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Breast Flashcards

1
Q

What are the 2 types of tissue in the breast?

A

fat

glandular

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2
Q

What is glandular tissue made up of?

A

ducts

lobules

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3
Q

What is the function of lobules?

A

secretory function
lined by epithelial cells
peripheral layer of myoepithelial cells

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4
Q

What is the chain of ductal

glandular tissue?

A

lobular ducts
extralobular ducts
lactiferous ducts
lactiferous sinuses

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5
Q

Describe the slide

A

lobules
ducts
fat tissue

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6
Q

Describe the higher magnification

A

myoepithelial cells - smaller dark nuclei
epithelial cells
stroma

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7
Q

What are common reasons for breast pain presentation?

A

cyclical - around the menstrual cycle
breast lump
discharge

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8
Q

What is cyclical mastalgia?

A

pain usually pre-menstrually

resolves during period

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9
Q

What can be advised?

A

evening primrose oil

reassure no malignancy

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10
Q

How do you describe nipple discharge?

A

single duct or multi-duct

clear, opaque or blood-stained

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11
Q

What is implied by clear discharge?

A

physiological/innocent

prolactin-secreting tumour of pituitary gland

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12
Q

How can you distinguish between single and multi-duct?

A

single - discharge pressing on one single around nipple

multi - discharge pressing anywhere around nipple

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13
Q

What is implied by multi-duct and opaque discharge?

A

mammary duct ectasia

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14
Q

What is implied by single duct?

A

underlying pathology
papilloma or papillary lesion
DCIS

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15
Q

When is duct ectasia common?

A

women 35-45

smokers

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16
Q

What is the management?

A

no treatment

duct excision if causing extreme problems

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17
Q

What is intraductal papilloma?

A

single duct
may be blood stained
rarely malignant

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18
Q

What is this?

A

intraductal papilloma
fibrovascular core
epithelial and myoepithelial cells

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19
Q

Name the parts of the clinical assessment for a breast lump

A

history
examination
radiology (mammography/ultrasound)
needle biopsy (FNA/core)

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20
Q

What is important in the clinical history of a breast lump?

A 
duration
increase/decrease in size
cyclical or constant
pain
skin changes (inflamm/tethering)
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21
Q

What is important in the clinical examination?

A 
location
size
consistency (soft/firm/hard)
character (focal/vague/smooth/irregular)
skin changes (raise arms)
axilla
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22
Q

Where are benign breast lumps more likely to occur?

A

lateral aspect

medial aspect of the breast are more likely malignant

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23
Q

How does mammography work?

A

X-ray

2 angles - craniocaudal and oblique

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24
Q

What kind of patient is mammography more effective in?

A

older patients

fatty tissue>glandular

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25
What can an ultrasound tell you about a breast lump?
cystic or solid outline of lesion useful for image guided biopsy
26
What is reasassuring on an ultrasound?
cysts are almost always benign | smooth outline is likely benign
27
What are the 5 types of benign breast lump?
``` simple cyst fibrocystic change fibroepithelial chane papilloma fat necrosis ```
28
Where are simple epidermal inclusion cysts often found?
near skin surface
29
How are epidermal inclusion cysts formed?
in-folding of squamous epithelium containing trapped keratin
30
Where do deep-seated simple cysts arise in the breast?
dilated ducts or lobules
31
What do dilated duct cysts contain?
entrapped secretions
32
What are deep breast cysts often lined by?
apocrine epithelium
33
Why are deep breast cysts' lining attenuated and thin?
because of the pressure of the secretions inside
34
What process causes breast cysts?
metaplastic
35
How are fibrocystic changes often picked up?
calcification of cysts or adenosis on mammography | no signs/symptoms
36
How are cysts formed in fibrocystic changes?
lobules unfold and coalesce | blockages
37
How does fibrosis occur in fibrocystic change?
as cysts rupture a chronic inflammatory response is provoked causing fibrosis
38
What is adenosis in fibrocystic change?
increased acini or glands in a lobule with no proliferation of epithelium
39
Describe the fibrocystic change seen here
grossly a cyst can be seen which has ruptured causing the adjacent fibrosis
40
Describe the histology seen here?
fibrocystic change cysts seen on left of screen calcification seen top right fibrosis between calcification and fatty tissue
41
What is a fibroadenoma?
painless palpable mobile mass
42
What is a fibroadenoma also known as?
breast mouse
43
What arer fibroadenomas made of?
epithelial and stromal elements
44
What are the 2 types of stroma in breast?
dense intERlobular stroma and looser intRAlobular stroma
45
What stroma do fibroadenomas arise from?
loose intralobular stroma
46
Why do fibroadenomas tend to fluctuate size wise?
they are hormonally responsive and so fluctuate with menstruation and pregnancy
47
What can be seen in this gross image?
fibroadenoma well-contained uniform pale, fibrous surface usually 2-3cm
48
Describe the histology seen in this fibroadenoma
epithelial lined spaces surrounded by loose fibrous stroma | no concerning features - nuclear pleomorphism, increased cellularity, mitotic activity or necrosis
49
What happens to a fibroadenoma to lead to a Phyllodes tumour?
stromal component proliferates out of proportion to epithelial component (stromal overgrowth) usually benign
50
What is a papilloma?
benign epithlium covering connective tissue cores
51
What kind of pattern is seen in papillomas?
branching
52
WHere does a papilloma occur?
within wall of breast duct causing blockage/widening of duct
53
What is the common presentation of a papilloma?
discharge (can be bloody) | lump
54
Why can papilloma discharge be bloody?
[papillomas are richly vascular and segments can twist and become infarcted
55
What is significant about a solitary papilloma?
large duct near nipple lower risk of malignancy
56
What is significant about multiple papillomas?
terminal ducts deep tissue higher risk of malignancy
57
What can be seen in this histological image?
papilloma in duct wall
58
Describe the histology of this papilloma?
epithelial lining fibrovascular core blood vessels seen upper right quadrant
59
Describe this histological image
fat necrosis fat globules surrounded by foamy macrophages and giant cells
60
Risk factors for breast cancer?
``` increased age family history previous history genetic - BRCA 1 and 2 increased breast density ```
61
What hormonal and reproductive risk factors contribute to breast cancer?
early menarche late menopause older first childbirth oral contraceptives
62
What is protective from breast cancer?
breast feeding
63
What general risk factors contribute to breast cancer?
obesity smoking alcohol ionising radiation
64
What are the 2 types of presentation of breast cancer and how do they differ?
symptomatic - breast lump/discharge/skin abnormalities | screening - mammographic abnormality (calcification/mass lesion)
65
How often are women screened for breast cancer? When does it begin?
3 yearly | 50-70 y/o
66
What is the triple assessment for diagnosis?
clinical radiological - mammogram/USS/MRI +/- biopsy pathological - FNA/core biopsy
67
What pathological investigation is this?
FNA
68
Describe the 2 slides seen
``` L: benign FNA cells form cohesive groups well-defined outlines dots are myoepithelial cells that have lost their cytoplasm during FNA ``` ``` R: malignant FNA pleomorphic nuclei different shapes and sizes discohesive necrotic ```
69
What pathological investigation can be seen here?
core biopsy
70
Describe the 2 slides seen
L: DCIS basement membrane seen around malignant cells pleomorphic cells darker area probably what presented as calcification on mammogram R: benign intraductal papilloma
71
Describe this slide
invasive carcinoma | dark purple malignant cells infiltrating lighter pink fibrous tissue
72
What kind of breast cancer is seen here?
in-situ neoplastic cells confined by basement membrane no potential for metastasis
73
What can be seen here?
invasive carcinoma neoplastic cells basement membrane breached can metastasize
74
Ductal v lobar classification | Clinical findings, radiology, micro and macro pathology
table
75
How is grade classified?
``` tubule formation mitotic activity nuclear pleomorphism scored 1-3 and added up grade 1: 3-5 grade 2: 6-7 grade 3: 8-9 ```
76
How does staging work?
TNM T - increases with increasing size, skin/chest wall involvement N - increases with increasing lymph node involvement M - presence or absence of metastases
77
Describe this slide
well differentiated low grade carcinoma
78
Describe this slide
high grade tumour
79
Explain the T staging
T1 <20mm T2 20-50mm T3 50-100mm or <50 with infiltration T4 >100mm
80
Explain the N staging
N0 node negative N1 node involved, mobile N2 node involved, fixed N3 supraclavicular nodes or oedema
81
Explain the M staging
M0 no metastases | M1 metastases
82
What are teh 2 predictive tests?
oestrogen receptor status | HER-2 (human epidermal growth factor)
83
What do patients with oestrogen receptor positive tumours benefit from?
hormone manipulation tamoxifen arimidex
84
What do patients with HER-2 positive tumours benefit from?
herceptin treatment
85
What can be done for BRCA 1 and 2 mutations
screening for mutation | elective prophylactic bilateral mastectomy with?hysterectomy and oophrectomy
86
When is BRCA screening recommended?
age 25
87
What preexisting breast conditions are risk factors?
``` breast cancers atypical ductal hyperplasia x4 hyperplasia of unusual type x2 LCIS x4 DCIS x6-8 ```

Pathology (5 decks)

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