Breast histopathology

Question 1

duct anatomy

Answer 1

lobule enters into the main duct which enters into the surface of the nipple

Question 2

what all types of cell are present in normal breast?

Answer 2

epithelium (two types in each breast ducts)

1. luminal (lines the part of the duct that faces the lumen)
2. basal/myoepithelial cells (under this) (have the properties of muscle and epithelial cells) (can contract which helps in secretion of milk)

*mainly constitutes of stromal cells / spindle cells but is normally replaced with fat cells as ageing

blood vessels
lymph nodes

Question 3

pain and breast mass

Answer 3

pain is usually a symptom of breast disease (cyclic) (fibrosis disease of the breast)

can be a sign of inflammation- abscess

usually cancer is painless

Question 4

breast cancer

Answer 4

painless
discrete palpable mass
nipple discharge

Question 5

when should you think of cancer?

Answer 5

age (rare <30)
painless breast lump
nipple discharge
previous fhx
hx of symptom onset- laterality, location, increase or reduction in size of the lesion

Question 6

investigate breast cancer

Answer 6

triple assessment
breast exam
imaging
biopsy

Question 7

bengin conditions of the breast

Answer 7

acute mastitis (acute inflammation normally seen in early breast feeding phase)
*encourage expression

fat necrosis
commonly associated with trauma to the breast. completely benign. mimics breast cancer on mammography

fibrocystic
*cyclic

Question 8

histology of acute mastitis

Answer 8

completely destroyed by inflammatory cells
neutrophils are there in response to bacteria causing destruction of the ducts

fat necrosis - foamy macrophage cells, giant cells, fibrosis, dead cells

Question 9

benign proliferative breast disease

Answer 9

epithelial hyperplasia
sclerosing adenosis
complex sclerosing lesion
papilloma

increases risk of breast cancer slightly.
most do not procede to become malignant

Question 10

epithelial hyperplasia

Answer 10

see lots more cells within the duct. duct is expanding/enlarging and the lumen of the duct is starting to fill with proliferation of the cells. still bengin- no features of malignancy

Question 11

sclerosing adnenosis of the breast

Answer 11

increase in the number of ducts

immunohistochemistry test is done to differentiate between sclerosing adenosis and breast cancer.

Question 12

papilloma

Answer 12

intraductal proliferation
occurs inside the duct
fibrovascular tissue
has fibrous and vascular tissue lined by a single layer of epithelium

Question 13

biphasic tumors of the breast

Answer 13

fibroadenoma (bengin)
phyllodes tumor

both epithelial and stromal elements

Question 14

fibroadenoma

Answer 14

‘breast mouse’ not fixed, mobile

Question 15

invasive carcinomas

Answer 15

carcinomas are epithelial malignancies

stromal cells are called sarcomas

malignancies that arise from haematopoetic cells (lymphomas)

ductal carcinomas
lobular carcinomas
tubular carcinoma
papillary carcinoma
metaplastic carcinoma

Question 16

invasive carcinomas

Answer 16

carcinomas are epithelial malignancies

stromal cells are called sarcomas

malignancies that arise from haematopoetic cells (lymphomas)

ductal carcinomas
lobular carcinomas
tubular carcinoma
papillary carcinoma
metaplastic carcinoma

Question 17

ductal and lobular cacinoma

Answer 17

two most common types of breast cancer

lobular - epithelial cells loose their ability to adhere with eachother. loose a transmembrane molecule. lobular- cannot stick together

HER-2 testing quite aggressive, poor prognosis

Question 18

risk factors for breast cancer

Answer 18

oestrogen exposure
nulliparous
not breast feeding
early menarche
late menopause
obesity (fat cells produce oestrogen)
radiation exposure
hx of endometrial carcinoma or contralateral breast carcinoma
moderate/heavy alcohol use

Question 19

national breast screening programme

Answer 19

50-70 years of age
three yearly mammogram
not offered to younger women because it is made up of fat/collagen so difficult to detect a lesion where as in older women it’s replaced with fat so it’s easier to see

Question 20

mammogram and biopsy

Answer 20

present as radiodense lesions
may have calcifications- benign/malignant
lesions are biopsied
calcifications that are bengin or malignant

Question 21

hereditary breast cancer

Answer 21

multiple affected 1st degree relatives
pre-menopausal cancer
fhx with specific malignancies
what genes associated- BCA1 BRCA2 PTEN TP53 CHEECK2

associated with breast and ovarian cancer, prostate cancer in males, male breast cancer

Question 22

breast biopsy

Answer 22

H+E morphological assessment
types of carcinoma
grade of carcinoma (how much the cancer resembles the oriignal tissue. not aggresive=1)
predictive biomarkers
ER, PR receptors
HER2

Question 23

grading of the carcinoma

Answer 23

grade 1 tumor- well differentiated. looks slightly like the normal breast

grade 3- poorly differentiated.

Question 24

staging

Answer 24

important for prognosis
TNM
tumour size
lymph node status (sentinel nodes *first lymph node the cancer is likely to metastasize, axillary node clearance)
metastases (spread to distant sites)

Question 25

treatment

Answer 25

surgery (wide local excision, sentinel node biopsy) mastectomy +/- axillary node clearance

chemo/radiotherapy
neoadjuvant
adjuvant

hormone therapy- depends if ER positive (imminohisto)

herceptin (HER2 status)

Question 26

P1
P3
P5

Answer 26

P1 benign
P3 indetermine
P5 malignant