hormonal Drugs - Oestrogen / Androgen
  7. Use of other Drugs - Digitalis / Cimetidine / Spironolactone

3rd Year - Reproductive Diseases (41 decks)

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