Breast Pathologies Flashcards
Where are ectopic Breast tissue most likely to develop?
what are these breast tissues called?
Along the milk line on the mammary ridge
Polymasia
When is nipple inversion of worry?
If it has started suddenly
What is it called when the breast is inflammed?
Mastitis
What is the common cause of Acute mastitis?
Cellulitis of the breast due to bacterial infection through a fissure. this combined with milk stasis - ideal breading ground
What changes may occur in fibrocystic changes on the breast, seperating them into proliferative and non-proliferative:
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.
Whats it called when there is an increase in glandular tissue of the breast?
Adenosis
Is there a risk of fibrocytic changes in the breast?
Depends if there is proliferative changes along with atypia changes in cells
What is a benign growth that occurs in women between 20-30, which feels like a smooth firm lump?
Fibroadenoma
What benign growth may indicated on a mammogram by a star like configuration? and what is at the centre of this benign growth?
Radial scars
- sclerosing of duct hyperplasia
Centred by elastotic core
What is a benign growth of the myoepithelial cells around the lobules?
Pseudo-angiomatous stromal hyperplasia
List some symptoms of breast cancer:
New lump/ thickening of breast
Altered shape of breast
Pain (not common)
Skin changes
- puckering
- Dimpling
- Rash
Nipple changes
- Paget’s disease
- tethering
- inversion
Name the two types of Non-invassive breast cancer:
Ductal Carcinoma in Situ
Lobular Carcinoma in Situ
Symptoms of DIS?
Post menopausal women
palpable mass, often with paget’s disease.
usually confined to one area and one breast
Necrosis is common
Symptoms of LIS?
Pre - menopause
no palpable mass.
Multi-focal and bilaterally.
Necrosis is uncommon.
Name the main types of invasive breast cancer:
Infiltration ductal of no special type
Infiltration of lobular
Mucinous
Tubular
Medullary
Papillary
List some risk factors to developing breast cancer:
Early Menarche
Late menopause
Older first pregnancy
Lack of breast feeding
OC
HRT
Obesity
Positive family history
What are the molecular sub-types of breast cancer?
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
Histologically what do infiltrating ductal carcinomas of no specific type look like?
Cords and tubules
Uniformed into gland like structures
Histologiclaly what do infiltrating lobular look like?
stacks of cells following ductules
highly motile
What type of cancer of the breast will not have E-Cadherin?
Lobular infiltrating
What is the most common benign breast cancer?
Fibroadenoma
What is the most common cause of bloody Nipple discharge?
Inductal Papilloma
What benign tumour presents like a leaf?
Phyllodes tumour
In acute mastitis what is the biggest cause and what is the most common pathogen?
Milk stasis
S. Aureus
What drug is used for Her2 positive cancers?
Trastuzumab
What drug is used for ER and PR positive?
Tamoxifen
What are the three most important prognostic factors in breast cancer?
Stage
Grade
Size
List 4 common causes of benign breast lumps:
fibroadenoma
Fibrocystic changes
Mastitis
Fat necrosis
Where do almost all the breast cancers originate from?
Terminal duct lobular unit
Which patients are candidates for neo-adjunctive therapy prior to breast surgery and what are some benefits of this?
- *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
Which patients typically receive radiotherapy?
those that get lumpectomies
- not mastectomy
those with axilla involvement
High grade - grade 3
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?
Cavity shavings
> 1mm
What are the indications for mastectomy?
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
How is breast reconstruction done?
Immediate - skin sparing
- use bodies own tissue - latissimus dorsi muscle
- abdomen fat - Diep flap
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?
Genetic testing
BRCA1
Who are candidates for neoadjuvant therapy?
Large tumors to try and shrink it
Oestrogen or HER2 positive can be considered
- allows us to see if it has an effect
If there was scarring in the nodes following neo-adjunctive therapy - what is this suggestive off?
that there was cancer there and it has shrunk down in response
How is follow up done following breast cancer treatment?
yearly:
- clinical examination
- mammogram
**mammogram done for 5 years.
What is the breast screening programme?
50-70 years
2 viewing mammography
- side views
- top to bottom
Recalled every 3 years
What are some negatives of fine needle biopsy?
No architecture
need trained cytologists
lots of false positives.
What type of biopsy is most commonly carried out on the breast now?
Core biopsy
What cells do cancerous cells develop from?
Epithelial cells
What is fibroadenomas made up off?
Epithelial and stroma tissue
What has a stellate appearance?
and what do they have that cancers do not?
Radial scar
- diagnosed with biopsy
contain myoepithelial cells - which cancers do not
What is duct Ectasia linked too?
Smoking
stopping smoking helps it
What things need to be established when someone has granulomatous mastitis?
How is it management?
Is there TB?
Is there sarcoidosis
Is there vasculitis?
NSAIDS
Steroids
What are the atypical proliferation of breast tissue?
Atypical Ductal Hyperplasia
Atypical lobular hyperplasia
Leads to 4x increase in breast cancer
- need follow ups
Whats the major risk factors for breast cancer:
Age - 40-70
Family history
Hormone environment
- lack of pregnancies
- early periods
- lack of breast feeding
- HRT
- Contraceptive pill
Whats the treatment of DCIS?
if large of diffuse - mastectomy (with or without reconstruction)
local excision + radiotherapy
What is the management for Lobular carcinoma in situ?
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
What are the gradings based on in breast cancer?
Tubules
Pleomorphism
Mitoses
What type of cancer is Lobular carcinoma?
ER positive
In lobular cancer, what do you need to do prior to surgery?
MRI - because its difficult to see on mammogram
What are the common spread of breast cancer?
Lung, bone, liver and brain
What drugs are used for ER positive cancers?
Tamoxifen
Aromatase inhibitors
What does the Nottingham prognostic index look at?
Size of tumour
Grade of tumour
Nodal involvement
What cancer will need chemotherapy?
Her2 positive
What can be done to determine the recurrence of breast cancer?
Oncotype Diagnosis
What colour does oestrogen positive stain?
Brown stain
