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Histo path > Breast > Flashcards

Breast Flashcards

1
Q

What does the ‘triple test’ for investigation of breast cancer involve?

A

Clinical examination

Imaging (sonography, mammography, MRI)- MRI tends to only be used for very small lesions that may be missed by US or mammography

Pathology (cytopathology and/or histopathology) – either FNA or core biopsy

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2
Q

Cell aspirates are coded C1-5 for cytopathology to investigate nipple discharge and palpable lumps. What are the 5 codes?

A 
C1 = inadequate 
C2 = benign
C3 = atypia, probably benign
C4 = atypia, probably malignant
C5 = malignant
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3
Q

Histology is the gold standard for breast cancer diagnosis. What stain is used for these samples from core biopsies/surgical excisions?

A

H&E

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4
Q

List 3 benign, inflammatory breast conditions

A

Duct ectasia, acute mastitis, fat necrosis

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5
Q

What is duct ectasia?

A

Inflammation and dilatation of large breast ducts

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6
Q

Presentation of duct ectasia

A

Usually presents with nipple discharge

May cause breast pain, breast mass and nipple retraction

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7
Q

Cytology vs histology of duct ectasia

A

Cytology: proteinaceous material and neutrophils ONLY

Histology:
Duct distension with proteinaceous material in it
Foamy macrophages

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8
Q

What is acute mastitis?

A

Inflammation of the breast, usually seen in breastfeeding women
Staph

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9
Q

Presentation and management of acute mastitis

A

Presentation: painful (tender), red breast

Treatment: drainage and antibiotics

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10
Q

Cytology of acute mastitis

A

Neutrophils

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11
Q

What is fat necrosis?

A

An inflammatory reaction to damaged adipose tissue caused by surgery/trauma/radiotherapy

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12
Q

Presentation of fat necrosis

A

Breast mass

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13
Q

Cytology of fat necrosis

A

Fat cells surrounded by macrophages

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14
Q

List 5 benign, non-inflammatory breast conditions

A

Fibrocystic disease, fibroadenoma, phyllodes tumour, intraductal papilloma, radial scar

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15
Q

Presentation of fibrocystic disease

A

Breast lumps

VERY common

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16
Q

What is fibrocystic disease?

A

Group of alterations which reflect normal, albeit exaggerated, responses to hormonal influences

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17
Q

Histology of fibrocystic disease

A

Ducts dilated; ducts calcified (seen on mammogram)

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18
Q

What is a fibroadenoma?

A

Benign fibroepithelial neoplasm of breast

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19
Q

Presentation of fibroadenoma

A

Well circumscribed mobile breast lump [young women; 20-30yo]

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20
Q

Histology of fibroadenoma

A

Glandular and stromal cells

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21
Q

What are phyllodes tumours?

A

A group of potentially aggressive fibroepithelial neoplasms of the breast

UNCOMMON

22
Q

Presentation of phyllodes tumour

A

Enlarging mass in women >50yrs old

23
Q

Are phyllodes tumours benign or malignant?

A

Majority benign, small proportion malignant

24
Q

Histology of phyllodes tumour

A

‘Leaf-like’
Overlapping cell layers, cellularity
Level of malignancy determined on cellularity of the stroma
High cellularity + stromal overgrowth –> malignant

25
Q

What is an intraductal papilloma?

Where do they arise from?

A

A benign papillary tumour arising within the duct system of the breast

Arises within the:
Small terminal ductules (peripheral papilloma)
Large lactiferous ductules (central papilloma)

26
Q

Presentation of intraductal papilloma

A

Central papillomas present with bloody nipple discharge
Peripheral papillomas may remain clinically silent

Age 50-60 years

27
Q

Cytology and histology of intraductal papilloma

A

Cytology: clusters of cells, potential increased risk with multiple papillomas of carcinoma

Histology: dilated ducts; polypoid mass in the middle
Fibrovascular core (which nourished the polyp)
Blood vessels within the stroma

28
Q

What is a radial scar?

A

Benign sclerosing lesion characterised by a central zone of scarring surrounded by a radiating zone of proliferating glandular tissue

Thought to be due to exuberant reparative phenomenon in response to areas of tissue damage in the breast

29
Q

Presentation of radial scar

A

Stellate masses on screening mammograms (may closely resemble carcinoma)

30
Q

Histology of radial scar

A

Two distinct areas:
Central stellate area
Peripheral proliferation of ducts and acini

31
Q

What are proliferative breast diseases?

A

A diverse group of microscopic intraductal proliferative lesions of the breast associated with an increased risk of subsequent development of invasive breast carcinoma –> produce no symptoms (found on biopsy)

32
Q

List 3 proliferative breast diseases

A

Usual epithelial hyperplasia, flat epithelial atypia/atypical ductal carcinoma, in situ lobular neoplasia

33
Q

Arrange usual epithelial hyperplasia, flat epithelial atypia/atypical ductal carcinoma and in situ lobular neoplasia in order of the most likely pre-malignant change

A

Usual epithelial hyperplasia < flat epithelial atypia/atypical ductal carcinoma < in situ lobular neoplasia

34
Q

Are the lumens regular or irregular in:
Usual epithelial hyperplasia
Flat epithelial atypia/atypical ductal carcinoma

A

Usual epithelial hyperplasia: irregular (benign change)

Flat epithelial atypia/atypical ductal carcinoma: regular

35
Q

Where is in situ lobular neoplasia found?

A

Acinar unit of the breast

36
Q

What does e-cadharin positive or negative indicate?

A

E-cadherin +ve = invasive ductal carcinoma

E-cadherin -ve = invasive lobular carcinoma

37
Q

Give 2 types of malignant breast disease

A

DCIS, invasive breast carcinomas

38
Q

What is DCIS?

A

Neoplastic intraductal epithelial proliferation with risk of progression to breast cancer

39
Q

Histology of DCIS (including classification)

A

Histological classification: low, intermediate or high grade

Histology (LOW): “cribriform / punched-out DCIS”
Lumens compact/regular
Calcification (cells are rapidly dying and rapidly regenerating)
Overlapping cells

Histology (HIGH):
  Central lumen necrotic material		
  Large cells
  Pleiomorphic cells occlude the duct 	
  Few lumens
40
Q

Describe the two genetic pathways of invasive breast carcinoma (low grade and high grade)

A

Low Grade – arise from low grade DCIS or in situ lobular neoplasia and show 16q loss

High Grade – arise from high grade DCIS and show complex karyotypes with many unbalanced chromosomal aberrations

41
Q

Histology and cytology of:

Invasive ductal carcinoma
Invasive lobular carcinoma
Invasive tubular carcinoma
Invasive mucinous carcinoma

A

Invasive ductal carcinoma: pleiomorphic cells with large nuclei
• AKA: Non-specific type
• E-cadherin +ve

Invasive lobular carcinoma: linear (‘Indian File’ pattern), monomorphic (look similar)

Invasive tubular carcinoma: elongated tubules invading the stroma

Invasive mucinous carcinoma: empty spaces contain lots of mucin

42
Q

What is basal-like carcinoma?

A

Carcinoma type discovered following genetic analysis of breast carcinomas, associated with BRCA mutations

43
Q

Histology of basal-like carcinoma

A

Sheets of markedly atypical cells, prominent lymphocytic infiltrate, central necrosis

44
Q

Name and describe the histological grading system for breast cancer

A

Nottingham Modification of Bloom-Richardson System:

Grading is dependent on:
Tubule formation 1, 2, 3
Nuclear pleomorphism 1, 2, 3
Mitotic activity 1, 2, 3

Graded up to score from 3-9
3-5 = grade 1 = well differentiated
6-7 = grade 2 = moderately differentiated
8-9 = grade 3 = poorly differentiated

45
Q

Which 3 receptors are all invasive breast cancers tested for?

A 
Oestrogen receptor (ER)
Progesterone receptor (PR) 
Her2 receptor
46
Q

Receptor status of:

Low grade
High grade
Basal-like carcinomas

A

LOW grade:
ER/PR positive
Her2 negative

HIGH grade:
ER/PR negative
Her2 positive

Basal-like Carcinomas:
ER/PR/Her2 negative (triple negative)

47
Q

What is the most important prognostic factor in breast cancer?

A

Status of the axillary lymph nodes

48
Q

Give the age range and frequency of the NHS breast screening programme

A

Women aged 47-73 years are screened every 3 years

49
Q

Biopsies are coded B1-B5a/b. What do the codes mean?

A 
B1 = normal breast tissue 
B2 = benign abnormality
B3 = lesion of uncertain malignant potential
B4 = suspicious of malignancy
B5 = malignant:
  B5a = DCIS 
  B5b = invasive carcinoma
50
Q

Give 2 types of male breast disease

A

Gynaecomastia

Male breast cancer

51
Q

Histology of gynaecomastia

A

Epithelial hyperplasia of ducts with finger-like projections extending to duct lumen + periductal stroma often cellular and oedematous [similar to fibroadenoma]

Histo path (4 decks)

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