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Pathology - Y5 > Breast > Flashcards

Breast Flashcards

1
Q

What are typical presentations of breast disease?

A

Breast lump.

Abnormal screening mammogram.

Nipple discharge.

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2
Q

What are appropriate investigations for breast disease?

A

Clinical examination.

Imaging- Sonography, mammography & MRI

Pathology (cytopathology and/or histopathology).

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3
Q

How are pathology investigations conducted?

A

Cytopathology/biopsy

Lesion aspirated by a 16/18gauge needle

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4
Q

What is cytopathology?

A

Cells spread across a slide and stained. Good cellular detail & quick to prepare but no architecture.

In breast disease used in the investigation of nipple discharge and palpable lumps.

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5
Q

How are breast lump aspirates coded?

A

Aspirates of breast lumps are coded C1-5:

C1: Inadequate

C2: Benign

C3: Atypical, probably benign

C4: Suspicious of malignancy

C5: Malignant

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6
Q

What is histopathology?

A

Intact tissue removed, fixed in formalin, embedded in paraffin wax, thinly sliced, stained with H&E.

Core biopsies, surgical excisions. Takes 24 hours to process.

Architectural & cellular detail.

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7
Q

What is duct ectasia?

A

Inflammation and dilation of large breast ducts.

Aetiology unclear.

Usually presents with nipple discharge. Sometimes causes breast pain, breast mass and nipple retraction.

Cytology of nipple discharge shows proteinaceous material and inflammatory cells only. Benign condition with no increased risk of malignancy.

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8
Q

What is acute mastitis?

A

Acute inflammation in the breast. Often seen in lactating women due to cracked skin and stasis of milk. May also complicate duct ectasia.

Staphylococci the usual organism.

Presents with a painful red breast. Drainage & antibiotics usually curative.

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9
Q

What is fat necrosis?

A

An inflammatory reaction to damaged adipose tissue.

Caused by trauma, surgery, radiotherapy.

Presents with a breast mass.

Benign condition.

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10
Q

What is fibrocystic disease?

A

A group of alterations in the breast which reflect normal, albeit exaggerated, responses to hormonal influences.

Very common.

Presents with breast lumpiness.

No increased risk for subsequent breast carcinoma

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11
Q

What is a fibroadenoma?

A

A benign fibroepithelial neoplasm of the breast.

Common.

Presents as a circumscribed mobile breast lump in young women aged 20-30.

Simple “shelling out” curative.

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12
Q

What is a Phyllodes tumour?

A

A group of potentially aggressive fibroepithelial neoplasms of the breast.

Uncommon tumours.

Present as enlarging masses in women aged over 50. Some may arise within pre-existing fibroadenomas.

Vast majority behave in a benign fashion but a small proportion can behave more aggressively.

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13
Q

What is an intraductal papilloma?

A

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

Arise within small terminal ductules (peripheral papillomas) or larger lactiferous ducts (central papillomas).

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14
Q

Summarise the epidemiology and presentation of an intraductal papilloma.

A

Common.

Seen mostly in women aged 40-60.

Central papillomas present with nipple discharge. Peripheral papillomas may remain clinically silent if small. Excision of involved duct is curative.

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15
Q

What are radial scars?

A

A benign sclerosing lesion characterised by a central zone of scarring surrounded by a radiating zone of proliferating glandular tissue.

Range in size from tiny microscopic lesions to large clinically apparent masses.

Lesions >1 cm are sometimes called “complex sclerosing lesions”.

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16
Q

How do radial scars present?

A

Reasonably common lesions.

Thought to represent an exuberant reparative phenomenon in response to areas of tissue damage in the breast.

Usually present as stellate masses on screening mammograms which may closely a carcinoma.

Excision is curative.

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17
Q

What are proliferative breast diseases?

A

A diverse group of intraductal proliferative lesions of the breast associated with an increased risk, of greatly different magnitudes, for subsequent development of invasive breast carcinoma.

Microscopic lesions which usually produce no symptoms.

Diagnosed in breast tissue removed for other reasons or on screening mammograms if they calcify.

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18
Q

What is usual epithelial hyperplasia?

A

Not considered a direct precursor lesion to invasive breast carcinoma but is a marker for a slightly increased risk (relative risk of 1.5-2.0) for subsequent invasive carcinoma.

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19
Q

What is flat epithelial atypia/atypical ductal carcinoma?

A

Emerging genetic data suggests FEA may represent the earliest morphological precursor to low grade ductal carcinoma in situ.

4 times relative risk of developing cancer.

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20
Q

What is in situ lobular neoplasia?

A

Current evidence suggests that in situ lobular neoplasia is a risk factor for subsequent invasive breast carcinoma in either breast in a minority of women.

The relative risk is quoted as between 7-12 times that expected in women without lobular neoplasia.

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21
Q

What is ductal cell carcinoma in situ (DCIS)?

A

A neoplastic intraductal epithelial proliferation in the breast with an inherent, but not inevitable, risk of progression to invasive breast carcinoma.

Common.

Incidence has markedly increased since the introduction of breast screening programmes.

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22
Q

How is DCIS classified?

A

85% are detected on mammography as areas of microcalcification.

10% produce clinical findings such as a lump, nipple discharge, or eczematous change of the nipple (Paget’s disease of the nipple).

5% are diagnosed incidentally in breast specimens removed for other reasons.

Subclassified histologically into low, intermediate and high grade.

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23
Q

What is the treatment of DCIS?

A

Treatment is surgical excision.

Complete excision with clear margins is curative.

Recurrence is more likely with extensive disease and high grade DCIS.

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24
Q

What are invasive breast carcinomas?

A

A group of malignant epithelial tumours which infiltrate within the breast and have the capacity to spread to distant sites.

The most common cancer in women with a lifetime risk of 1 in 8.

Incidence rates rise rapidly with increasing age, such that most cases occur in older women.

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25
Q

What are risk factors for invasive breast carcinomas?

A

Early menarche, late menopause, increased weight, high alcohol consumption, oral contraceptive use, and a positive family history are all associated with increased risk.

About 5% show clear evidence of inheritance. BRCA mutations cause a lifetime risk of invasive breast carcinoma of up to 85%.

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26
Q

What is the clinical presentation of invasive breast carcinomas?

A

Most cases present symptomatically with a breast lump.

An increasing proportion of asymptomatic cases are detected on screening mammography.

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27
Q

What is basal-like carcinoma?

A

Recently described type of carcinoma discovered following genetic analysis of breast carcinomas.

Histologically characterised by sheets of markedly atypical cells with a prominent lymphocytic infiltrate. Central necrosis is common.

Immunohistochemically characterised by positivity for “basal” cytokeratins CK5/6 and CK14.

Often associated with BRCA mutations.

Seem to have particular propensity to vascular invasion and distant metastatic spread.

28
Q

How is histology graded?

A

All invasive breast cancers are graded histologically by assessing 1) Tubule formation, 2) Nuclear pleomorphism, and 3) Mitotic activity.

Each parameter is scored from 1-3 and the three values are added together to produce total scores from 3-9.

  • 3-5 points: Grade 1 (well differentiated).
  • 6-7 points: Grade 2 (moderately differentiated).
  • 8-9 points: Grade 3 (poorly differentiated).
29
Q

What is the association between receptor status and prognosis?

A

All invasive breast carcinomas are assessed for oestrogen receptor (ER), progesterone receptor (PR) and Her2 status.

  • Low grade tumours tend to be ER/PR positive and Her2 negative.
  • High grade tumours tend to be ER/PR negative and Her2 positive.
  • Basal-like carcinomas are often ER/PR/Her2 negative (“triple negative”).
30
Q

What is the prognosis of breast cancer?

A

The single most important prognostic factor is the status of the axillary lymph nodes.

Other important factors include tumour size, histological type, and histological grade.

31
Q

What is the NHS breast screening programme?

A

The aim of screening is to pick up DCIS or early invasive carcinomas.

Women aged 47-73 are invited for screening every three years.

The screening test is a mammogram which looks for abnormal areas of calcification or a mass within the breast.

32
Q

What are the results of the NHS breast screening programme?

A

About 5% of women have an abnormal mammogram and are recalled to an assessment clinic for further investigation.

This may include more mammograms or an ultrasound followed by sampling of the abnormal area, usually by core biopsy.

33
Q

How are the results of the NHS breast screening programme coded?

A

Core biopsies taken from the breast as part of the screening programme are given a B code from 1-5.

  • B1: Normal breast tissue.
  • B2: Benign abnormality.
  • B3: Lesion of uncertain malignant potential.
  • B4: Suspicious of malignancy.
  • B5: Malignant (B5a: DCIS, B5b: Invasive carcinoma).
34
Q

What is gynaecomastia?

A

Refers to enlargement of the male breast.

Pubertal boys and older men aged over 50.

Idiopathic or associated with drugs (both therapeutic and recreational).

Histologically the breast ducts show epithelial hyperplasia with typical finger-like projections extending into the duct lumen. The periductal stromal is often cellular and oedematous.

Benign, no risk of malignancy.

35
Q

What is male breast cancer?

A

Carcinoma of the male breast is rare (0.2% of all cancers).

Median age at diagnosis 65 years old.

Most present with a palpable lump.

Histologically the tumours show similar features to female breast cancers.

36
Q

What is this?

A

Duct ectasia

37
Q

What is this?

A

Acute mastitis cytology

38
Q

What is this?

A

Fat necrosis cytology

39
Q

What is this?

A

Fibrocystic disease histology

40
Q

What is this?

A

Fibroadenoma cytology

41
Q

What is this?

A

Fibroadenoma histology

42
Q

What is this?

A

Phyllodes tumour cytology

43
Q

What is this?

A

Phyllodes tumour histology

44
Q

What is this?

A

Phyllodes tumour histology

45
Q

What is this?

A

Intraductal papilloma cytology

46
Q

What is this?

A

Intraductal papilloma cytology

47
Q

What is this?

A

Intraductal papilloma histology

48
Q

What is this?

A

Radial scar histology

49
Q

What is this?

A

Usual epithelial hyperplasia histology

50
Q

What is this?

A

Flat epithelial atypia/Atypical ductal carcinoma histology

51
Q

What is this?

A

In situ nobular neoplasia

52
Q

What is this?

A

Low grade DCIS histology

53
Q

What is this?

A

High grade DCIS histology

54
Q

What is this?

A

Invasive ductal carcinoma cytology

55
Q

What is this?

A

Invasive ductal carcinoma cytology

56
Q

What is this?

A

Invasive duct carcinoma histology

57
Q

What is this?

A

Invasive lobular carcinoma histology

58
Q

What is this?

A

Invasive tubular carcinoma histology

59
Q

What is this?

A

Invasive mucinous carcinoma histology

60
Q

What is this?

A

Basal-like carcinoma histology

61
Q

What is this?

A

Basal-like carcinoma histology

62
Q

What is this?

A

Basal-like carcinoma histology

63
Q

What is this?

A

Basal-like carcinoma histology

64
Q

What is this?

A

Basal-like carcinoma histology

65
Q

What is this?

A

Gynaecomastia

Pathology - Y5 (59 decks)

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