Breast And Male Reproductive Anatomy- Abnormal pathologies Flashcards
How do we image the
breast? – mammography
Mammography is the imaging method; mammogram is the image produced by it.
- There are 2 standard views – CC (craniocaudal), and MLO (mediolateral oblique)
How do we image the breast - MRI
Most sensitive (>90%) method for the detection of breast cancer.
MRI with contrast provides additional information about the morphology and function of a lesion.
It is usually combined with biopsies to confirm benign or malignant features.
How do we image the breast – PET/CT
Not used in screening – FDG is taken up by highly metabolic tissue – breast can have different uptakes depending on hormones / lactation etc – it can upstage and change patient management.
It does have a use in staging to assess for metastatic disease – 90% sensitivity approx.
Also used for advanced cancer and recurrence.
It is superior to CT in the detection of nodal disease
How do we image the breast – Ultrasound
Usual initial imaging used in symptomatic patients under 30.
Used in conjunction with pathology and mammography for diagnosis generally.
High sensitivity, lower specificity.
Useful for assessing breast cysts.
Pathology examples
Breast cancer
Ductal cancer in situ
Invasive breast cancer
Breast cysts
Breast implants
Mastectomy
Lymphadenopathy
Breast cancer summary
There are many different types from benign to precursor lesions and invasive tumours.
Up to 99% of breast cancers are adenocarcinomas.
Genetic mutations
- Annual MRI breast and CA-125 and transvaginal US if high risk.
- Risk reducing mastectomy and removal of ovaries and fallopian tubes – age 35-40
Genetic mutations
- Hereditary breast and ovarian syndrome is caused by a mutation to either BRCA1 or BRCA2 genes.
Patients have increased risk of breast, ovarian, pancreatic and prostate cancer.
BRCA genes provide instructions for making a protein that acts as a tumour suppressor – the tumour suppressor proteins help prevent cells from growing and dividing too rapidly or in an uncontrolled way. They are also involved in repairing damaged DNA.
Lifetime risk – breast cancer – 55-65%
Ovarian – 40%
Ductal carcinoma in situ: description, risk factors, symptoms, diagnosis, complications, treatments, differential diagnosis.
Description
Breast cancer limited to the ducts.
No extension beyond the basement membrane – cancer cells have not spread into the breast parenchyma and the lymph system and so cannot metastasize.
Risk factors
Increasing age
Family history of breast cancer
Nulliparity
Age of 30 or over at the birth of their first child.
Symptoms
Mostly asymptomatic
Nipple discharge / palpable abnormality.
Diagnosis
Mammogram – calcifications are common. Soft tissue opacity
US – useful to guide interventional biopsy procedures. A hypoechoic mass is the most common feature.
Complications
Can lead on to invasive disease.
Treatment
Mastectomy
Lumpectomy with / without radiation if it’s a small (<2cm)
Differential diagnosis
Invasive carcinoma
Invasive breast cancer of no special type: description, risk factors, symptoms, diagnosis, complications, treatments, differential diagnosis.
Description
Used to be called invasive ductal cancer
Most common type (70-80%)
It is an infiltrating and malignant proliferation of cells/
Risk factors
Increasing age – peak age is 50-60
Symptoms
Large, palpable, immobile mass
Diagnosis
Mammogram – irregular mass with/without calcifications, Spiculated and hyperdense, Microcalcifications
US – ill defined, hypoechoic mass. Spiculated pattern, calcifications
MRI – irregular / spiculated mass.
Complications
Prognosis depends on stage of cancer.
Ranges from 96% 10 year survival tp 44%
Treatment
Surgery
Chemotherapy and radiotherapy
Differential diagnosis
Other types of breast cancer
What are Breast metastases?
Metastatic breast cancer / secondaries / metastases.
Metastases can occur several years after the primary breast cancer – may be seen at the time or before the primary diagnosis.
Metastatic cells often differ from the primary breast cancer and are resistant to many types of treatment.
Distant metastases are the cause of about 90% of deaths due to breast cancer.
Common sites are bone, lung, regional lymph nodes, liver and brain. Most commonly the bones.
Treatment includes surgery, radiotherapy, chemotherapy
Pathophysiology
There is cell division and growth within the primary tumour.
There is invasion of the primary tumour border and the tissue surrounding.
The cells enter the blood or lymph systems.
The cells extravasate to a distant site and invade the target tissue.
The cells then multiply at the metastatic site.
They grow and form a large metastases
Breast cysts – simple: description, risk factors, symptoms, diagnosis, complications, treatments, differential diagnosis.
Description
common
Can be simple or complicated.
Aetiology
Caused by a blockage or the terminal acini and dilatation of the ducts.
Often bilateral and multifocal.
Symptoms
May be asymptomatic
May have a lump with / without pain.
Diagnosis
US – oval or round, circumscribed margins, smooth walls
Mammography – oval or round, circumscribed margins
Complications
Simple cysts are benign.
Treatment
If small – no treatment
If large – may need aspiration.
Differential diagnosis
Complicated cysts.
Complicated cysts can imitate a solid mass.
Low risk of malignancy but need follow up.
If there are changes in size biopsy is recommended
Where are breast implants placed and what are the complications?
Can be placed,
Behind the glandular tissue, but in front of the pectoral muscle.
Behind the pectoral muscle.
Can be made of saline, silicone or a mix of both.
Complications include
Rupture
Infection
NOTE
On imaging particularly CXR’s be careful the breast implant doesn’t obscure or imitate pathology
What is Mastectomy?
Surgical treatment for breast cancer.
Entire breast tissue is removed sometimes with lymph nodes.
Male reproductive system pathology examples
Testicular cancer
Prostate cancer
Varicocele
Testicular cancer: description, risk factors, symptoms, diagnosis, complications, treatments, differential diagnosis.
Description
Most common malignancy in men aged 20-34
Relatively rare
Most are primary germ cell tumours
Causes
Germ cells
A germ cell in women eventually mature into eggs, in men the germ cells mature into sperm.
Therefore germ cell tumours most commonly form where eggs (ovaries) and sperm (testicles) are made.
Mutations are thought to begin in the womb as the foetus develops.
These germ cells divide abnormally and form a tumour.
They can be malignant or benign.
Teratomas (dermoid cysts) – tumours that contain teeth, hair and bone – usually benign.
Symptoms
Solid, firm lump, oddly shaped testicle, back pain.
Diagnosis
Depends on the type of tumour.
MRI is best for staging
US also commonly used for initial investigation.
Complications
Tend to metastasise to the lymphatic system, then the lung, liver and bone.
Treatment
Orchidectomy followed by chemotherapy.
Differential diagnosis
The type of tumour
Prostate cancer: description, risk factors, symptoms, diagnosis, complications, treatments, differential diagnosis.
Description
Most common primary malignant tumour in men.
There is a difference between clinically significant and insignificant cancer
95% are adenocarcinomas.
Cause
Increasing age
Symptoms / clinical presentation:
Urinary symptoms
Haematuria
Back pain
An elevated PSA
Diagnosis
US – transrectal US – diagnose and guide a biopsy. Will see a hypoechoic region
MRI – normally done post biopsy to see if there is extracapsular extension. Will see a region of mixed signals
CT – only really used in advanced disease to look for enlarged lymph nodes
Nuclear medicine – bone scans for mets
Complications
Can spread by local invasion (commonly bladder), lymphatic spread and mets to bone, lung, liver, pleura and adrenal glands.
Treatment
Depends on stage.
If there is no spread, there is curable disease – prostatectomy, brachytherapy and / or radiotherapy.
Differential diagnosis
Benign prostate hypertrophy
What is Brachytherapy?
Type of radiation therapy.
A radioactive source is placed within the prostate – small beads – gives a high radiation dose to the prostate and much lower dose to the rectum and bladder.
On plain radiography and CT
Multiple, small linear metallic density radiopacities in the region of the prostate.
What is Varicocele?
This is the dilation of the veins found in the male spermatic cord.
Seen in adolescents and above.
Patients may present with pain and a scrotal mass.
On imaging
US – dilatation of the veins
CT – a dilated cluster of veins
MRI – dilated veins that enhance following gadolinium administration.
This is a surgically correctable cause of male infertility.
Patients can have embolization of the testicular vein
What is Varicocele embolisation?
Interventional radiography.
This is a way to treat varicoceles by embolising the testicular vein .
Access is via the internal jugular vein or the common femoral vein.
By blocking off the enlarged vein the veins shrink and new collateral veins develop.
