Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MD3002 Week 11 > 2. Female Reproductive pathology 1 > Flashcards

2. Female Reproductive pathology 1 Flashcards

1
Q

Examples of benign breast diseases that present as lesions?

A

Developmental abnormalities
Inflammatory lesions
Epithelial and stromal proliferations
Neoplasms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Surgical alternatives to diagnosing benign breast disease?

A

Mammography
Ultrasound
MRI
Needle biopsies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Use of U/S in assessing breast lumps?

A

Benign:

  • Oval/ellipsoid
  • Wider> deeper
  • Smooth/thin margins

Malignant:

  • Variable shape
  • Deeper> wide
  • Irregular/spiculated margins
  • Other: Calcification, microlobulation, intraductal extension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Difference between normal and malignant cells on cytology?

A

Normal:

  • Large cytoplasm
  • Single nucleus
  • Single nucleolus
  • Fine chromatin

Cancer:

  • Small cytoplasm
  • Multiple nuclei
  • Multiple and large nucleoli
  • Coarse chromatin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Adolescent breast histology?

A

Large and intermediate-size ducts are seen within a dense fibrous stroma.
No lobular units are present.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Postpubertal breast histology?

A

The terminal duct lobular unit consists of small ductules arrayed around an intralobular duct.
The two-cell-layered epithelium shows no secretory or mitotic activity.
The intralobular stroma is dense and confluent with the interlobular stroma.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Lactating breast histology?

A

The terminal duct lobular units are conspicuously enlarged, with inapparent interlobular and intralobular stroma.
The individual terminal ducts, now termed acini, show prominent epithelial secretory activity (cytoplasmic vacuolization).
The acinar lumina contain secretory material.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Postmenopausal breast histology?

A

The terminal duct lobular units are absent. The remaining intermediate ducts and larger ducts are commonly dilated.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the Fibrocystic change?

A 
FCC
An exaggerated physiological response 
A non-proliferative change that includes:
-Gross and microscopic cysts
-Apocrine metaplasia
-Mild epithelial hyperplasia
-Adenosis 
-Increase in fibrous stroma

Typically bilateral and multifocal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Relationship between FCC and breast cancer?

A

FCC doesn’t increase the risk of getting breast
cancer, but it can make it more difficult to identify potentially cancerous lumps during breast examination and on mammograms.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is proliferative breast disease?

A

Proliferative disease without atypia entails a 2 fold increased risk of developing carcinoma over 5–15 years and is classified simply as proliferative breast disease.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Proliferative lesions with atypia involve …..

A

even greater relative risk (5 fold). Such patients require close clinical monitoring.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Breast cacinogenesis?

A 
Normal epithelium -->
Proliferative disease without atypia -->
Atypical hyperplasia -->
DCIS -->
Invasive breast cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is gynaecomastia?

A

Hyperplasia of the male breast stromal and ductal tissue.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Causes of gynaecomastia?

A
  1. Relative increase in oestrogen to androgen ratio in circulation or breast tissue
  2. Secondary to drugs.
    - Older patients; CV and prostate drugs
    - Younger patients: Cannabis, anabolic steroids, anti-ulcer drugs and antidepressants
  3. Physiological and present spontaneously in a trimodal age pattern (neonates, pubertal and senescence). Self limited cases
  4. Pathological e.g. undiagnosed hyperprolactinaemia, liver failure, alcohol excess, obesity and malignancy of testes and lung
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Name 4 benign breast tumours?

A

Fibroadenoma
Duct papilloma
Adenoma
Connective tissue tumour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Fibroadenomas:

  • Arise from?
  • Composition?
  • Features?
  • Clinical presentation?
A
  • Fibroadenomas arise from breast lobules and are composed of fibrous and epithelial tissue.
  • They are well circumscribed and highly mobile, because of the encapsulation and pliability of young breast tissue.
  • Clinically, fibroadenomas are difficult to differentiate from Phyllodes Tumours, which is a distinct pathology.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How to differentiate between fibroadenomas and Phyllode tumours?

A
  • Phyllodes tumours are sarcomas which rapidly enlarge and have variable degrees of malignant potential.
  • They are larger than fibroadenomas and tend to occur in an older age group (15-20 years later).
  • Fibroadenomas appear as a well-defined, smooth, oval- shaped lump, distinctly mobile and easily identified on ultrasound.
  • Young patients (less than 25 years) with clearly benign clinical and imaging findings are usually spared a core biopsy.
  • In older patients we have to rule out occult malignancy / Phyllodes tumour.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Difference between FCC and fibroadenoma?

A

FCC:

  • Most common benign condition of the breast
  • May be painful
  • Needle aspiration demonstrates straw-coloured / green fluid

Fibroadenoma:

  • Benign solid tumour containing glandular and fibrous tissue
  • Typically a painless, well-circumscribed round and mobile mass
  • More biopsy may be recommended
  • Can be followed clinical or surgically excised
20
Q

Presentation of fat necrosis in the breast?

A

Soft, indistict lump that develops a few weeks after a traumatic incident and often in older women with fatty breasts.
On imaging, difficult to distinguish from breast cancer so a core biopsy is needed.

21
Q

Epidemiology of breast cancer?

A

20% of all cancers in women
Commonest cause of death in women in 35-55 age group.
Commonest cancer in the UK (except scotland.. lung cancer)

22
Q

Main risk factors for breast cancer?

A 
Alcohol
Oestrogen-progesterone contraceptives 
HRT for menopause
X-radiation and gamma radiation
Body fatness
Adult attained height 
Smoking

Reduces risk: Breastfeeding and PA

23
Q

What are the two forms of non-invasive precursors?

A

Ductal carcinoma in situ (often unilateral)

Lobular carcinoma in situ (often bilateral)

24
Q

Features of high-grade (poorly differentiated) DCIS?

A

Breast duct filled with atypical, crowded cells with a high mitotic rate and areas of apoptosis
The lumen of the duct is filled with dead cells, inflammatory cells and fine calcium granules
There is no invasion of cells beyond the duct

25
Q

What is the more common type of invasive carcinoma?

A

“No special type” (75-90%)

Also infiltrating lobular carcinoma (10%)

26
Q

What is Paget’s disease of the nipple?

A

Leads to erosion of the nipple that resembles eczema

Associated with underlying in situ or invasive carcinoma

27
Q

What are the prognostic factors for breast cancer?

A 
Tumour type
Tumour grade (A)
Tumour stage: Size, metastasise to nodes (B), other metastases
Oestrogen receptor (C)
HER-2 amplification
28
Q

What 4 interventions have improved the prognosis for women with breast cancer?

A

Better diagnosis
Improved treatments
Screening programmes
Public awareness

29
Q

What are the screening strategies for breast cancer?

A
  • Breast self examination
  • Clinical breast examination
  • Mammography (Mainly post-menopausal)
  • Ultrasonography
  • Magnetic Resonance Imaging (MRI)

The NHS Breast Screening Programme invites all women aged between 50 and 70 for screening every 3 years.

30
Q

What is the different NICE recommendations for women with mutation related to breast cancer?

A

Yearly MRI scans from:

  • Age 20 for women with TP53 mutation
  • Age 30 for women with BRCA1 or BRCA2 mutation
31
Q

Urgent referral for suspected breast cancer when..

A

• aged 30 and over and have an unexplained breast lump with or without pain
• aged 30 and over with an unexplained lump in the axilla
• with skin changes that suggest breast cancer
• aged 50 and over with any of the following symptoms in
one nipple only: discharge / retraction / other changes of concern.

(Consider non-urgent referral in people aged under 30 with an unexplained breast lump with or without pain.)

32
Q

Signs for suspected breast cancer?

A 
Lump
Pulled in nipple
Dimpling
Dripping
Redness/rash
Skin changes
33
Q

Diagnosis of the following presentations in breast:

  1. Mobile single lump?
  2. Ill defined lump(s) or lumpy areas- cyclical pain
  3. Firm lump (fixed) and tethering
A
  1. Fibroadenoma / Phyllodes tumour (older)
  2. Fibrocystic change
  3. Carcinoma / Fat necrosis (older)
34
Q

Diagnosis for the following nipple discharge characteristics:

  1. Clear/pus
  2. Bloody
  3. Nipple ulceration, eczema
A
  1. Clear/pus: Duct ectasia
  2. Bloody: Duct papilloma, in situ carcinoma (older)
  3. Nipple ulceration,eczema: Nipple adenoma, Paget’s disease (older)
35
Q

What is the commonest cervical squamous neoplasia?
Main etiological factor?
Immune modulation?

A

Commonest cervical cancer that is an invasive tumour of epithelial origin with squamous differentiation
Human papillomavirus main aetiological factor
Immune modulation: smoking, HIV infection

36
Q

Pre-invasive phase of cervical squamous neoplasia, detected by…

A

Cervical cytology via:

  • pap test
  • liquid based cytology (LBC)
  • Large loop excision of transformation zone (LLETZ)
37
Q

Grading of pre-invasive cervical squamous neoplasia?

A

Bethesda classification:
- ‘Low grade squamous intraepithelial
neoplasia’ LSIL versus ‘high grade’ HSIL
- Cervical intraepithelial neoplasia (CIN)
grades 1 to 3 (2 and 3 correspond to HSIL)

38
Q

How does HPV cause cervical cancer?

A

STI –>
• If infection is persistent the virus may incorporate its DNA into the host cell’s genome.
• Once incorporated, the production of viral oncoproteins can go on unchecked, and the host’s genes that suppress tumours (p53 and pRb) can be inactivated.
• Damaged DNA is replicated without being checked and repaired, and malignantly transformed cells proliferate uncontrollably.

39
Q

Screening and intervention strategies for cervical cancer?

A
  • Cytology :Spatula, Cytobrush, Glass slide, Liquid based
  • HPV detection (16, 18, others)
  • Visual inspection with acetic acid or iodine
  • Vaccination!
  • Colposcopy and biopsy
  • Local excision (‘large loop excision’)
  • Cryotherapy
40
Q

Name an invasive cervical cancer?

Symptoms?

A

Adenocarcinoma

Symptoms: Post coital bleeding, many asymptomatic in early stages

41
Q

Meaning of:

SIL and CIN?

A 
SIL= Squamous intraepithelial lesions
CIN= Cervical intraepithelial neoplasia
42
Q

Progression of LSIL to invasive cancer?

A

70% percent of cases of LSIL (CIN 1) regress, 6% progress to HSIL (CIN 2 & 3) and less than 1% become invasive cancer.

43
Q

Progression of HSIL to invasive cancer?

A

Progression of HSIL (CIN 2 & 3) to invasive squamous carcinoma occurs with greater frequency and over a shorter interval, but the exact figures vary with intervening management.
10% to 20% of cases of HSIL (CIN 2 & 3) progress to invasive carcinoma if untreated.

44
Q

SIL and CIN??

A 
SIL = CIN
LSIL = CIN 1
HSIL = CIN 2 + 3
45
Q

Treated of cervical tumours?

A

Localised = Radical hysterectomy

More advanced= Radiation therapy +/ hysterectomy

MD3002 Week 11 (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions