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Phase 3 > Breast Pathologies > Flashcards

Breast Pathologies Flashcards

1
Q

Where are ectopic Breast tissue most likely to develop?

what are these breast tissues called?

A

Along the milk line on the mammary ridge

Polymasia

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2
Q

When is nipple inversion of worry?

A

If it has started suddenly

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3
Q

What is it called when the breast is inflammed?

A

Mastitis

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4
Q

What is the common cause of Acute mastitis?

A

Cellulitis of the breast due to bacterial infection through a fissure. this combined with milk stasis - ideal breading ground

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5
Q

What changes may occur in fibrocystic changes on the breast, seperating them into proliferative and non-proliferative:

A

Non- proliferative:
- fibrosis around ducts.

Cyst formation:
- lined squamous epithelium with water filling

Apocrine metaplasia:
- epithelium undergo metaplasia making them apocrine glandular

Proliferative:
- epithelial hyperplasia

  • Ductal columnar epithelium changes.
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6
Q

Whats it called when there is an increase in glandular tissue of the breast?

A

Adenosis

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7
Q

Is there a risk of fibrocytic changes in the breast?

A

Depends if there is proliferative changes along with atypia changes in cells

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8
Q

What is a benign growth that occurs in women between 20-30, which feels like a smooth firm lump?

A

Fibroadenoma

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9
Q

What benign growth may indicated on a mammogram by a star like configuration? and what is at the centre of this benign growth?

A

Radial scars
- sclerosing of duct hyperplasia

Centred by elastotic core

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10
Q

What is a benign growth of the myoepithelial cells around the lobules?

A

Pseudo-angiomatous stromal hyperplasia

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11
Q

List some symptoms of breast cancer:

A

New lump/ thickening of breast

Altered shape of breast

Pain (not common)

Skin changes

  • puckering
  • Dimpling
  • Rash

Nipple changes

  • Paget’s disease
  • tethering
  • inversion
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12
Q

Name the two types of Non-invassive breast cancer:

A

Ductal Carcinoma in Situ

Lobular Carcinoma in Situ

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13
Q

Symptoms of DIS?

A

Post menopausal women

palpable mass, often with paget’s disease.

usually confined to one area and one breast

Necrosis is common

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14
Q

Symptoms of LIS?

A

Pre - menopause

no palpable mass.

Multi-focal and bilaterally.

Necrosis is uncommon.

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15
Q

Name the main types of invasive breast cancer:

A

Infiltration ductal of no special type

Infiltration of lobular

Mucinous

Tubular

Medullary

Papillary

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16
Q

List some risk factors to developing breast cancer:

A

Early Menarche

Late menopause

Older first pregnancy

Lack of breast feeding

OC

HRT

Obesity

Positive family history

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17
Q

What are the molecular sub-types of breast cancer?

A

Luminal A

  • Steroid Receptor positive
  • Her2 negative

Luminal B

  • steroid positive
  • Her2 positive

Triple Neg/ Basal like:
- all neg. BRCA1 related

Her2 rich:

  • steroid negative
  • Her2 positive
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18
Q

Histologically what do infiltrating ductal carcinomas of no specific type look like?

A

Cords and tubules

Uniformed into gland like structures

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19
Q

Histologiclaly what do infiltrating lobular look like?

A

stacks of cells following ductules

highly motile

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20
Q

What type of cancer of the breast will not have E-Cadherin?

A

Lobular infiltrating

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21
Q

What is the most common benign breast cancer?

A

Fibroadenoma

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22
Q

What is the most common cause of bloody Nipple discharge?

A

Inductal Papilloma

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23
Q

What benign tumour presents like a leaf?

A

Phyllodes tumour

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24
Q

In acute mastitis what is the biggest cause and what is the most common pathogen?

A

Milk stasis

S. Aureus

25
Q

What drug is used for Her2 positive cancers?

A

Trastuzumab

26
Q

What drug is used for ER and PR positive?

A

Tamoxifen

27
Q

What are the three most important prognostic factors in breast cancer?

A

Stage

Grade

Size

28
Q

List 4 common causes of benign breast lumps:

A

fibroadenoma

Fibrocystic changes

Mastitis

Fat necrosis

29
Q

Where do almost all the breast cancers originate from?

A

Terminal duct lobular unit

30
Q

Which patients are candidates for neo-adjunctive therapy prior to breast surgery and what are some benefits of this?

A
  • *Very large breast tumours
  • **Axilla involvement

treatments can be:

  • chemotherapy
  • endocrine treatment
  • may shrink the tumour size - reducing the surgical invasion
  • allows for analysis if the treatment is working
31
Q

Which patients typically receive radiotherapy?

A

those that get lumpectomies
- not mastectomy

those with axilla involvement

High grade - grade 3

32
Q

If a breast cancer is removed - there has to be an area around it taken as well to ensure no tumour cells are present.
What is this called, and what is the minimal distance?

A

Cavity shavings

> 1mm

33
Q

What are the indications for mastectomy?

A

Multiple tumours within the breast

Diffuse DCIS

Large tumour in small breast
- would try neoadjuvant treatment first

Involved margin
- if you keep taken margins then eventually leads to mastectomy

Recurrent cancer

Contraindication of radiotherapy (remember usually if just a lumpectomy is performed, then radiotherapy is given afterwards, but if this can’t be done (pregnancy) then full mastectomy is done)

previous radiotherapy

34
Q

How is breast reconstruction done?

A

Immediate - skin sparing

  • use bodies own tissue - latissimus dorsi muscle
  • abdomen fat - Diep flap
35
Q

If you had a young women come in with breast cancer and is ER, PR and HER2 negative (triple negative), what should be thought about?

A

Genetic testing

BRCA1

36
Q

Who are candidates for neoadjuvant therapy?

A

Large tumors to try and shrink it

Oestrogen or HER2 positive can be considered
- allows us to see if it has an effect

37
Q

If there was scarring in the nodes following neo-adjunctive therapy - what is this suggestive off?

A

that there was cancer there and it has shrunk down in response

38
Q

How is follow up done following breast cancer treatment?

A

yearly:

  • clinical examination
  • mammogram

**mammogram done for 5 years.

39
Q

What is the breast screening programme?

A

50-70 years

2 viewing mammography

  • side views
  • top to bottom

Recalled every 3 years

40
Q

What are some negatives of fine needle biopsy?

A

No architecture

need trained cytologists

lots of false positives.

41
Q

What type of biopsy is most commonly carried out on the breast now?

A

Core biopsy

42
Q

What cells do cancerous cells develop from?

A

Epithelial cells

43
Q

What is fibroadenomas made up off?

A

Epithelial and stroma tissue

44
Q

What has a stellate appearance?

and what do they have that cancers do not?

A

Radial scar
- diagnosed with biopsy

contain myoepithelial cells - which cancers do not

45
Q

What is duct Ectasia linked too?

A

Smoking

stopping smoking helps it

46
Q

What things need to be established when someone has granulomatous mastitis?

How is it management?

A

Is there TB?
Is there sarcoidosis
Is there vasculitis?

NSAIDS

Steroids

47
Q

What are the atypical proliferation of breast tissue?

A

Atypical Ductal Hyperplasia

Atypical lobular hyperplasia

Leads to 4x increase in breast cancer
- need follow ups

48
Q

Whats the major risk factors for breast cancer:

A

Age - 40-70

Family history

Hormone environment

  • lack of pregnancies
  • early periods
  • lack of breast feeding
  • HRT
  • Contraceptive pill
49
Q

Whats the treatment of DCIS?

A

if large of diffuse - mastectomy (with or without reconstruction)

local excision + radiotherapy

50
Q

What is the management for Lobular carcinoma in situ?

A

Because its often bilateral and diffuse throughout the breast, the options are limited.

Bilateral mastectomy
or
Follow up regularly and then carry out surgery if needed

51
Q

What are the gradings based on in breast cancer?

A

Tubules
Pleomorphism
Mitoses

52
Q

What type of cancer is Lobular carcinoma?

A

ER positive

53
Q

In lobular cancer, what do you need to do prior to surgery?

A

MRI - because its difficult to see on mammogram

54
Q

What are the common spread of breast cancer?

A

Lung, bone, liver and brain

55
Q

What drugs are used for ER positive cancers?

A

Tamoxifen

Aromatase inhibitors

56
Q

What does the Nottingham prognostic index look at?

A

Size of tumour

Grade of tumour

Nodal involvement

57
Q

What cancer will need chemotherapy?

A

Her2 positive

58
Q

What can be done to determine the recurrence of breast cancer?

A

Oncotype Diagnosis

59
Q

What colour does oestrogen positive stain?

A

Brown stain

Phase 3 (50 decks)

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