Breast path Flashcards
Acute mastitis: symptoms (3), cause (1), what is the involved breast tissue full of?
Red, painful breast + fever
Almost always a staph invasion in breast feeding/ lactating mothers via cracks in the skin
Involved breast tissue is necrotic and full of neutrophils
Treatment of acute mastitis? (3)
Continued expression of milk
+ antibiotics
+/- surgical drainage
Periductal mastitis: association (2), Histology
Mostly in SMOKERS & NOT associated with lactation
Histology - keratinizing squamous epithelium extends deep into nipple duct orifices
Mammary duct ectasia: epidemiology (2), what is it? Cause? what does it mimic on mammography? Cytology? (2)
Multiparous 40-60 yr olds
Poorly defined palpable periareolar mass wit THICK, WHITE NIPPLE SECRETIONS
Caused by granulomatous inflammation of large breast ducts
Mimics mammography of cancer
Cytology - proteinaecous material, inflammatory cells
Fat necrosis what is it? presentation (3), causes (all traumatic - 3)
Inflammatory rxc to damaged adipose tissue
presents as PAINLESS breast mass/ skin thickening/ mammographic lesion
Cause - trauma, surgery, radiotherapy
Fibrocystic disease/ fibroadenosis (breast lumpiness): what is it? Cystic change. Fibrosis. Adenosis
Group of changes caused by exaggerated normal response to hormones
Cystic change - small cysts from due to dilation of lobules; contain fluid +/- calcified
Fibrosis - inflammation + fibrosis occurs secondary to cyst rupture
Adenosis - increased number of acini per lobule (normal in pregnancy)
Gynaecomastia: what is it? indicator of what? Histology (2)
Breast enlargement in males
Indicates HYPEROESTRINISM - alcohol, age, liver cirrosis, functioning testicular tumour
Histology - epithelial hyperplasia, finger like projections into ducts
Fibroadenoma (breast mouse - moves): what is it? age group? describe lumps (4). Cure?
Most common benign tumour, from stroma, usually multiple
Ocurrs in any age group of reproductive age 20-30 most common
Epithelium responsive to hormones - enlarges during preg, calcifies in menopause
Lumps - firm, spherical, mobile, rubbery
Overgrowth of collagenous mesenchyme
‘shelling out’ is curative
Duct papillomas are benign or malignant? Arise from where? (2) Discharge? Ix (1)
Benign papillary tumours, arising from duct system:
small terminal ductules - peripheral papilloma. Large lacterferous ducts - central papilloma.
Bloody discharge
Ix - galactogram (not seen on mammogram)
Radial scar - what is it? Significance?
Benign sclerosing lesion - central scarring surrounded by proliferating glandular issue in stellate pattern.
Resembles carcinoma on mammogram
Breast carcinoma epidemiology: (3)
most common cancer in women
1:8 lifetime risk
99% in women
Breast carcinoma risk factors (6)
Susceptibility genes - BRCA1/2; cause lifetime risk to go up to 85% (they also increase risk of ovarian, prostate & pancreatic cancer)
Hormone exposure - anything to do with high oestrogen; remember also pregnancy results in terminal differentiation of milk-producing cells, removing them from pool of potential cancer precursors
Age
FH
Race: caucasian>afro-carribean>asian>hispanic
Obesity/alcohol/tobacco
Presentation of breast carcinoma (4)
Hard fixed lump
Paget’s disease
Peau d’orange
nipple retracation
Screening programme for breast cancer
47-73 yr olds invited every 3 yrs for mammography - which looks for abnormal areas of calcification in the breast
Carcinoma in situ (30%) what is it? types? (2)
Neoplastic epithelial proliferation LIMITED to ducts/lobules by BM
DCIS or LCIS
LCIS characteristics (3)
ALWAYS an incidental finding on biopsy as no microcalcifications or stromal rxns.
Cells lack adhesion protein E-cadherin
F for subsequent invasive breast carcinoma
DCIS characteristics ( (3)
Dramatically increased incidence following development of mammography
Appear as areas of microcalcifications
10% present with clinical symptoms
Much increased risk of progressing to invasive breast CA
Invasive breast CA (80%) what are they? what are the 4 subtypes?
Malignant epithelial tumours that infiltrate within breast and can spread to distant sites Histologically classified into: Ductal Lobular Mucinous Tubular
Invasive ductal carcinoma is the most common - T or F?
T
Invasive lobular carcinoma characteristics
Cells aligned in single file chains/strands
Invasive tubular carcinoma characteristics (2)
Well formed tubules with low grade nuclei. Rarely palpable as
Mucinous carcinoma characteristic
Produces excess EV mucin which dissects into surrounding stroma
Triple assessment
Examination
Radiology - mammography/ USS
FNA & cytology
Function of core biopsy, what it assesses (3) grading
Neoplastic lesions are biopsied to check histological subtype + grading
Assess nuclear pleomorphism, tubule formation & mitotic activity
Each gets a score out of 3 (max 9): 3-5 = grade 1, 6-7 = grade 2, 8-9 = grade 3
