Breast Flashcards
What are the main features of fibroadenoma?
Histology?
Diagnosis?
Young women with discrete mobile breast lump.
Lesion of stroma and epithelium, showing lots of proliferation.
Do an US if under 35, then a core biopsy. Show C2/ B2,B3
What are the main features of Phyllodes tumours?
Histology?
Diagnosis?
Treatment?
Ages 30-40 with lump becoming bigger in lateral half of cycle. May be painful.
Stromal changes e.g. pleomorphic, stromal overgrowth. No epithelial changes.
Core biopsy/FNA. May be benign or malignant.
Need to take out margin.
What are the main features of a radial scar?
Histology?
Diagnosis?
Treatment?
Usually asymptomatic and seen on routine mammography. Similar to tubular carcinoma.
Have myoepithelial cells which are not present in cancer.
Core biopsy to exclude cancer.
Excision to stop progression to cancer.
What are the main features of duct ectasia?
Histology?
Green/brown nipple discharge, nipple inversion, and pain. Linked to smoking and stopping can cause regression.
Squamous metaplasia of lactiferous duct.
What are the main features of intraduct papilloma?
Solitary central papilloma
What are the main features of papillomatosis?
Multiple papillomas, associated with malignancy
What are the features of nipple adenoma?
Histology?
Nipple discharge, can be bloody and contain epithelial cells.
Microcalcification and epithelial hyperplasia.
Do core biopsy to avoid surgical excision.
What are the main features of PASH?
Histology?
Premenopausal women with a hard palpable lump. Can be rapidly enlarging with skin changes.
Well defined, dense stroma, encapsulated.
What are the main features of granulomatous mastitis?
30s with distinct hard mass, usually parous. Can be caused by TB, vasculitis, sarcoid etc.
DO core biopsy
Inflammation with abscess formation.
What are atypical proliferations?
Increased risk of becoming cancer, e.g. Phyllodes.
What are risk factors for breast cancer?
Age 40-70 family history BRCA1/2 No breast feeding HRT 1st child over 30
What are the main features of DCIS?
Usually asymptomatic and seen on screening, but some bay have lump, nipple discharge, and Paget’s.
A malignant proliferation of epithelial cells contained in BM. Can be calcification. If untreated, 30% get invasive carcinoma.
What is the management of DCIS?
Complete excision, with mastectomy +/- reconstruction.
OR
Local excision and radio.
What are the main features of LCIS?
Asymptomatic and only picked up in breast biopsies. Usually multifocal and bilateral.
10x greater risk of cancer.
What is the management of LCIS?
Regular follow up for changes.
Can do bilateral mastectomy.
What are the features of invasive ductal carcinoma?
Most common cancer, with variable histology. Low grade = better prognosis, but less likely to respond to chemo.
What are the features of lobular carcinoma?
May not have a lump or a mammographic finding. Cells are in lines and shows Signet ring cells, with diffuse infiltration rather than in a lump. Usually bilateral.
Usually ER positive
What are the features of tubular carcinoma?
Similar appearance to radial scars, but without myofibroblasts.
usually well differentiated with good prognosis.
What are the features of mucinous/mucoid carcinoma?
Common in elderly (75+). Can appear similar to fibroadenoma.
Good survival.
What are routes of metastases of breast cancers?
Lymph: to nodes
Blood: to lungs, bone, liver, brain.
What is axillary staging?
Do US of axilla and core abnormal nodes. Clearance if positive, sentinel node biopsy if negative.
What are the main prognostic features in a breast cancer?
Type, size, grade, node.
Hormone receptor status (ER = good, HER = bad
What is the NPI?
Looks at grade, nodal status, and size.
Grade 1-3
Nodes 0 = 1, 1-3 = 2, 4+ = 3
Size in cm x 02.
Good <3.4, 3.4-5.4 = intermediate, >5.4 = bad.
do molecular tests if >3.4 and >20 mm
What is involved in invasive carcinoma treatment?
Mastectomy Lumpectomy + radio Axillary surgery Hormones Chemo (not often) Targeted therapy e.g. tamoxifen, aromatase inhibitors.
What are prognostic and predictive factors in breast cancer?
Prognostic: stage and grade
Predictive: ER, PR, HER2
How are cancers graded?
1 = slow growing, well differentiated. 3 = fast growing, poorly differentiated
What are the 4 main molecular subtypes in cancer?
Depends on HER2, ER, and PR.
Basal = triple negative.
Her2 = ER and PR negative, Her2 +ve.
Luminal A/normal = ER/PR+ve, Her2 -ve. Less Ki67.
Luminal B = ER/PR+ve, Her2 +ve or -ve. Grow faster and have mroe Ki67.
