48 Breast pathology

Question 1

What are the majority of breast cell malignancies?

Answer 1

Carcinomas.

Question 2

How are breasts of younger people different to older people?

Clinical significance?

Answer 2

More glandular and fibrous - more lumpy.

Mammograms and palpation less good at finding tumours in younger people.

Question 3

Name three factors that decrease the risk of breast cancer:

Answer 3

Breast feeding.
Physical activity.
Body fatness (pre-menopausal only).

Question 4

What are the risk factors of breast cancer? (12).

Answer 4

Alcohol.
Oestrogen-Progesterone medication.
Diethylstilbestrol.
Radiation.
Body fatness (post-menopausal only).
Shiftwork.
Height.
Baby birth weight. (pre-menopausal only).
Digoxin.
Tobacco.
Female.
Long interval between menarche + menopause.

Question 5

Who is eligible for breast screening?

Frequency of screening?

Answer 5

Women aged 43 to 73.

Every 3 years.

Question 6

What is the triple assessment for breast screening?

Answer 6

Clinical: exam + palpation.
Radiological.
Pathology: histopathology or cytology.

Question 7

How are breast biopsies graded? (5)

Answer 7

1. normal.
2. benign lesion.
3. atypical probably benign.
4. atypical probably malignant.
5. malignant.

Question 8

What is a fibroadenoma?

How do they present?

Answer 8

Benign fibroepithelial neoplasms with coordinated growth of glandular and connective tissue.
Mobile lumps.

Question 9

What is a phyllodes tumour?

How do they present?

Answer 9

Rare fibroepithelial neoplasm.
Spectrum from fibroadenoma to overgrowth of stomal element which may be sarcomatous.
Discrete lump.

Question 10

What is fibrocystic change of the breast? (3).

Answer 10

Constellation of:
Ductal hyperplasia
Apocrine metaplasia
Cysts

Question 11

How does fibrocystic change present? (2).

Answer 11

Lump.

Micro calcifications.

Question 12

How is fibrocystic change related to breast cancer?

Answer 12

Very common - almost physiological.
Oestrogen is shared exposure.
Probably not a precursor.

Question 13

What is peau d’orange and why does it occur with breast cancer? (2).

Answer 13

Puckered appearance of the skin.

Fat necrosis. Tumour cells interact with fibroblasts causing contraction.

Question 14

What are the causes of breast inflammation? (4).

Answer 14

Mastitis during breast feeding.
Breast abscesses and fistula.
TB.
Sarcomas/carcinomas.

Question 15

What are the causes of nipple duct discharge? (4)

Answer 15

Duct ectasia.
Intraductal papilloma.
In situ papillary carcinoma.
Intracystic papillary carcinoma.

Question 16

Which prognostic score is used for breast cancer?

Answer 16

Nottingham prognostic index.

Question 17

What is a duct papilloma of the breast?

Presentation?

Answer 17

Benign solitary lesion occurring in large ducts.

Blood stained nipple discharge.

Question 18

What is the aetiology of breast cancer?

Answer 18

Overexposure to oestrogen.

Underexposure to progesterone.