Breast Flashcards
Common presenting symptoms of breats pathology arE:
Pain (mastalgia/mastodynia)
Palpable masses
Nipple dischargePain (mastalgia/mastodynia)
Palpable masses
Nipple dischargePain (mastalgia/mastodynia)
Palpable masses
Nipple discharge
Name 4 Inflammatory breast conditions
Acute mastitis Periductal mastitis Mammary duct extasia Fat necrosisAcute mastitis Periductal mastitis Mammary duct extasia Fat necrosisAcute mastitis Periductal mastitis Mammary duct extasia Fat necrosis
Symptoms, causes and treatment of acute mastitis
Symptoms: painful, red breast and fever
Causes: almost all occur during lactation and breast-feeding as a result of staphylococcal infection via cracks in the nipple. Involved breast tissue is necrotic and infiltrated by neutrophils
Tx: continued expression of milk + antibiotics +/- surgical drainSymptoms: painful, red breast and fever
Causes: almost all occur during lactation and breast-feeding as a result of staphylococcal infection via cracks in the nipple. Involved breast tissue is necrotic and infiltrated by neutrophils
Tx: continued expression of milk + antibiotics +/- surgical drainSymptoms: painful, red breast and fever
Causes: almost all occur during lactation and breast-feeding as a result of staphylococcal infection via cracks in the nipple. Involved breast tissue is necrotic and infiltrated by neutrophils
Tx: continued expression of milk + antibiotics +/- surgical drain
define Periductal mastitis (+symptoms):
Periductal mastitis occurs when the ducts under the nipple become inflamed and infected. It’s a benign condition, which can affect women of all ages but is more common in younger women. Symptoms include: the breast becoming tender and hot to the touch. the skin may appear reddened.
It is mostly in smokers and NOT associated with lactation
Histologially, keratinizing squamous epithelium extends deep into nipple duct orificesPeriductal mastitis occurs when the ducts under the nipple become inflamed and infected. It’s a benign condition, which can affect women of all ages but is more common in younger women. Symptoms include: the breast becoming tender and hot to the touch. the skin may appear reddened.
It is mostly in smokers and NOT associated with lactation
Histologially, keratinizing squamous epithelium extends deep into nipple duct orificesPeriductal mastitis occurs when the ducts under the nipple become inflamed and infected. It’s a benign condition, which can affect women of all ages but is more common in younger women. Symptoms include: the breast becoming tender and hot to the touch. the skin may appear reddened.
It is mostly in smokers and NOT associated with lactation
Histologially, keratinizing squamous epithelium extends deep into nipple duct orifices
Define mammary duct ectasia:
Duct ectasia of the breast or mammary duct ectasia or plasma cell mastitis is a condition in which the lactiferous duct becomes blocked or clogged.
This is the most common cause of greenish discharge.
Mammographically can mimic breast cancer.
Occurs mainly in multiparous 40-60yr old women
Poorly defined palpable periareolar mass with thick, white nipple secretions
Caused by granulomatous inflammation and dilation of large breast ducts
Cytology - proteinaceous material, inflammatory cellsDuct ectasia of the breast or mammary duct ectasia or plasma cell mastitis is a condition in which the lactiferous duct becomes blocked or clogged.
This is the most common cause of greenish discharge.
Mammographically can mimic breast cancer.
Occurs mainly in multiparous 40-60yr old women
Poorly defined palpable periareolar mass with thick, white nipple secretions
Caused by granulomatous inflammation and dilation of large breast ducts
Cytology - proteinaceous material, inflammatory cellsDuct ectasia of the breast or mammary duct ectasia or plasma cell mastitis is a condition in which the lactiferous duct becomes blocked or clogged.
This is the most common cause of greenish discharge.
Mammographically can mimic breast cancer.
Occurs mainly in multiparous 40-60yr old women
Poorly defined palpable periareolar mass with thick, white nipple secretions
Caused by granulomatous inflammation and dilation of large breast ducts
Cytology - proteinaceous material, inflammatory cells
Define fat necrosis:
Inflammatory reaction to damaged adipose tissue
Presents as painless breast mass/skin thickening/mammographic lesion
Caused by trauma, radiotherapy or surgeryInflammatory reaction to damaged adipose tissue
Presents as painless breast mass/skin thickening/mammographic lesion
Caused by trauma, radiotherapy or surgeryInflammatory reaction to damaged adipose tissue
Presents as painless breast mass/skin thickening/mammographic lesion
Caused by trauma, radiotherapy or surgery
Name 2 benign proliferative breast conditions:
Fibrocystic disease/Fibroadenosis (breast Lumpiness)
GynacomastiaFibrocystic disease/Fibroadenosis (breast Lumpiness)
GynacomastiaFibrocystic disease/Fibroadenosis (breast Lumpiness)
Gynacomastia
Describe gynaecomastia:
Unilateral or bilateral enlargment of the male breast
Indicator of hyperoestrinism - alcohol, age, liver cirrhosis, functioning testicular tumour
Histology - epithelial hyperplasia, finger like projections into ductsUnilateral or bilateral enlargment of the male breast
Indicator of hyperoestrinism - alcohol, age, liver cirrhosis, functioning testicular tumour
Histology - epithelial hyperplasia, finger like projections into ductsUnilateral or bilateral enlargment of the male breast
Indicator of hyperoestrinism - alcohol, age, liver cirrhosis, functioning testicular tumour
Histology - epithelial hyperplasia, finger like projections into ducts
Name 3 benign neoplastic breast conditions:
Fibroadenoma ('breast mouse')
Duct papilloma
Radial scarFibroadenoma ('breast mouse')
Duct papilloma
Radial scarFibroadenoma ('breast mouse')
Duct papilloma
Radial scarDescribe duct papilloma:
A benign papillary tumour arising within the duct system of the breast. It can be within small terminal ductules (peripheral papillomas) or larger lactiferous ducts (central papillomas) Causes bloody discharge No lump Not seen on mammogram Treatment: GalactogramA benign papillary tumour arising within the duct system of the breast. It can be within small terminal ductules (peripheral papillomas) or larger lactiferous ducts (central papillomas) Causes bloody discharge No lump Not seen on mammogram Treatment: GalactogramA benign papillary tumour arising within the duct system of the breast. It can be within small terminal ductules (peripheral papillomas) or larger lactiferous ducts (central papillomas) Causes bloody discharge No lump Not seen on mammogram Treatment: Galactogram
Describe breast mice (fibroadenoma)
Most common benign tumour, from stroma, often multiple and bilateral
Occurs at any age within reporductive period (usually 20-20)
Epithelium responsive to hormones, therefore increase in size during pregnancy and calcify after menopause
Spherical, freely mobile, variable in size, rubbery
Overgrowth of collagenous mesenchyme
“shelling out” is curativeMost common benign tumour, from stroma, often multiple and bilateral
Occurs at any age within reporductive period (usually 20-20)
Epithelium responsive to hormones, therefore increase in size during pregnancy and calcify after menopause
Spherical, freely mobile, variable in size, rubbery
Overgrowth of collagenous mesenchyme
“shelling out” is curativeMost common benign tumour, from stroma, often multiple and bilateral
Occurs at any age within reporductive period (usually 20-20)
Epithelium responsive to hormones, therefore increase in size during pregnancy and calcify after menopause
Spherical, freely mobile, variable in size, rubbery
Overgrowth of collagenous mesenchyme
“shelling out” is curative
What is triple assessment?
Examination
Radiological examination (mammography/USS/MRI)
FNA & CytologyExamination
Radiological examination (mammography/USS/MRI)
FNA & CytologyExamination
Radiological examination (mammography/USS/MRI)
FNA & Cytology
Risk factors for breast carcinomas are:
Obesity
Tobacco
Alcohol
Race (Caucasian > Afro-Caribbean > Asian > Hispanic)
Family History
Advancing age
Hormone exposure - early menarche, late menopause, late 1st live birth (pregnancy –> terminal differentiation of milk-producing luminal cells, removing these from pool of potential cancer precursors), OCP/HRT
Susceptibility genes (12%) - BRCA1/BRCA2, also increased risk iof ovarian, prostate and pancreatic malignancy. BRCA mutations cause a lifetime risk of invasive breast carcinoma of up to 85%Obesity
Tobacco
Alcohol
Race (Caucasian > Afro-Caribbean > Asian > Hispanic)
Family History
Advancing age
Hormone exposure - early menarche, late menopause, late 1st live birth (pregnancy –> terminal differentiation of milk-producing luminal cells, removing these from pool of potential cancer precursors), OCP/HRT
Susceptibility genes (12%) - BRCA1/BRCA2, also increased risk iof ovarian, prostate and pancreatic malignancy. BRCA mutations cause a lifetime risk of invasive breast carcinoma of up to 85%Obesity
Tobacco
Alcohol
Race (Caucasian > Afro-Caribbean > Asian > Hispanic)
Family History
Advancing age
Hormone exposure - early menarche, late menopause, late 1st live birth (pregnancy –> terminal differentiation of milk-producing luminal cells, removing these from pool of potential cancer precursors), OCP/HRT
Susceptibility genes (12%) - BRCA1/BRCA2, also increased risk iof ovarian, prostate and pancreatic malignancy. BRCA mutations cause a lifetime risk of invasive breast carcinoma of up to 85%
Name 5 malignant neoplastic breast conditions:
Breast carcinoma Carcinoma in situ (30%) Invasibe breast carcinoma (80%) Basal-like carcinoma Phyllodes tumourBreast carcinoma Carcinoma in situ (30%) Invasibe breast carcinoma (80%) Basal-like carcinoma Phyllodes tumourBreast carcinoma Carcinoma in situ (30%) Invasibe breast carcinoma (80%) Basal-like carcinoma Phyllodes tumour
Describe basal-like carcinomas:
Sheets of atypical cells with lymphocytic infiltrate
Stain positive for CK5/6/14Sheets of atypical cells with lymphocytic infiltrate
Stain positive for CK5/6/14Sheets of atypical cells with lymphocytic infiltrate
Stain positive for CK5/6/14
Incidence + Presentation of Breast carcinomas:
Most common cancer in women, lifetime risk 1 in 8
age 75-80 years (younger in Afro-Caribbeans)
99% in women
Present with hard fixed lump, Pagets disease, peau d’orange, nipple retraction
Most common cancer in women, lifetime risk 1 in 8
age 75-80 years (younger in Afro-Caribbeans)
99% in women
Present with hard fixed lump, Pagets disease, peau d’orange, nipple retraction
What is the screening programme for breast carcinoma
47 - 73 year old women are invited every 3 years for mammography (looks for abnormal areas of calcification or a mass within the breast)
What are the 2 forms of carcinoma in situ?
Lobular (LCIS)
Ductal (DCIS)Lobular (LCIS)
Ductal (DCIS)
Describe lobular carcinomas in situ:
ALWAYS an incidental finding in biopsy as no microcalcifications or stromal reactiosn
20-40% bilateral
Cells lack adhesion protein E-cadherin
Risk factor for subsequent invasive breast carcinomaALWAYS an incidental finding in biopsy as no microcalcifications or stromal reactiosn
20-40% bilateral
Cells lack adhesion protein E-cadherin
Risk factor for subsequent invasive breast carcinoma
Describe Ductal carcinoma in situ
Incidence increased dramatically since development of mammography
Appear as areas of microcalcification
10% present with clinical symptoms
Much increased risk of progressing to invasive breast Ca
High, intermediate and low gradeIncidence increased dramatically since development of mammography
Appear as areas of microcalcification
10% present with clinical symptoms
Much increased risk of progressing to invasive breast Ca
High, intermediate and low grade
Define carcinoma in situ:
neoplastic epithelial proliferation limited to ducts/lobules by basement membrane
Define invasive breast carcinoma:
Malignant epithelial tumours which infiltrate within breast, capacity to spread to distant sites.
How are invasive breast carcinoma histologically subcategorised?
Ductal Lobular Tubular MucinousDuctal Lobular Tubular Mucinous
Define invasive ductal:
carcinoma that cannot be subclassified into another group. Most common
Define invasive lobular
cells aligned in single file chains/strands
Define tubular carcinomas
Well-formed tubules with low grade nuclei. rarely palpable as
Describe mucinous invasive breast cancer:
Mucinous carcinoma cells produce abundant quantities of extracellular mucin which dissects into surrounding stroma.
How are biopsy scored
Neoplastic lesions undergo core needle biopsy to confirm histological subtype and grading. Assessment of nuclear pleomorphism, tubule formation and mitotic activity.
Each gets a score /3, total score /9.
3-5/9 = grade 1/well differentiated
6-7/9 = grade 2/moderately differentiated
8-9/9 = grade 3/poorly differentiatedNeoplastic lesions undergo core needle biopsy to confirm histological subtype and grading. Assessment of nuclear pleomorphism, tubule formation and mitotic activity.
Each gets a score /3, total score /9.
3-5/9 = grade 1/well differentiated
6-7/9 = grade 2/moderately differentiated
8-9/9 = grade 3/poorly differentiated
What are neoplastic lesions assessed for
Oestrogen receptors
progesterone receptors
HER2 receptors
Oestrogen receptors
progesterone receptors
HER2 receptors
What is associated with a good prognosis
ER/PR receptor positive is associated with good prognosis because it predicts response to tamoxifen
HER 2 positive associated with bad prognosisER/PR receptor positive is associated with good prognosis because it predicts response to tamoxifen
HER 2 positive associated with bad prognosis
What is the treatment for invasive?
Tamoxifen = mixed agnoist/antagonists of oestrogen at its receptor Herceptin/trastuzumab = monoclonal Ig to HER2 (direct toxic effect on myocardium, must monitor LVEF)Tamoxifen = mixed agnoist/antagonists of oestrogen at its receptor Herceptin/trastuzumab = monoclonal Ig to HER2 (direct toxic effect on myocardium, must monitor LVEF)
Describe Phyllodes tumour
Arises from interlobular stroma with increased cellularity and mitoses.
Present >50 years as palpable mass
Low grade or high grade lesions
Mostly relatively benign, but can be aggressive therefore excised with wide local excision/mastectomy to limit local recurrence
Mets are very rare
