Breast Disease

Question 1

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?

Answer 1

Terminal ductal-lobular unit

Cuboidal epithelium lining the ductile
Myoepithelial cells resting on the basement membrane

Interlobular and intralobular stroma

Question 2

What ligaments keep the breast anchored to the chest wall?

Answer 2

Coopers ligaments (suspensory ligaments)

Question 3

Describe the physiological changes that are seen in breast tissue at each of these stages.

Answer 3

Menarche - increased lobules/ interlobular stroma

Post-ovulation - stromal oedema, ductal cell proliferation

Pregnancy - increase in size and number of lobules, decreased stroma - more secretory

Question 4

Why are mammograms easier to interpret in elderly patients?

Answer 4

TDLU decrease in number and size

Interlobular stroma is replaced by adipose tissue

Question 5

Between what ages are women invited for breast cancer screening?

Answer 5

47-73 every year

Question 6

Give two disorders of breast development.

Answer 6

Polythelia

Accessory axillary breast tissue

Question 7

Acute mastitis.

Causative organism?

Symptoms?

Treatment?

Answer 7

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

Question 8

What is often in the history of someone with fat necrosis of the breast?

Mammogram?

Answer 8

Trauma/ surgery

Microcalcifications

Question 9

Fibrocystic disease.

Pain presentation?

Mammogram abnormalities?

Answer 9

Bilateral cyclic pain

Calcification

Question 10

Fibro adenoma

Why does it increase in size during pregnancy and decrease in size post-menopausal?

Examination?

Age range?

Answer 10

High estrogen response

Well circumscribed, mobile, rubbery mass.

20-24 yo

Question 11

Phyllodes tumour.

Risk?

Size on examination vs fibro adenoma?

Histological appearance.
How can you distinguish it’s histology from fibro adenoma?

Treatment?

Answer 11

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.

Question 12

Give 3 benign lesions of breast.

Answer 12

Fibro adenoma
Fibrocystic disease
Phyllodes tumour

Question 13

Why do malignant breast tumours arise form the upper-outer quadrant?

Main type?

Answer 13

Most dense region of the breast and therefore most epithelium in this region.

Adenocarcinoma

Question 14

What can increase breast cancer risk in males?

Give some risk factors for breast cancer.

Answer 14

Kleinfelters syndrome
Male to female transsexuals
Men treated with oestrogen for prostate cancer

Early menarche
Late menopause 
Nullparity 
Obesity 
BRCA1/BRCA2

Question 15

What syndrome is linked to germline mutations of the p53 tumour supressor gene?

What cancers is this person pre-disposed to?

Answer 15

Li-Fraumeni syndrome

Sarcoma
Breast
Leukaemia

Question 16

DCIS.

Describe histopathology.

Typically presents how?

Answer 16

Neoplasticism cells limited to the ducts and lobules by the basement membrane
Myoepthelial cells are preserved.

Mammographic calcifications (clusters or linear/branching) (rarely symptomatic)

Question 17

Paget’s disease.

Symptoms?

Cells seen?

Answer 17

unilateral red and crusting nipple
Straw coloured, blood discharge

Paget’s cells. 1

Question 18

Why does peas de‘ orange occur?

Why does nipple inversion occur?

Answer 18

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

Question 19

What is the most common type of breast carcinoma?

Which type has an excellent prognosis?

Answer 19

Invasive ductal carcinoma

Mucinous.

Question 20

What makes metastasis of ILC unique?

Answer 20

Can spread to odd sites such as the peritoneum, retroperitoneum, leptomeninges, GI tract, ovaries and uterus.

Question 21

What is the main phenotype for BRCA1 tumours?

Which molecular type of breast cancer has the worst prognosis?

What molecular types have better prognoses?

Answer 21

Her-2 and ER negative

ER negative but her 2 positive.

ER positive.

Question 22

What are two pathology techniques that can be used to diagnose breast cancer?

Answer 22

Core biopsy

Fine needle aspiration cytology

Question 23

What percentage of cancers are ER positive compared to HER-2 positive?

Proper name for herceptin?

Answer 23

ER positive - 80%
Her-2 - 20%

Trastuzumab

Question 24

Intraductal papilloma presentation?

Answer 24

Bloody nipple discharge

Question 25

Symptoms of duct ectasia.

Tx

Answer 25

Nipple discharge 
Retracted nipple
Peri-ductal mastitis 
Abscess
Fistula forms 

Surgical excision of the major duct
Correction of nipple retraction

Question 26

What is the difference between a staph/ strep infection of the breast?

Answer 26

Strep more diffuse and superficial treated with ABx whereas staph

Staph more local requires incision and drainage.