Breast Disease Flashcards
what are breast lobules made up of?
acini and interlobular stroma
normal histological breast tissue
slide 3 7.1
physiological changes to breast tissue during menarche
more lobules, bigger interlobular stroma volume
physiological changes to breast tissue during menstrual cycle
after ovulation: cell proliferation, stromal oedema
menstraution: smaller lobules
physiological changes to breast tissue during pregnancy and breastfeeding
increase size and number of lobules, less stroma
filled with colostrum, breast milk
how do breasts change as we age? effect of this?
interlobular stroma replaced by adipose
so mammograms become easier to interpret as adipose is less dense
commonest benign breast tumour
fibroadenoma
benefits of mammograms
increased detection of small invasive and in situ carcinomas
presentation of breast conditions
pain (advanced)
palpable mass
nipple discharge
skin changes
lumpiness
mammogram abnormalities
breast screening programme
47-73 women
3 yearly
what’s looked for on mammograms?
- asymmetric densities e.g. carcinomas, cyst
- parenchymal deformities
- calcifications e.g. DCIS
how to assess abnormalities found on mammogram?
core biopsy, FNAC, more imaging
which breast conditions cause densities on mammogram? what do they look like?
invasive carcinoma- regular, speculated
fibroadenoma- smooth
cyst- central hole of cystic fluid
which breast conditions cause calcifications on mammogram?
ductal carcinoma in situ
bengin changes
phyllodes tumour
malignant stromal tumour, common in 6th decade of life
better imaging for young women breasts?
USS
common age for fibroadenoma
<30, reproductive age
acute mastitis
-when it happens
-organism
-symtpoms
-treatment
-lactation usually
-s. aureus
-erythematous, painful, pyrexia
-express milk, ABx
fat necrosis
-when it happens
-symptoms
-confirmation
-trauma, surgery (fat cells breakdown, macrophages and inflammatory cells surround)
-mass, skin changes, mammogram abnormality
-biopsy
fibrocystic change COMMONEST BREAST LESION
-presentation
-treatment
-histology
-mass, mammogram abnormality
-fine needle aspiration
-apocrine metaplasia, cyst, fibrosis
list some stromal tumours
fibroadenoma
phyllodes tumour
lipoma
leiomyoma
hamartoma
fibroadenoma
-presentation
-macroscopic
-histology
-mobile mass, mammogram abnormality
-well circumscribed, rubbery, grey/white
-stromal/epithelial mix
is fibroadenoma true neoplasm?
no, localised hyperplasia
hormonal causes of gynaecomastia
decreased androgen effect
increased oestrogen effect
causes of gynaecomastia
-klinefelters (XX male, infertility, small testicles)
-oestrogen excess e.g. cirrhosis
-prostate cancer oestrogen treatment
-neonates
-puberty (oestrogen peaks earlier)
most common type of breast cancer
adenocarcinoma
most common location of breast cancer
upper outer quadrant
risk factors for breast cancer
-female
-older age
-early menarche
-late menopause
-nulliparity
-obesity
-exogenous oestrogen
-bigger breast density
-radiation
-family history BRCA1/2
genes involved in breast cancer
BRCA1/2- tumour suppressor genes
p53
define in situ carcinoma
neoplastic population of cells limited to ducts and lobules by basement membrane, myoepithelial cells preserved
doesn’t invade vessels so cant metastasise
why is DCIS a problem?
-precursor to invasive carcinoma
-spread through ducts/lobules to be extensive
histology of DCIS
central (comedo) necrosis
calcification
sentinel lymph nodes for breast cancer
axillary
peau d’orange
shows involvement of lymphatic skin drainage
Paget’s disease
unilateral red, crusting, scaling, bleeding nipple as cells extend to nipple skin without crossing BM
associated with DCIS/invasive carcinoma
triple approach to diagnosing breast cancer
- clinical: FH, exam
- imaging: mammogram, USS
- pathology: core biopsy, fine needle aspiration cytology
classify breast carcinoma, and histological appearance of the main ones
invasive ductal carcinoma
70-80%
-well differentiated: tubules lined by atypical cells
-poor differentiated: sheets of atypical pleomorphic cells
invasive lobular carcinoma
-infiltrating cells in single file, lack cohesion
tubular, mucinous
why’s the spread of invasive lobular carcinoma different?
can spread to weird places e.g. peritoneum, leptomeninges, GI tract, ovaries
molecular classifications of breast cancer
-HER2 positive or negative
-oestrogen receptor positive or negative
surgeries available for breast cancer
-total mastectomy
-wide local excision
-axillary dissection surgery
hormonal treatment of breast cancer
oestrogen receptor positive: tamoxifen
HER2 receptor positive: Herceptin (trastuzumab)
staining if oestrogen receptor positive
nuclear
staining if HER2 receptor positive
cytoplasmic, around malignant cells
how to improve breast cancer survival
-early detection
-neoadjuvant chemo
-hormal treatment
-gene expression profiles
-genetic screening, prophylactic mastectomy
breast cancer staging
TNM
intraductal papilloma
-symtpoms
-why
-sponenous discharge from one nipple
-benign growth in single milk duct
