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Pathology > Breast > Flashcards

Breast Flashcards

1
Q

When is it preferable to examine the pre-menopausal breast?

A

In the first half of the menstrual cycle

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2
Q

What happens in the breast in pregnancy and lactation?

A

Inc. in no. of acini per lobule and in overall lobule size
epithelial cells differentiate- synthesis and secretion of milk
when feeding ceases, involution of differentiated cells

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3
Q

What happens to the breast with age?

A

involution
may happen at an uneven rate- lumps
connective tissue goes from dense to loose
inc. adipose tissue

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4
Q

Why are mammograms more useful in older women?

A

Inc. adipose tissue results in more radiolucent tissue

allows detection of radio dense abnormalities

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5
Q

Diagnostic methods for breast cancer?

A

mammography, ultrasound, biopsy, screening

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6
Q

Development abnormalities?

A

Failure to develop e.g., Turner’s syndrome
Juvenile hypertrophy
Milk line remnants (extra nipples)
Nipple inversion (congenital/acquired)

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7
Q

When is nipple inversion concerning?

A

When it is acquired rather than congenital

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8
Q

Causes of inflammation of the breast?

A

Infection, mammary duct ectasia, fat necrosis

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9
Q

Significance of inflammation of the breast?

A

Can be confused with breast cancer

does not increase risk

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10
Q

Main cause of acute mastitis?

A

Lactation

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11
Q

Who is squamous metaplasia of the lactiferous ducts associated with?

A

Smokers
Both men and women
Not associated with lactation

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12
Q

Clinical presentation of squamous metaplasia of lactiferous ducts?

A

painful erythematous subareolar mass

keratin plugs and blocks ducts -> chronic inflammation

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13
Q

Treatment of squamous metaplasia of lactiferous ducts?

A

Drainage

If recurrent, surgical removal of ducts

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14
Q

Who is duct ectasia common in?

A

post-menopausal, parous women

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15
Q

Presentation of duct ectasia?

A

Painless peri-areolar palpable mass
duct dilation
thick nipple discharge
if fibrosis-> nipple retraction

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16
Q

Is duct ectasia associated with smoking?

A

No

in comparison to squamous metaplasia of the lactiferous ducts which is

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17
Q

Causes of fat necrosis?

A

trauma (seatbelt injury)

surgery (implants, biopsy)

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18
Q

Presentation of fat necrosis?

A

Painless palpable mass

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19
Q

Who is fat necrosis more common in?

A

Obese, post-menopausal women (more adipose tissue)

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20
Q

What is seen histologically in fat necrosis?

A

necrosis, inflammation, macrophages, giant cells, fibrosis

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21
Q

Types of benign epithelial lesions?

A

Non-proliferating breast changes
Proliferating breast changes without atypia
Proliferating breast changes with atypia

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22
Q

Non-proliferating breast changes?

A

Fibrosis
Cystic change
Adenosis

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23
Q

Proliferative breast disease without atypia?

A

Epithelial hyperplasia
Sclerosing Adenosis
Complex sclerosing lesion
Papilloma

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24
Q

80% of papillomas produce what?

A

Nipple discharge

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25
Q

Complex sclerosing lesion has components of?

A

Epithelial hyperplasia
Papilloma
Sclerosing Adenosis

26
Q

What lesion can mimic breast carcinoma grossly, mammographically and histologically?

A

Radial sclerosing lesion

27
Q

Proliferative breast disease with atypia?

A

Atypical ductal hyperplasia
Atypical lobal hyperplasia

*******NOT DCIS or LCIS

28
Q

3 main groups of breast carcinomas?

A

ER pos, HER2 neg (60%)
HER2 pos (20%)
ER neg, HER2 neg, PR neg (15%)

29
Q

What do most HER2 receptors respond to?

A

Trastuzumab (Herceptin)

30
Q

Risk factors for breast cancer?

A 
Gender 
Age 
Oestrogen exposure
Family history
Breast itself
Lifestyle (diet, obesity, smoking inc. risk, breastfeeding protects against)
31
Q

What percentage of breast cancers occur in men?

A

1%

32
Q

What percentages of breast cancers occur in women under 40?

A

5%

33
Q

What percentage of breast cancer is hereditary and what genes are involved?

A

12%

BRCA1, BRCA2, p53, CHEK2

34
Q

Main risk of sporadic breast cancer?

A

Oestrogen exposure

35
Q

What is the most common form of breast cancer?

A

Adenocarcinoma (>95%)

36
Q

Where do all carcinomas of the breast arrive?

A

In the terminal ductal lobular unit

37
Q

Lobular vs Ductal Carcinoma?

A 
Lobular = carcinoma of a specific type
Ductal = all breast adenocarcinomas
38
Q

DCIS detection?

A

15-30% of breast carcinomas in well-screened populations
50% of detected ca on mammogram (calcifications)
rarely nipple discharge

39
Q

DCIS treatment?

A

surgery + irradiation, tamoxifen

if untreated, about 1/3 progress to invasive ca

40
Q

If DCIS progresses where does it go?

A

Usually infiltrates same breast/quadrant

41
Q

DCIS prognosis?

A

Excellent, 97% survival rate

42
Q

What happens in Paget Disease of the nipple?

A

Rare manifestation of breast cancer

malignant cells extend from DCIS through lactiferous sinuses without breaching the basement membrane

43
Q

How is LCIS detected?

A

Incidental biopsy finding

Can not be picked up on mammogram (no calcification/densification)

44
Q

Major histological feature of LCIS?

A

Loss of e-cadherin

45
Q

Treatment of LCIS?

A

close follow-up
chemoprevention with tamoxifen
bilateral prophylactic mammectomy (less common)

46
Q

Progression of LCIS?

A

1/3 progress to invasive carcinoma

can invade either breast- 2/3 the same, 1/3 the opposite

47
Q

Invasive carcinoma symptoms?

A 
palpable mass
axillary lymph nodes
nipple retraction
blocked lymphatics
mammography- radio-dense mass
48
Q

Characteristics of NST carcinoma?

A 
No special type = ductal
80%
firm, irregular border
grating sound when cut (water chestnut)
chalky areas of stroma
foci of calcification
49
Q

Characteristics of lobar carcinomas?

A

10-15%

dyscohesive infiltrating cells

50
Q

Locations of breast carcinomas?

A

Upper Outer Quadrant 50%
Central Portion 20%
Each other quadrant 10%

51
Q

Spread of breast carcinoma?

A

Direct- skin, muscle
Lymph- axillary and local
vascular- lung, liver, brain, bone
may be delay before spread

52
Q

Fibroadenoma characteristics?

A

tumour of the stroma
most common benign tumour in young women
‘breast mouse’

53
Q

Which tumour is characterised as a ‘breast mouse’?

A

Fibroadenoma

54
Q

How are Phyllode’s tumours detected?

A

Palpable mass, mammography

55
Q

What percentage of Phyllode’s tumours mets?

A

10-15%

56
Q

Tumours of the stroma?

A

Fibroadenoma

Phyllode’s tumour

57
Q

What are male breasts comprised of?

A

Nipples and ducts

no lobules

58
Q

Causes of gynaecomastia?

A 
hormonal
liver cirrhosis (Dec. metabolism of oestrogen)
Klinefelter syndrome (47, XXY)
59
Q

Genes associated with male breast carcinoma?

A

BRCA1, BRCA2, 47 XXY

60
Q

Lifetime risk of breast carcinoma men vs women?

A

0.1%

13%

61
Q

What is the most frequent causative organism of acute mastitis?

A

Staph aureus

Pathology (13 decks)

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