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9. CP - Diseases of the Reproductive System > (48) Breast pathology > Flashcards

(48) Breast pathology Flashcards

1
Q

The majority of malignancies in the breast arise from which tissue type?

A

Epithelial cells = CARCINOMAS

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2
Q

Malignant tumours from connective tissue cells rarely occur. What are these called?

A

Sarcomas

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3
Q

Many tumours have more fibrous tissue which has what characteristics?

A

Fibrous tissue makes things lumpy/harder and more radio-opaque. (fat is soft and radiolucent)

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4
Q

What are the 3 principal components of the anatomy of the breast?

A
  • fat
  • fibrous connective tissue
  • epithelial tissue

lobes - ducts - nipple

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5
Q

How is younger breast tissue different?

A

More glandular and therefore fibrous - more lumpy, even when benign and radio-dense

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6
Q

Why are mammograms less effective in younger people?

A

As young breast tissue is more lumpy anyway as it is more glandular - USS is better for detecting tumours

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7
Q

What factors increase the risk of breast cancer?

A
  • alcohol
  • oestrogen-progesterone contraceptives/menopausal therapy
  • x-ray/gamma radiation
  • body fat
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8
Q

What factors decrease the risk of breast cancer?

A
  • breastfeeding

- (physical activity)

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9
Q

Who does the NHS breast screening programme target?

A
  • all women aged 50 and over
  • free breast screening every 3 years
  • for some areas, screening is extended to cover ages 47-73
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10
Q

Has the NHS breast screening programme been effective?

A
  • lowered mortality rates from breast cancer in the 55-69 age group
  • benefits of mammographic screening is greater than harm in terms of over diagnosis
  • 2-2.5 lives saved for every overdiagnosed case
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11
Q

Is fibrocystic change in the breast always pathological?

A

So common as to be almost physiological - can mimic cancer both clinically and pathologically

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12
Q

How does breast disease present?

A
  • lumps
  • puckered skin/indrawn nipple
  • pain
  • inflammation/infection
  • nipple discharge
  • abnormal/sore nipple
  • radiology/screening
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13
Q

What is the “triple assessment” of breast abnormality?

A
  • all breast lumps should be considered in 3 parameters
    1. clinical (examination and palpation)
    2. radiological (look for calcifications)
    3. pathological (cytology or histopathology)
  • the results of all these need to be triangulated at an MDT meeting
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14
Q

If suspicious calcifications or a mass is found, what needs to be done?

A

It will need to be biopsied to permit the pathologist to make a diagnosis

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15
Q

How can normal breast tissue be described histologically?

A

Very organised

lots of “little villages” connected by roads

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16
Q

How can invasive breast tumours be described histologically?

A

Irregular disorganised margins of invasive tumours, high grade tumours might get rounded edge due to fast growth

uncontained, untidy

“urban sprawl”

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17
Q

What procedure should happen in any breast lump?

A

Triple assessment

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18
Q

What type of genes are BRCA genes?

A

Tumour suppressor genes - mutation causes lack of function

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19
Q

Biopsies are graded using the “B” grading system. What is this?

A 
B1 = unsatisfactory
B2 = benign lesion
B3 = atypical probably benign
B4 = atypical probably malignant 
B5a = malignant, in-situ
B5b = malignant, invasive
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20
Q

What are fibroadenomas?

A

Fibroepithelial neoplasms in which there is coordinated growth of the glandular and connective tissue (stromal) element “breast mice” - benign

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21
Q

How do fibroadenomas present?

A

They are common and present as mobile lumps or radiological masses

  • painless
  • firm
  • solitary
  • mobile
  • slowly-growing
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22
Q

Are fibroadenomas are cause for concern?

A

Should be biopsied but if confirmed to be fibroadenoma by biopsy then can be left alone as they are benign

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23
Q

What are phyllodes tumours?

A

Rare fibroepithelial neoplasm which forms a spectrum of lesions - at one end are lesions very similar to fibroadenomas, other end very aggressive and malignant

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24
Q

What do the more aggressive phyllodes tumours show?

A

Overgrowth of the stromal element, which in some cases might be frankly sarcomatous

25
Q

If a tumour is seen histologically to be invading into the fat, is it benign or malignant?

A

Malignant

26
Q

If a tumour is seen histologically to have sharp edges and not infiltrating, is it benign or malignant?

A

Benign

27
Q

Name some benign reasons for lumps

A
  • physiological
  • lipoma
  • fibroadenoma
  • fibrocystic change
28
Q

Which type of breast lump may be either benign or malignant?

A

Phyllodes tumour (rare, extremely rarely they may be malignant)

29
Q

Malignant breast lumps can exist in which two states?

A
  • in situ

- invasive

30
Q

What constitutes fibrocystic change?

A

A constellation of changes - includes usual type ductal hyperplasia, apocrine metaplasia and cysts

31
Q

How does fibrocystic change present?

A
  • may present as a lump
  • may be associated with microcalcifications
  • can therefore be tricky for histopathologist to interpret correctly in rare cases and limited samples
32
Q

If fibrocystic chance a precursor for breast cancer?

A

May share risk factors e.g. oestrogen exposure, but probably not a precursor

33
Q

What is the different between benign and malignant breast tumours in terms of macroscopic appearance?

A

Benign = generally expansile and do not invade, leading to a rounded border

Malignant = typically invasive, irregularly take over adjacent tissues

34
Q

What causes the puckered skin/indrawn nipple in breast cancer?

A
  • tumour cells interact with carcinoma-associated fibroblasts
  • fibroblasts contract = retract the nipple
35
Q

What causes the Peau d’orange sign?

A

Caused by a cancer blocking up all the lymphatic capillaries leading to oedema - but tethered where the sweat glands are

36
Q

What may cause inflammation/infection in the breast?

A
  • mastitis during breast feeding
  • breast abscesses and fistulae
  • TB
  • carcinoma/sarcomas
37
Q

What may cause nipple discharge or abnormal/sore nipple?

A
  • duct ectasia
  • intraductal papilloma
  • in-situ papillary carcinoma
  • intracystic papillary carcinoma
38
Q

What is duct ectasia?

A

A condition in which the lactiferous duct becomes blocked or clogged. This is the most common cause of greenish discharge.

39
Q

What is a papilloma?

A

A small wart-like growth on the skin or on a mucous membrane, derived from the epidermis and usually benign

40
Q

What is Paget’s disease of the nipple?

A

A malignant condition that outwardly may have the appearance of eczema, with skin changes involving the nipple of the breast - a consequence of cancer cells growing into the skin of the nipple

41
Q

Pain in the breast is an uncommon way for carcinoma to present and is difficult to treat. It can be cyclical, what does this mean?

A

Related to the menstrual cycle

42
Q

How are breast cancers radiologically detected?

A
  • opacities - as for lumps

- calcifications (character indicates specific disease)

43
Q

Cancers may be associated with formation of calcium crystals. How does this appear?

A

Reddish-purple coloured on histology

44
Q

Why is a biopsy of a calcification difficult to take?

A

As the calcification cannot be felt (especially if detected be breast screening) - a guide wire will need to be inserted to assist the surgeon in removing the right bit

45
Q

What should a path report tell you about malignancy?

A
  • in-situ or invasive
  • type
  • grade
  • size
  • vascular invasion
  • nodal status
  • relationship to margins
  • ER, PR, HER2 status
46
Q

Can you have in situ carcinoma and invasive cancer at the same time?

A

Yes

47
Q

What does DCIS stand for?

A

Ductal carcinoma in situ

48
Q

Is there a need to remove lymph nodes in in-situ carcinoma?

A

No

49
Q

What are the main recognised types of breast carcinoma?

A
  • ductal (everything else) - 75%
  • lobular 12%
  • tubular/cribriform 3%
  • medullary 3%
  • mucoid 2%
  • metaplastic 1%
  • others 4%
50
Q

How does mucinous carcinoma appear on histology?

A

Lots of white bits which is the jelly-like mucin produced by the tumour cells

51
Q

How does lobular carcinoma appear on histology?

A

‘Indian files’ of cancer cells

52
Q

Most cancers don’t fall into a recognisable type. So what is more important?

A

Grading

53
Q

Give a main difference between a grade III and a grade I cancer?

A

More mitotic figures etc.

54
Q

How does grade (1, 2 or 3) affect survival?

A

Higher grade, lower survival

55
Q

How is ‘grade’ different from ‘stage’?

A

Grade = the intrinsic biology, how quickly it is able to progress potentially

Stage = how far it has got at the time of diagnosis

56
Q

Nodal status and size of mass is a key indicator of what?

A

Stage

57
Q

What is the Nottingham prognostic index?

A

Grade + nodal status (0 = score 1, 1-3 = score 2, 4 or more = score 3) + 0.2 x tumour size

  1. 4 or less = good, 80% + 16yr survival
  2. 41-5.4 = moderate, 46%
  3. 41+ = poor, 10%
58
Q

What is important about knowing if a tumour is ER +ve (oestrogen receptor positive)?

A

It will response to oestrogen-targetting agents eg. Tamoxifen

59
Q

Which drug will cause a response in cancers that have overexpression of HER2 gene?

A

Herceptin

9. CP - Diseases of the Reproductive System (5 decks)

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