Breast Flashcards
What are the two main types of tissue in the breast?
What is the ratio in older and younger women?
- Breast made up of fat and glandular tissue
- Older females have more fat content
- Younger females have more glandular
What are the two constituents of glandular breast tissue and what are they made up of?
Lobules- secretory function that produce milk- lined by epithelial cells with peripheral layer of myoepithelial cells
Ducts consist of intralobular , extralobular, lactiferous ducts and sinuses
Discuss the normal structure of the breast
Contains ducts and lobules
- Secretion takes place in lobules
- Ducts are located under the nipple and open up into lactiferous ducts and lactiferous sinuses
- Dual cell layer in all breast tissue has epithelial cells and myoepithelial cells that contain muscle filaments
What are the causes of breast pain?
- Cyclical mastalgia- pain usually greatest just before period
- Reassure not associated with malignancy
- Simple analgesia and primrose oil
Discuss the different types of nipple discharge
Single duct- usually papillary lesion, rarely underlying malignancy (ductal carcinoma in situ)
Multiple ducts- duct ectasia- pressure anywhere around nipple expels
Clear discharge- physiological
Blood stained- single duct, can be intraductal papilloma which will twist and infarct- can cause malignancy
What is duct ectasia ?
- Occurs in women between 34-45 (older reproductive yrs)
- Defect in duct elastic tissue associated with smoking
- May need duct excision if infected
- No increased risk of malignancy
What does an intraductal papilloma look like histologically?
- Has a central fibrovascular core
- With multi-layered epithelial and myoepithelial cells
How do you investigate a breast lump?
- History and exam
- Radiology - mammogram (older), ultrasound (younger) - ultrasound has many false positives but can tell if something is cystic or solid
- Needle biopsy (fine needle aspiration and core needle biopsy)
What do you ask about in a breast lump history?
- Duration of lump
- Cyclical nature
- Pain
- Skin changes - inflammation or tethering
What clinical findings are associated with a malignant breast lump?
- Lesion in the medial aspect of the breast
- Hard consistency
- Focal or irregular
- Skin changes- dimpling
- Enlarged glands in axilla for axillary nodal metastases
Explain mammography
- X-ray of breast tissue
- 2 angles- head to toe and at 30 degrees
- Effective in older patients - fatty tissue easier to see masses
- Cant examine all tissue- medial aspect not always shown
Highlight the factors for breast cancer?
- Increasing age
- Family history
- Genetic conditions- BRCA1 BRCA2
- Previous history of breast cancer
- Increased breast density
- Early menarche/ late menopause
- Older age at first childbirth
- OCP
- Obesity, alcohol, smoking, radiation
Breastfeeding is protective
Discuss the breast screening programme in the UK
- 3 year cycle
- Women 50-70
- Triple assessment- clinical exam radiology and pathology
What are the pros and cons of using fine needle aspirate in cytology of breast cancer?
Pros- quick, simple, cheap equipment, quite painless, few complications
Cons- Can’t subtype benign or malignant cells, doesn’t give an entirely positive benign diagnosis (narrow gauge), can’t tell between invasive vs in situ carcinoma, unsuitable in sampling calcifications
What are the pros and cons of using core biopsy histology in Breast cancer diagnosis?
Pros- Specific benign diagnosis, Low false positives, can distinguish between invasive and in situ carcinoma, identifies invasive subtypes, can give grade and ER/HER2 status
Cons- More complex, needs radiological guidance, local anaesthetic needed, high complication rate (haematoma), more expensive
What are the 6 types of breast cancer classification
- invasive vs in situ
- Cell type - glandular vs lobular
- Grade
- Stage
- Hormone receptor expression
- Molecular classification
What is an in situ carcinoma and what does it look like histologically?
- made of neoplastic (malignant) cells confined to a duct and confined by the basement membrane
- Basement membrane still in tact
- No potential for metastases
- Will become invasive if untreated
Describe an invasive carcinoma
- Neoplastic cells that have breached the basement membrane and can metastasise
- Darker cells infiltrating pink cells histologically
What are the differences between a ductal and lobular carcinoma
Ductal
- Clinical : Well defined lump (due to loss of e cadherin)
- Radiology: Circumscribed mass
- Pathology: Firm clearly outlined tumour with abnormal glandular structures- attempt at gland formation
Lobular
- Clinical: Vague thickening
- Radiology: less distinct mass
- Pathology: Poorly defined with single cells- no attempt to make gland- infiltrate in single file
Discuss the staging of breast cancer
Scored 3-9 based on
- Tubule formation -Mitotic activity -Nuclear polymorphism
- Grade 1= 3-5 -Grade 2 = 6-7 -Grade 3= 8-9
TNM staging
- T- size of tumour and skin/ chest wall involvement
- N- lymph node involvement
- M-Presence of absence of distant metastases
Describe the types of cystic breast lump
- Epidermal inclusion cyst- near skin surface- infolding squamous epithelium trapping keratin
- Dilated duct or lobule- in breast parenchyma- has developed abnormally and trapped secretions
- Breast cysts= ;lined by apocrine epithelium- epithelium will be thinner due to fluid in cyst
- Fibrocystis change- common, no symptoms, detected in screening due to calcification
Discuss the components of fibrocystic change
- Calcification caused by
1. Cyst formation- build up of secretions in dilated epithelial lined structure
2. Fibrosis- when cyst is there long enough it ruptures causing chronic inflam
3. Adenosis- increase in no of acini or glands with epithelial proliferation
What is a fibroadenoma ?
- Common fibroepithelial lesion
- Young women, multiple and bilateral, palpable- moveable and non painful
- Epithelial and stromal elements
- Hormonally responsive- size fluctuates
- Can treat by excision or leave
What is a phyllodes tumour
- Fibroepithelial lesion where stromal component proliferates out of proportion to epithelial component leading to stromal overgrowth
- Can turn malignant or recurr
