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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
What is an intraductal papilloma? Where do they arise from?
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
Presentation of intraductal papilloma
Central papillomas present with bloody nipple discharge Peripheral papillomas may remain clinically silent Age 50-60 years
27
Cytology and histology of intraductal papilloma
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
What is a radial scar?
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
Presentation of radial scar
Stellate masses on screening mammograms (may closely resemble carcinoma)
30
Histology of radial scar
Two distinct areas: Central stellate area Peripheral proliferation of ducts and acini
31
What are proliferative breast diseases?
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
List 3 proliferative breast diseases
Usual epithelial hyperplasia, flat epithelial atypia/atypical ductal carcinoma, in situ lobular neoplasia
33
Arrange usual epithelial hyperplasia, flat epithelial atypia/atypical ductal carcinoma and in situ lobular neoplasia in order of the most likely pre-malignant change
Usual epithelial hyperplasia < flat epithelial atypia/atypical ductal carcinoma < in situ lobular neoplasia
34
Are the lumens regular or irregular in: Usual epithelial hyperplasia Flat epithelial atypia/atypical ductal carcinoma
Usual epithelial hyperplasia: irregular (benign change) Flat epithelial atypia/atypical ductal carcinoma: regular
35
Where is in situ lobular neoplasia found?
Acinar unit of the breast
36
What does e-cadharin positive or negative indicate?
E-cadherin +ve = invasive ductal carcinoma E-cadherin -ve = invasive lobular carcinoma
37
Give 2 types of malignant breast disease
DCIS, invasive breast carcinomas
38
What is DCIS?
Neoplastic intraductal epithelial proliferation with risk of progression to breast cancer
39
Histology of DCIS (including classification)
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
Describe the two genetic pathways of invasive breast carcinoma (low grade and high grade)
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
Histology and cytology of: Invasive ductal carcinoma Invasive lobular carcinoma Invasive tubular carcinoma Invasive mucinous carcinoma
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
What is basal-like carcinoma?
Carcinoma type discovered following genetic analysis of breast carcinomas, associated with BRCA mutations
43
Histology of basal-like carcinoma
Sheets of markedly atypical cells, prominent lymphocytic infiltrate, central necrosis
44
Name and describe the histological grading system for breast cancer
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
Which 3 receptors are all invasive breast cancers tested for?
``` Oestrogen receptor (ER) Progesterone receptor (PR) Her2 receptor ```
46
Receptor status of: Low grade High grade Basal-like carcinomas
LOW grade: ER/PR positive Her2 negative HIGH grade: ER/PR negative Her2 positive Basal-like Carcinomas: ER/PR/Her2 negative (triple negative)
47
What is the most important prognostic factor in breast cancer?
Status of the axillary lymph nodes
48
Give the age range and frequency of the NHS breast screening programme
Women aged 47-73 years are screened every 3 years
49
Biopsies are coded B1-B5a/b. What do the codes mean?
``` 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
Give 2 types of male breast disease
Gynaecomastia | Male breast cancer
51
Histology of gynaecomastia
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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