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Integration for Clinical Application > Breast Disease > Flashcards

Breast Disease Flashcards

1
Q

What are the normal histological features of normal breast tissue?

A
  • Ducts and acini arranged into lobules
  • Dual layer of epithelium
    • Inner layer cuboidal
    • Outer layer of myoepthilium to allow contraction
  • Surrounded by adipose tissue
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2
Q

What physiologial changes are seen in breast tissue throughout a womans life?

A

Pre-puberty: few lobules (identical to male)

Menarche: increased number of lobules, increased volume of interlobular stroma

Menstrual cycle: follicular lobules develop to prepare for pregnancy, after ovulation see proliferation and stromal oedema, with menstruation a decrease in lobule size

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3
Q

What does breast tissue look like in pregnancy?

A
  • Less fibromuscular stroma
  • Lobules contain colostrum - white + fluffy
  • Will go back to normal afterwards
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4
Q

What physiological changes are seen in breast tissue with increasing age?

A
  • Decrease in number and size of terminal duct lobular units
  • Interlobular stroma is replaced by adipose tissue - fattier breast compared with younger woman
    • makes examining breasts easier if older
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5
Q

How can breast conditions present?

A
  • Pain
  • Palpable mass
  • Nipple dicharge
  • Skin changes
  • Lumpiness
  • Mammographic abnormalities (picked up on screening)
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6
Q

What does cyclical and diffuse breast pain suggest?

A

Often phsycological or linked to periods, can’t do much to treat the pain

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7
Q

What does non-cyclical and focal breast pain suggest?

A

could be:

  • ruptured cysts
  • injury
  • inflammation
  • only occasionally would cancer cause pain
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8
Q

What breast conditions can cause a palpable mass?

A
  • Normal nodularity
  • Invasive carcinoma
  • Fibroadenomas
  • Cysts

Most worrying if hard, craggy and fixed

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9
Q

What would densities on a mammmogram suggest?

A
  • Invasive carcinoma
  • Fibroadenoma
  • Cysts
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10
Q

What would calcification on a mammogram suggest?

A
  • Ductal carcinoma in situ (DCIS)
  • May be benign
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11
Q

Briefly explain the principles of the breast screening programme (UK)

A

Mammogram performed on wome aged 47-73 invited every 3 years

Increases detection of small invasive tumours and in situ carcinomas

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12
Q

What is the most common type of benign breast tumour?

A

Fibroadenoma

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13
Q

What age group do breast fibroadenomas most commonly appear in?

A

<30 years

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14
Q

What is a phyllodes tumour?

A

A very rare breast neoplasm

Although very similar to a fibroadenoma, the stromal component is hypercellular with increased pleomorphism and mitotic activity

Presents mostly in women in 6th decade

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15
Q

What is acute mastitis?

A
  • Usually a Staphylococcus aureus infection from cracked nipples from breastfeeding
  • Breast is erythematous and often pyrexic
  • May produce abscesses
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16
Q

How is acute mastitis treated?

A

Expressing milk and antibiotics

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17
Q

What occurs in breast fat necrosis?

A
  • Destruction of fatty tissue surrounded by macrophages and inflammatory cells
  • Often have a history of trauma or surgery
  • Can mimic carcinoma clinically and on mammograms
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18
Q

What is the most common type of breast lesion?

A

Fibrocystic change

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19
Q

What changes are seen in benign epithelial fibrocystic breast disease?

A
  • May present as a mass or on mammogram
  • Often dissapears after fine needle aspiration
    • but can come back as cyst refills
  • Histology - see cysts, fibrosis and apocrine metaplasia (pink cells) and large dilated ducts
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20
Q

What are breast fibroadenomas? a.k.a breast mouse

A
  • Present as a mass, usually mobile or mammographic abnormality
  • Can be multiple and bilateral
  • Can grow very large and replace msot of the breast
21
Q

How do fibroadenomas appear macroscopically?

A

Well circumscribed, rubbery, greyish/white

Can easily be scooped out in surgery without removing surrounding tissue

22
Q

What do brest fibroadenomas look like histologically?

A

A mix of stromal and epithelial elements

23
Q

What is gynaecomastia?

A
  • Enlargement of male breast
  • Unilateral or bilateral
  • Often seen at puberty and the elderly
  • Caused by relative decrease in androgen effect or increase in oestrogen
  • Can mimic male breast cancer if unilateral
  • No increased risk of cancer
24
Q

Why does gynaecomastia occur in most neonates?

A

Due to circulating maternal and placental oestrogens and progresterone

25
Q

What are some of the causes of gynaecomastia?

A
  • Transiet gynaecomastia: affects more than 1/2 boys in puberty as oesterogen production peaks earlier than testosterone
  • Klinefelter’s syndrome: XXY chromosome
  • Oestrogen excess: if patient has liver cirrohosis oestrogen cannot be effectively metabolised
  • Gonadotrophin excess: functioning testicular tumour e.g. Leydig and Sertoli tumours, germ cell tumours
  • Drug related: spironolacton,e chlorpromazine, digitalise, cimetidine, alcohol, marijuana, heroin, anabolic steroids
26
Q

What is the most common type of breast cancer?

A

Adenocarcinoma

27
Q

In what location do approximately 50% of breast cancers occur?

A

Upper outer qudrant

28
Q

List some risk factors for developing breast cancer

A
  • Female
  • Uninterrupted menses
  • Early menarche (<11 yrs)
  • Late menopause
  • Reproduction - parity and age of 1st full term pregnancy >30 years higher risk
  • Breast feeding though to be protective
  • Obesity and high fat diet
  • Exogenous oestrogens (HRT, long term OCP use)
  • Breast density - harder to detect if more fibrous
  • Geography - high incidence in US and Europe
  • Previous breast cancer or atypical change
  • Radiation
29
Q

Which genes are associated with 25% of familiar breast cancers? Explain how they can cause cancer?

A

BRCA1 and BRCA2

Both are tumour suppressor genes - repair damaged DNA therefore mutation in gene allows proliferation of tumour

30
Q

What gene is mutated in Li-Fraumeni syndrome?

A

p53

(The guardian of the genome)

31
Q

What is an in situ carcinoma?

A

A neoplastic population of cells limited to ducts and lobules by the basement membrane

Does not invade into surrounding vessels, so cannot metastasise or kill the patient

32
Q

What is ductal carcinoma in situ a problem if it doesn’t have ability to metastasise?

A
  • Non obligate precursor of invasive carcinoma
  • Presents as mammographic calcifications or a mass
  • Can spread through ducts and lobules extensively (without invading other tissues)
  • Shows central necrosis with calclification (comedo)
33
Q

What is Paget’s disease?

A
  • Unilateral red and crusing nipple
  • Atypical and malignant cells can grow up the epidermis extending to the nipple
  • Suggests malignanc elsewhere in breast
  • Eczematous or inflammatory conditions of nipple need biopsy to exclude Paget’s
34
Q

How does invasive carcinoma differ from DCIS?

A

Neoplastic cells have extended beyond the basement membrane into the stroma, can invade into vessels and metastasise to lymph nodes and other sites

35
Q

What is peau d’orange?

A

A symptom of malignant tumour causing the skin of the breast to pull in

Suggests involvement of lymphatic drainage of skin

36
Q

What are the classifications of invasive breast carcinoma?

A

​Invasive Ductal Carcinoma:

  • 70-80%
  • Well differentiated - tubules lined by atypical cells
  • Poorly differentated type - sheets of pleomorphic cells
  • 25-50% survival 10 years

Invasive Lobular Carcinoma:

  • 5-15%
  • Inflitrating cells in single file, lack cohesion

Other types: tubular, mucinous

37
Q

What does invasive ductal carcinoma look like histologically?

A

No organisation

Lots of tubules and glands in stroma

38
Q

What does invasive lobular carcinoma look like histologically?

A
  • Single banded line
  • Can be hard to spot
  • Doesn’t create much change to the stroma
39
Q

What does a mucinous carcinoma look like histologically?

A

Lots of island cells floating in mucin

40
Q

How can breast cancer spread?

A
  • Lymphatics to lymph nodes, usually the ipsilateral axilla
  • Blood vessels spread causes distant metastases
  • Invasive lobular carcinoma can spread to: peritoneaum, retroperitoneum, leptomeninges, GI tract, ovaries, uterus
41
Q

What are the most frequent sites for breast cancer to metastasise to?

A
  • Bones
  • Lungs
  • Liver
  • Brain
42
Q

What factors determine prognosis in breast disease?

A
  • In situ or invasive
  • Tumour Stage (TNM)
  • Tumour Grade
  • Histological subtype (Invasive ductal poorer prognosis)
  • Molecular classifcation and gene expression profile
43
Q

Explain the molecular classifications of breast cancer

A

Either Oestrogen receptor +/- or HER2 +/-

44
Q

What is the triple approach to investigating and diagnosis breast cancer?

A
  1. Clinical: history, family history, examination
  2. Radiographic imaging: mammogram and ultrasound
  3. Pathology: core biopsy and fine needle aspiration cytology
45
Q

What is sentinel lymph node biopsy?

A
  • Reduced risk of post-op morbidity
  • Intra-operative mapping of lymph nodes with dye to identify sentinal node (most likely to contain metastases)
  • If sentinel node is negative, axillary dissection can be avoided
46
Q

Which receptor does tamoxifen target?

A

Oestreogen receptor if patient is ER +

47
Q

What receptor does Herceptin target?

A

HER2 (a tyrosine kinase receptor)

Herceptin = trastuzumab = humanised antibodies against the HER2 protein

48
Q

What is mammary duct ectasia?

A
  • Dilation of the major ducts, filled with creamy secretion and inflammation
  • May be asymptomatic or symptoms
    • nipple discharge
    • retracted nipple
    • acute inflammation
    • recurrent chronic inflammation/ abscess
49
Q

What symtpoms can suggest breast cancer?

A
  • Lump
  • Nipple retraction
  • Dimples
  • Weight loss
  • Axillary node enlargement
  • Discharge

Integration for Clinical Application (8 decks)

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