Benign and Malignant Breast Disease

Question 1

Describe the breast screening program and what is done is there is a positive screen

Answer 1

Targets 50 - 74y.o. women.
Mammogram every two years.

Positive screen - triple test: Clinical, radiological and pathological exam

Question 2

What abnormalities can be found on a breast mammogram?

Answer 2

• Densities/masses
• Distortions
• Calcification

Question 3

What abnormalities can be found on an ultrasound of the beast?

What is the advantage/disadvantage vs mammogram?

Answer 3

• Cysts
• Masses

Not good at detecting calcifications or distortions

Question 4

Symptomatic presentation of benign breast disease?

Answer 4

• Mass/lump
• Pain
• NIpple changes/discharges
• Skin changes

Question 5

How does risk of breast malignancy vary according to age?

Answer 5

6% <40

70% >50

Question 6

Three nipple symptoms:

Answer 6

• Galactorrhoea (increased fluid production)
• Discharge (serous/bloody)
• Crusting/itching

Question 7

4 types of inflammatory breast disease:

Answer 7

• Acute mastitis
• Sub-areola abscess
• Mammary duct ectasia
• Fat necrosis

Question 8

What is SMOLD?

Answer 8

Squamous metaplasia of lactiferous ducts (SMOLD) caused by obstruction/dilation.

Question 9

What risk factor is sub-areolar abscesses (SMOLD) associated with?

Answer 9

Smoking - 90% of cases are smokers

Question 10

List the 3 inflammatory breast disease that present with hot, red, swollen mass?

Answer 10

Acute mastitis

Sub-areolar abscess

Mammary duct ectasia

Question 11

What is the name given to non-neoplastic change in breast epithelium?

Answer 11

Non-proliferative fibrocystic change

Question 12

How are proliferative benign breast diseases classed?

Answer 12

As epithelial, stromal, or mixed elements of both.

Question 13

What are the two types of epithalil proliferation benign breast disease?

How are they classed?

Answer 13

Epithelial hyperplasia

Columnar cell change

Both are classed based on atypia.

Question 14

What is the stroma-only proliferative breast disease?

Answer 14

PASH - Pseudoangiomatous stromal hyperplasia.

Question 15

What are the 4 types of proliferative breast disease that involve both epithelia and stroma?

Answer 15

• Sclerosing adenosis
• Complex sclerosing lesion
• Papilloma
• Fibroadenoma

Question 16

What is breast carcinoma in situ and how is it classed?

Answer 16

In situ = malignant cells confined by an anatomical structure.

In this case, they are confined to the ductal lobular system without invasion.

Classification:

• Ductal (DCIS)
• Lobular (LCIS)

Question 17

Site and treatment differences in DCIS vs LCIS?

Answer 17

DCIS = confined to ducts

LCIS = confined to lobes

DCIS management = surgigcal excision with clear margins

LCIS management = excision at surgical margins

Question 18

Loss of which protein expression is hallmark of LCIS?

Answer 18

E-cadherin

Question 19

Which disease is strongly associated with DCIS, with red, weeping eczematous nipple?

How is it treated?

Answer 19

Paget’s disease.

Treated the same as DCIS.

Question 20

What are the prevalence of different types of invasive breast cancer?

Answer 20

Invasice ductal carcinoma (80%)

Invasive lobar carcinoma (10%)

Question 21

What are the rare types (2 each) with good and bad prognosis?

Answer 21

Good:

• Mucinous
• Tubular

Bad:

• Micropapillary
• Basal

Question 22

How is invasive breast cancer graded?

Answer 22

Nottingham grade:

Score/3 for:

• Tubule formation
• Nuclear atypia
• Mitotic rate

SUmmed.

Question 23

Which biomarkers should be chekced in invasive breast cancer?

Answer 23

ER (estrogen receptor)
PR (progesterone receptor)

HER2 receptor

Question 24

Why is activation of ER/PR/HER2 significant in breast cancer?

How is it predictive for treatment?

Answer 24

These receptors give overexpressing malignant cells a growth advantage

ER+/PR+ responds better to anti-oestrogen therapy.

HER2+ = poor prognosis, HER2- is good. Strong predictor of anti-HER2 therapy.