Breast Disease

Question 1

What are the different types of breast disease that can occur?

Answer 1

Inflammatory conditionsBenign epithelial lesionsStromal tumoursBreast carcinoma

Question 2

Give some pathological breast changes that can occur

Answer 2

Development disordersInflammatory conditionsbenign epithelial lesionsStromal tumoursGynecomastia Breast carcinoma

Question 3

What kind of development disorders can you get?

Answer 3

milk line remnantsaccessory axillary breast tissue

Question 4

Give some inflammatory condition of the breast

Answer 4

acute mastitisduct ectasiafat necrosis

Question 5

Give some benign epithleial lesions

Answer 5

fibrocystic changeepithelial hyperplasiapapilloma

Question 6

Give some stromal tumours

Answer 6

fibroadenomaphyllodes tumourlipomahamartoma

Question 7

What are some presentation of breast conditions?

Answer 7

PainPalpable massNipple dischargeSkin changesLumpinessMammographic abnormalities

Question 8

Give some of the common age ranges for different breast conditions

Answer 8

Fibroadenomas- occur at any repro. age- often in

Question 9

How are breast lesions investigated and diagnosed?

Answer 9

1. Clinical - history, family history, examination2. Radiographic imaging- mammogram, ultrasound3. Pathology- fine needle aspiration cytology- core biopsy

Question 10

Describe acute mastitis

Answer 10

• commonly due to staph. aureus- mainly occurs during lactation- erthymatous, painful breast, fever- can produce breast masses- treated by expressing milk and antibiotics

Question 11

Describe duct ectasia

Answer 11

• dilation and inflammation of lactiferous ducts- lots of macrophages are present- common in 50s and 60s- can have a peri-alveolar mass and/or nipple discharge- can mimic carcinoma clinically

Question 12

Describe fat necrosis

Answer 12

• presents as mass, skin changes, mammographic abnormality- often have a history of trauma or surgery- can mimic carcinoma clinically and mammographically- adipocytes and inflammatory cells

Question 13

Describe gynaecomastia

Answer 13

Enlargement of the male breast- uni or bilateral- seen at puberty and in elderly- can mimic male breast cancer, especially if unilateral

Question 14

What can gynaecomastia indicate?

Answer 14

Hormonal abnormalityLiver cirrhosisFunctioning testicular tumourAlcoholMarijuana useHeroin useAnabolic steroid use

Question 15

Describe fibrocystic change

Answer 15

Are benign epithelial lesions and are VERY commonMass often disappears after FNAC

Question 16

Describe epithelial hyperplasia

Answer 16

Benign epithelial lesions- proliferations of epithelial cells which fill and distend ducts and lobules- associated with a slight risk of cancer

Question 17

Describe papilloma

Answer 17

Benign tumour which grow with finger-like projections- usually in lactiferour ducts near the nipple - intraduct lesions with multiple branching cores covered by myoepithelial and epithelial cells

Question 18

Describe a fibroadenoma

Answer 18

Stromal tumourLooks like lumpy golf ballPresent with mass which is mobile- younger women- can mimic carcinoma clinically and mammographically

Question 19

Describe a phyllodes tumour

Answer 19

Stromal tumour- present as mass/mammographic abnormality- occur in older women (>60)Have three varieties1. benign (most common)2. malignant3. borderlineNeed to be excised with a wide margin (prevent reoccurrence)Malignant behave aggressively, recur often and metastasise via the blood

Question 20

What are some risk factors for breast cancer?

Answer 20

Most are related to oestrogen exposure- gender- long interval between menarche and menopause- reproductive history- obesity- exogenous oestrogens- geographic influence- atypical changes on previous biopsy- genetics(BRCA1 and 2 tumour suppresor genes have a mutation)

Question 21

How can breast cancers be classified?

Answer 21

• 95% are adenocarcinomas- divided into in-situ and invasive- can be ductal or lobular- tend to be in the upper outer quadrant of breast tissue

Question 22

Describe in-situ carcinoma

Answer 22

Neoplastic cells are linited to duct and lobules by the basement membrane- have both layers of epithelium- doenst invade into vessels- cells can extend to the nipple skin without crossing the BMe.g. Pagets disease of breast, unilateral red and crusting nipple

Question 23

Describe ductal in-situ carcinoma

Answer 23

Commonly presents as mammographic calcifications- clusters or linear and branchingSpreads through ducts and lobulesOften have central necrosis with calcification due to poor blood supply to the centre

Question 24

Describe invasive carcinoma

Answer 24

Invades beyond the BM into the stroma- can invade vessels, causing metastases- by the time the tumour is palpable, more than half with have metastases to the axillary lymph nodesHave two types

Question 25

What are the two main types of invasive carcinoma?

Answer 25

Invasive ductal carcinoma, no specific typeInvasive lobular carcinoma

Question 26

What are some other, less common types of invasive carcinoma?

Answer 26

• tubular (good prognosis)- mucinous - medullary- papillary

Question 27

Where to metastases of breast cancer usually occur?

Answer 27

Lymph nodes - ipsilateral axillaDistant metasteses via blood vessels- lung, bone, liver, brain– BONE is the most common metastasis

Question 28

Where are some odd sites that invasive lobular carcinoma can spread to?

Answer 28

• peritoneum- retroperitoneum- leptomeninges- GI tract- ovaries- uterus

Question 29

What are the factors that determine the prognosis of breast cancer?

Answer 29

• in situ vs. invasive- tumour grade- tumour stage- gene expression aptters

Question 30

What is gene expression patterns?

Answer 30

Microarrays examine expression and it can correctly determine about 90% of women who would go on to develop metastases. This can help to determine treatment - if they are more likely to get metastases, they are more likely to be give chemotherapy and vice versa.

Question 31

What are the two main types of control in breast cancer?

Answer 31

Local and regional controlSystemic control

Question 32

Give some examples of local and regional control

Answer 32

Breast surgeryAxillary surgeryPost-operative radiotherapy to the chest

Question 33

Give some things that must be taken into consideration when offering axillary surgery

Answer 33

Can get post-operative lymphoedema which can be unsightly and uncomfortable both physically and mentally for the patient. Try not to avoid lymph nodes if possible.

Question 34

Give some methods of systemic control

Answer 34

ChemotherapyHormonal treatment- tamoxifenHerceptin treatment

Question 35

Describe tamoxifen treatment

Answer 35

Given if a high number of oestrogen positive receptors are found on assessment- any oestrogen binding to these receptors will excite the cell and cause it to grow- brown stain in the nuclei- tamoxifen is the antagonist to this receptor

Question 36

Describe herceptin treatment

Answer 36

Given if it is found that there is an overexpression of HER2 receptors- are human epidermal growth factor receptors therefore need to block to prevent growth of cellHerceptin is a monoclonal antibodu that interferes with the HER2 receptor- brown stain on the cell membrane

Question 37

What is looked for in mammographic screening?

Answer 37

• asymmetric differences- parenchymal deformities- calcifications

Question 38

What further investigations occur following finding abnormalities?

Answer 38

Further imagingFNACBiopsy