Breast Flashcards
What is a carcinoma?
• Malignant tumour of epithelial origin
Subtype of carcinoma depends on organ or tissue of origin
Eg: Squamous cell carcinoma (skin, head and neck, cervix)
Adenocarcinoma = gland forming tumour/mucin producing
tumour (Gastrointestinal tract, breast, endometrium, prostate
etc)
Transitional cell (urothelial) carcinoma (urinary bladder)
What is a sarcoma?
• Malignant tumour arising from mesenchymal tissue
Examples -
Leiomyosarcoma (smooth muscle origin)
Rhabdomyosarcoma (striated muscle)
Liposarcoma (adipose tissue)
Osteosarcoma (bone)
What is a lymphoma?
• Malignancy arising in lymphoid tissue (lymph nodes)
Eg
Hodgkin’s lymphoma
Diffuse large B cell lymphoma
What is the normal breast histology?
• Grape like cluster of acini – lobule
• Lobules connect into duct
• Luminal epithelial cells
• Overlie myoepithelial cells on basement membrane
Normal vs benign vs malignant breast
What is a breast abscess?
• Usually infection acquired during breast feeding
• Staphylococcus aureus (nipple skin)
• Formation of lactational abscess
• Treat with antibiotics, continued expression of milk
• Rarely – incision and drainage
What is fibrocystic disease?
• Most common benign breast disease
• Commonest in ages group 30 - 50 years
• Benign cysts typically mobile and rubbery on examination
• Fibrocystic change – prone to hormonal alteration
• Benign – not associated with an increased risk of malignancy
What is fibroadenoma?
• Most common benign tumour of the female breast
• Well-circumscribed, unencapsulated
• Biphasic tumour, proliferation of glandular and stromal elements
• Can occur at any age, median age of 25 years
• Management -> patient risk factors, patient preference
• Conservative management – follow-up
• Local surgical excision
What are the risk factors for breast carcinoma?
What are the types of breast malignancy?
• Greater than 95% of breast malignancies - adenocarcinomas
• In situ stage – neoplastic proliferation limited to ducts and lobules by basement membranes
• Invasive carcinoma – penetrated the basement membrane into the stroma – potential for Lymphovascular invasion and metastatic spread
• Ductal Carcinoma – arises from ducts
• Lobular carcinoma – arises from the lobules
What is Carcinoma in situ?
• Neoplastic proliferation limited to ducts and lobules by the intact basement membrane
• Ductal carcinoma in situ – Ducts , express e-cadherin (cell adhesion protein)
• Mammography - calcification
• Lobular carcinoma in situ – lobules, loss of e-cadherin expression
Histological DCIS features:
- atypical epithelial proliferation
- intact basement membrane
- come do necrosis
- calcification
- abnormal nuclear features
What is invasive carcinoma?
• Has penetrated through the basement membrane and infiltrates the stroma
• Most common - Invasive ductal carcinoma, no special type (70-80%)
• Capacity for lymphatic/vascular invasion and metastases
• If central -> nipple retraction
• Lymphatics involved/blocked – peau d’orange (orange peel appearance)
• Mammography – radiodense mass
Histological features:
- crab like infiltration of the stroma and tissues
- haphazard malignant glands infiltrating stroma
- malignant cells in Indian files
What is the treatment of breast cancer?
What is the breast cancer screening programme?
women from the age of 50 to 70 registered with a GP for screening every 3 years
How are breast cancers graded?
• Bloom Richardson System:
1) Tubule formation (1-3)
2) Nuclear Pleomorphism (1-3)
3) Mitotic activity (1-3)
3-5 Grade 1 (well differentiated)
6-7 Grade 2 (moderately differentiated)
8-9 Grade 3 (poorly differentiated)
What is the treatment if the target is ER vs PGR vs HER2?
What are the draining lymph nodes of the breast?
• Axillary lymph nodes (75-90% of ipsilateral breast drainage)
• Infraclavicular lymph nodes
• Internal mammary (parasternal)clymph nodes
