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SYSTEMIC PHARMACOLOGY > Breast > Flashcards

Breast Flashcards

1
Q

4 groups of diseases of breast**

A
  • Inflammatory disorders: mastitis, fat necrosis
  • Benign epithelial diseases: fibrocystic changes
  • Neoplastic conditions: fibroadenoma, carcinoma
  • Gynecomastia
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2
Q

diagnostic tests for breast (3)**

A
  • Clinical examination
  • Radiology – ultrasound, Mammogram, MRI
  • Pathology – FNA (fine needle aspiration), Core Biopsy, Excision Biopsy
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3
Q

acute mastitis pathogenesis

A

proliferation of staphs in milk

  • > acute inflammation w/ neutrophils
  • > acute abscess formation
  • > inflammatory breast cancer
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4
Q

treatment of breast abscess (3 steps)

A
  1. incise and drain
  2. antibiotics
  3. excision
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5
Q

idiopathic granulomatous mastitis

  • what type of disease
  • who it affects
  • complications
A 
inflammatory disease (rare)
parous women (given birth)

TB (granulomatous inflammation)

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6
Q

treatment of idiopathic granulomatous mastitis (3)

A

steroids
immunosuppressives
surgery

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7
Q

breast augmentation causes (3)

A
  • paraffin injections
  • implants
  • autologous tissue (tissue taken from somewhere else then implanted into the breast
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8
Q 
breast augmentation (paraffin injections) complications
\+ micro characteristics
A

paraffinoma

- multinucleate giant cell rxn

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9
Q

fibrocystic change (FCC)

  • occurs at which age group
  • clinical presentation
  • micro features (4)**
  • complication
A

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
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10
Q

histological classification of breast neoplasms (8)**

A
  • 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
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11
Q

fibroadenoma

  • what type of tumour
  • affects who
  • macro + micro characteristics
  • behavior
A

benign fibroepithelial tumour
young women (25yrs)
firm, well defined lump
proliferation of glandular and stromal elements, circumscribed and uniform

can recur/regress

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12
Q

phyllodes tumour

  • what type of tumour
  • origin
  • microscopic appearance
  • complication
A

fibroepithelial
leaflike architecture. not well circumscribed - some parts enter adjacent tissue
risk of malignancy (higher than fibroadenoma)

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13
Q

risk factors of breast cancers (6)**

A
  • 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)
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14
Q

clinical presentation of breast cancers (5)**

A
  • Palpable NON MOBILE mass
  • Nipple discharge, nipple retraction, Paget’s disease
  • lumps in axillary area
  • skin: tethering/ ulcerations
  • Mammographic density and calcifications
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15
Q

non-invasive malignant epithelial carcinomas of breast (5 types)

A
  • 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
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16
Q

in-situ cancer vs
invasive cancer vs
metastatic cancer

A
  • 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
17
Q

DCIS presentation (5)

A 
Incidental finding 
Mammographic density 
Nipple discharge 
Paget’s disease 
Palpable mass
18
Q

LCIS presentation

A

Incidental finding

not associated with calcifications or stromal desmoplastic reactions that produce mammographic densities

19
Q

location: DCIS vs LCIS

A

DCIS: ducts
LCIS: lobules
(based on their name DUH)

20
Q

cell size: DCIS vs LCIS

A

DCIS: medium/large
LCIS: Small

21
Q

histological subtypes: DCIS vs LCIS

A 
DCIS: 
- Comedo (prominent apoptotic cell death and has greater malignant potential
- cribriform
- solid
- papillary
- micropapillary 
LCIS:
- solid
22
Q

presence of calcifications: DCIS vs LCIS

A

DCIS: may be present
LCIS: absent

23
Q

Risk of subsequent invasive breast cancer + location: DCIS vs LCIS

A

DCIS: higher risk. ipsilateral invasion -> increases risk of invasice carcinoma by 10 times
LCIS: lower risk. can be ipsilateral/contralateral

24
Q

types of breast carcinoma (8)

A
  • Lobular **
  • Mucinous
  • Tubular
  • Papillary
  • Apocrine
  • Micropapillary
  • Medullary
  • Secretory
    no special type
25
Q

lobular carcinoma

  • association
  • gross features
  • micro features
  • complications
A
  • **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

26
Q

medullary carcinoma

  • histo features
  • prognosis
  • metastasis
A
  • 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
27
Q

tubular carcinoma

  • micro features
  • prognosis
  • metastasis
A
  • 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
28
Q

Paget’s disease

  • what is it
  • pathogenesis
  • location
  • gross appearance
A
  • 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
29
Q

factors affecting prognosis of breast cancers (6)

A 
(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
30
Q

male breast diseases (2)

A
  • gynaecomastia

- carcinoma (rare)

31
Q

causes of gynaecomastia (6)**

A
  • pubertal: hormonal imbalance
  • testicular atrophy
  • liver cirrhosis
  • estrogen secreting tumours
  • increased prolactin levels
  • drugs: digoxin
32
Q

frequency of breast screening

A

40-49: once a year

>50: once every 2 years

33
Q

what increases risk of malignancy of FCC (fibrocystic change)**

A
  • epithelial hyperplasia
  • atypical ductal hyperplasia
  • sclerosing adenosis (ductal proliferation)
34
Q

invasive ductal carcinoma histological features**

A
  • invasive glandular structures
  • desmoplastic stroma (dense connective tissue)
  • malignancy cytologica features
35
Q

symptoms of metastatic disease (4)

A
  • bone pain
  • jaundice
  • pleural effusion
  • weight loss
36
Q

what organism is likely to be found in breast abscess

A

staph aureus

37
Q

gynaecomastia clinical presentation

A

BILATERAL breast enlargement

SYSTEMIC PHARMACOLOGY (22 decks)

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