Breast Disease Flashcards
What is the functional unit fo the breast?
What two types of cell make up the lobules?
What two types of stroma are there in the breast?
Terminal ductal-lobular unit
Cuboidal epithelium lining the ductile
Myoepithelial cells resting on the basement membrane
Interlobular and intralobular stroma
What ligaments keep the breast anchored to the chest wall?
Coopers ligaments (suspensory ligaments)
Describe the physiological changes that are seen in breast tissue at each of these stages.
Menarche - increased lobules/ interlobular stroma
Post-ovulation - stromal oedema, ductal cell proliferation
Pregnancy - increase in size and number of lobules, decreased stroma - more secretory
Why are mammograms easier to interpret in elderly patients?
TDLU decrease in number and size
Interlobular stroma is replaced by adipose tissue
Between what ages are women invited for breast cancer screening?
47-73 every year
Give two disorders of breast development.
Polythelia
Accessory axillary breast tissue
Acute mastitis.
Causative organism?
Symptoms?
Treatment?
Staph aureus (spread through cracks and fissures)
Erythematous painful breast with a fever
+/- abscess
NSAIDs, ice packs
Continue breast feeding to allow for ejection of bacteria
What is often in the history of someone with fat necrosis of the breast?
Mammogram?
Trauma/ surgery
Microcalcifications
Fibrocystic disease.
Pain presentation?
Mammogram abnormalities?
Bilateral cyclic pain
Calcification
Fibro adenoma
Why does it increase in size during pregnancy and decrease in size post-menopausal?
Examination?
Age range?
High estrogen response
Well circumscribed, mobile, rubbery mass.
20-24 yo
Phyllodes tumour.
Risk?
Size on examination vs fibro adenoma?
Histological appearance.
How can you distinguish it’s histology from fibro adenoma?
Treatment?
Can be malignant
Much larger
Nodules of proliferating stroma covered by epithelium - lead like appearance
Stroma is much more cellular and atypical in phyllodes tumour.
Excise with large margin or high risk of recurrence.
Give 3 benign lesions of breast.
Fibro adenoma
Fibrocystic disease
Phyllodes tumour
Why do malignant breast tumours arise form the upper-outer quadrant?
Main type?
Most dense region of the breast and therefore most epithelium in this region.
Adenocarcinoma
What can increase breast cancer risk in males?
Give some risk factors for breast cancer.
Kleinfelters syndrome
Male to female transsexuals
Men treated with oestrogen for prostate cancer
Early menarche Late menopause Nullparity Obesity BRCA1/BRCA2
What syndrome is linked to germline mutations of the p53 tumour supressor gene?
What cancers is this person pre-disposed to?
Li-Fraumeni syndrome
Sarcoma
Breast
Leukaemia
DCIS.
Describe histopathology.
Typically presents how?
Neoplasticism cells limited to the ducts and lobules by the basement membrane
Myoepthelial cells are preserved.
Mammographic calcifications (clusters or linear/branching) (rarely symptomatic)
Paget’s disease.
Symptoms?
Cells seen?
unilateral red and crusting nipple
Straw coloured, blood discharge
Paget’s cells. 1
Why does peas de‘ orange occur?
Why does nipple inversion occur?
Cancer cells enter and block off lymphatic causing lymphatic build up in the interstitial space.
Usually would cause swelling but suspensory ligaments do not allow for the skin to stretch so the skin becomes thickened and dimpled
Fibrosis of the lactiferous ducts and suspensory ligaments
What is the most common type of breast carcinoma?
Which type has an excellent prognosis?
Invasive ductal carcinoma
Mucinous.
What makes metastasis of ILC unique?
Can spread to odd sites such as the peritoneum, retroperitoneum, leptomeninges, GI tract, ovaries and uterus.
What is the main phenotype for BRCA1 tumours?
Which molecular type of breast cancer has the worst prognosis?
What molecular types have better prognoses?
Her-2 and ER negative
ER negative but her 2 positive.
ER positive.
What are two pathology techniques that can be used to diagnose breast cancer?
Core biopsy
Fine needle aspiration cytology
What percentage of cancers are ER positive compared to HER-2 positive?
Proper name for herceptin?
ER positive - 80%
Her-2 - 20%
Trastuzumab
Intraductal papilloma presentation?
Bloody nipple discharge
