Breast Flashcards
4 groups of diseases of breast**
- Inflammatory disorders: mastitis, fat necrosis
- Benign epithelial diseases: fibrocystic changes
- Neoplastic conditions: fibroadenoma, carcinoma
- Gynecomastia
diagnostic tests for breast (3)**
- Clinical examination
- Radiology – ultrasound, Mammogram, MRI
- Pathology – FNA (fine needle aspiration), Core Biopsy, Excision Biopsy
acute mastitis pathogenesis
proliferation of staphs in milk
- > acute inflammation w/ neutrophils
- > acute abscess formation
- > inflammatory breast cancer
treatment of breast abscess (3 steps)
- incise and drain
- antibiotics
- excision
idiopathic granulomatous mastitis
- what type of disease
- who it affects
- complications
inflammatory disease (rare) parous women (given birth)
TB (granulomatous inflammation)
treatment of idiopathic granulomatous mastitis (3)
steroids
immunosuppressives
surgery
breast augmentation causes (3)
- paraffin injections
- implants
- autologous tissue (tissue taken from somewhere else then implanted into the breast
breast augmentation (paraffin injections) complications \+ micro characteristics
paraffinoma
- multinucleate giant cell rxn
fibrocystic change (FCC)
- occurs at which age group
- clinical presentation
- micro features (4)**
- complication
benign epithelial breast lesion
- reproductive age group
- lumps (not localised)
(CASE)
- **stromal sclerosis/ fibroadenomatoid change,
cystic dilation of ducts,
epithelial hyperplasia,
apocrine metaplasia (breast epithelial cells -> sweat glandular cells)
- risk of malignancy
histological classification of breast neoplasms (8)**
- Epithelial tumours: Papilloma, carcinoma
- Myoepithelial tumours: adenomyoepithelioma
- Fibroepithelial tumours – fibroadenoma, phyllodes
- Mesenchymal tumours - lipoma
(mesenchymal cells -> develop into connective/lymphatic tissue) - Tumours of nipple – Paget’s
- Malignant lymphoma
- Metastatic tumours
- Tumours of male breast – gynecomastia, carcinoma
fibroadenoma
- what type of tumour
- affects who
- macro + micro characteristics
- behavior
benign fibroepithelial tumour
young women (25yrs)
firm, well defined lump
proliferation of glandular and stromal elements, circumscribed and uniform
can recur/regress
phyllodes tumour
- what type of tumour
- origin
- microscopic appearance
- complication
fibroepithelial
leaflike architecture. not well circumscribed - some parts enter adjacent tissue
risk of malignancy (higher than fibroadenoma)
risk factors of breast cancers (6)**
- caucasian
- perimenopausal age (before menopause - 40yrs)
- nulliparous (never given birth) or give birth >30 yrs
- early menarche (start menstruation early)/ late menopause
- high socio-economic status: obese/ alcohol
- past history of breast disease/ family history (affects 5% - BRCA1 gene mutation)
clinical presentation of breast cancers (5)**
- Palpable NON MOBILE mass
- Nipple discharge, nipple retraction, Paget’s disease
- lumps in axillary area
- skin: tethering/ ulcerations
- Mammographic density and calcifications
non-invasive malignant epithelial carcinomas of breast (5 types)
- Ductal carcinoma in-situ
- Lobular carcinoma in-situ: tend to be invasive
- NST (no special type)
- Special types – mucinous, tubular, medullary, micropapillary, metaplastic etc
- Lobular carcinomas
in-situ cancer vs
invasive cancer vs
metastatic cancer
- in-situ cancer: basement membrane intact
- invasive cancer: basement membrane disrupted, invasion into surrounding stroma
- metastatic cancer: distal spread through blood vessels to lymph nodes/ distant organ
DCIS presentation (5)
Incidental finding Mammographic density Nipple discharge Paget’s disease Palpable mass
LCIS presentation
Incidental finding
not associated with calcifications or stromal desmoplastic reactions that produce mammographic densities
location: DCIS vs LCIS
DCIS: ducts
LCIS: lobules
(based on their name DUH)
cell size: DCIS vs LCIS
DCIS: medium/large
LCIS: Small
histological subtypes: DCIS vs LCIS
DCIS: - Comedo (prominent apoptotic cell death and has greater malignant potential - cribriform - solid - papillary - micropapillary LCIS: - solid
presence of calcifications: DCIS vs LCIS
DCIS: may be present
LCIS: absent
Risk of subsequent invasive breast cancer + location: DCIS vs LCIS
DCIS: higher risk. ipsilateral invasion -> increases risk of invasice carcinoma by 10 times
LCIS: lower risk. can be ipsilateral/contralateral
types of breast carcinoma (8)
- Lobular **
- Mucinous
- Tubular
- Papillary
- Apocrine
- Micropapillary
- Medullary
- Secretory
no special type
lobular carcinoma
- association
- gross features
- micro features
- complications
- **E cadherin mutation
- mass w/ irregular border
- infiltrative tumour cells often arranged in a single file/loose clusters/sheets
No tubule formation
Minimal/no desmoplasia
May have signet-ring cells - metastasis (peritoneum & retroperitoneum, leptomeninges, GIT, ovary & uterus)
- mutation: form Invasive lobular carcinoma/ Signet-ring cell gastric adenocarcinoma
does not form glands
single cell lined up
medullary carcinoma
- histo features
- prognosis
- metastasis
- Well-circumscribed, soft, fleshy
Little desmoplasia
Solid sheets of large cells with vesicular pleomorphic nuclei & prominent nucleoli
presence of mitotic figures
Lymphocytic infiltrate: pushing non-infiltrative borders
Poorly differentiated - better prognosis than IDC (invasive ductal carcinoma)
- does not usually metastasise
tubular carcinoma
- micro features
- prognosis
- metastasis
- Small irregular masses
Well-formed tubules without myoepithelial cell layer
May see cribriform pattern, apocrine metaplasia or intraluminal calcifications - good prognosis
- may metastasise to axillary lymph nodes
Paget’s disease
- what is it
- pathogenesis
- location
- gross appearance
- DCIS involving nipple
- Extension of DCIS along ducts within the epithelial layer to the area under the skin over nipple
- UNILATERAL
- ulceration of nipple, erythematous eruption with a scaley crust
factors affecting prognosis of breast cancers (6)
(based on gross features) - TNM stage** T: size of tumour, invasion of pectoralis, invasion of skin/ ulceration N: nodal involvement - how many M: metastasis
(based on micro features) - grade (3 grades)** tubule formation, mitosis, nuclear pleomorphism - histologic subtype - lymph/vascular invasion
(based on immunohistochemical stains)
- whether it involves estrogen/progesterone receptors (ER/PR) -> HR (hormone receptor) positive will have better prognosis
- CerB2 (growth factor) amplification
male breast diseases (2)
- gynaecomastia
- carcinoma (rare)
causes of gynaecomastia (6)**
- pubertal: hormonal imbalance
- testicular atrophy
- liver cirrhosis
- estrogen secreting tumours
- increased prolactin levels
- drugs: digoxin
frequency of breast screening
40-49: once a year
>50: once every 2 years
what increases risk of malignancy of FCC (fibrocystic change)**
- epithelial hyperplasia
- atypical ductal hyperplasia
- sclerosing adenosis (ductal proliferation)
invasive ductal carcinoma histological features**
- invasive glandular structures
- desmoplastic stroma (dense connective tissue)
- malignancy cytologica features
symptoms of metastatic disease (4)
- bone pain
- jaundice
- pleural effusion
- weight loss
what organism is likely to be found in breast abscess
staph aureus
gynaecomastia clinical presentation
BILATERAL breast enlargement
