Breast histopathology Flashcards
duct anatomy
lobule enters into the main duct which enters into the surface of the nipple
what all types of cell are present in normal breast?
epithelium (two types in each breast ducts)
- luminal (lines the part of the duct that faces the lumen)
- 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
pain and breast mass
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
breast cancer
painless
discrete palpable mass
nipple discharge
when should you think of cancer?
age (rare <30) painless breast lump nipple discharge previous fhx hx of symptom onset- laterality, location, increase or reduction in size of the lesion
investigate breast cancer
triple assessment
breast exam
imaging
biopsy
bengin conditions of the breast
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
histology of acute mastitis
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
benign proliferative breast disease
epithelial hyperplasia
sclerosing adenosis
complex sclerosing lesion
papilloma
increases risk of breast cancer slightly.
most do not procede to become malignant
epithelial hyperplasia
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
sclerosing adnenosis of the breast
increase in the number of ducts
immunohistochemistry test is done to differentiate between sclerosing adenosis and breast cancer.
papilloma
intraductal proliferation
occurs inside the duct
fibrovascular tissue
has fibrous and vascular tissue lined by a single layer of epithelium
biphasic tumors of the breast
fibroadenoma (bengin)
phyllodes tumor
both epithelial and stromal elements
fibroadenoma
‘breast mouse’ not fixed, mobile
invasive carcinomas
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
invasive carcinomas
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
ductal and lobular cacinoma
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
risk factors for breast cancer
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
national breast screening programme
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
mammogram and biopsy
present as radiodense lesions
may have calcifications- benign/malignant
lesions are biopsied
calcifications that are bengin or malignant
hereditary breast cancer
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
breast biopsy
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
grading of the carcinoma
grade 1 tumor- well differentiated. looks slightly like the normal breast
grade 3- poorly differentiated.
staging
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)
treatment
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)
P1
P3
P5
P1 benign
P3 indetermine
P5 malignant
