Breast Lecture 3 - Pathology of Breast Disease

Question 1

describe fibrocystic change

Answer 1

• benign breast condition
• characterised by fibrosis, adenosis, cysts, apocrine metaplasia, ductal epithelial hyperplasia (usual type, atypical)

Question 2

what is a fibroadenoma?

Answer 2

• circumscribed, mobile, painless, benign nodule in women of reproductive age
• proliferation of epithelial and stromal elements
• most common breast tumour in adolescent and young women
• ducts distorted elongated > slit-like structures intracanalicular pattern
• ducts not compressed > pericanalicular growth pattern

Question 3

describe intraductal papilloma

Answer 3

• benign breast condition affecting lactiferous ducts, nipple discharge.
• usually affects middle-aged women
• can show epithelial hyperplasia, which may be atypical

Question 4

describe fat necrosis

Answer 4

• benign breast condition
• can simulate carcinoma clinicallt and mammographically
• history of antecedent trauma, prior surgical intervention
• histiocytes with foamy cytoplasm
• lipid-filled cysts
• fibrosis, calcifications, egg shell on mammography

Question 5

describe a Phyllodes tumour

Answer 5

• fleshy tumour, leaf-like pattern and cysts on cut surface.
• circumscribed, connective tissue and epithelial elements, 1-15cm
• less than 1% of breast tumours
• benign, borderline, malignant
• metastases are hematogenous

Question 6

breast cancer risk factors

Answer 6

• Women more likely
• age 35-55 most common cause of death in women
• menstrual history
• age at first pregnancy
• radiation
• family history
• personal history
• hormonal treatment
• genetic factors
• other factors: obesity, lack of physical activity, alcohol

Question 7

what genes can contribute to hereditary breast cancer?

Answer 7

• BRCA1 (20-40%)
• BRCA2 (10-30%)
• TP53 (< 1%)
• PTEN (< 1%)
• other genes (30-70%)

Question 8

how is non-invasive breast cancer classified?

Answer 8

• ductal carcinoma in situ (DCIS)
• lobular carcinoma in situ (LCIS/LISN)

Question 9

how is invasive breast cancer classified?

Answer 9

• invasive no specifal type (ductal) carcinoma, NST (75%)
• special types (rest) including invasive lobular carcinoma and its variants (5-15%)

Question 10

give some features of an in situ breast carcinoma

Answer 10

• preinvasive - does not form a palpable tumour
• not detected clinically (only x-rays in DCIS-screening)
• multicentricity and bilaterality (LCIS)
• no metastatic spread (basement membrane)
• risk of invasion depending on grade

Question 11

In Situ breast cancer - risk of progession

Answer 11

• low grade DCIS - 30% in 15 years
• high grade DCIS - 50% in 8 years
• LCIS - 19% in 25 years and bilaterally

Question 12

breast cancer diagnostic procedures

Answer 12

• clinical exam
• radiology (mammogram, ultrasound, MRI)
• FNA cytology
• needle core biopsy
• diagnostic excision

Question 13

what is the overall, 5-year survival rate of breast cancer?

Answer 13

64%

Question 14

breast cancer molecular markers determining treatment

Answer 14

• eostrogen/progesterone receptors (ER/PR) strong predictors of response to hormal therapies
• ER/PR negative tumours do not respond
• HER-2: about 20-30% positive - predicts response to trastuzumab (Herceptin)

Question 15

what are the 5 subtypes used for molecular classification of breast cancer?

Answer 15

• luminal A
• luminal B
• basal
• HER2+
• normal breast-like

Question 16

what % of patients undergoing breast conservation for breast cancer will develop 2nd cancer within 10 years?

Answer 16

• around 10%
• < 10 years > majority are true recurrences
• 10 years > 50/50
• > 10 years > majority are new primaries

Question 17

Describe Paget’s disease of the nipple

Answer 17

• result of intraepithelial spread of intraductal carcinoma
• large, pale-staining cells within the epidermis of the nipple
• limited to the nipple or extend to areola
• pain or itching, scaling and redness, mistaken for eczema
• ulceration, crusting, and serous or bloody discharge