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Scientific Basis of Clinical Practice > Breast Pathology > Flashcards

Breast Pathology Flashcards

1
Q

describe the glandular tissue of the breast

A

consists of breast ducts and lobules

surrounded by fibrous tissue and a peripheral layer of myoepithelial cells

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2
Q

describe breast composition in different ages

A

older; more fatty tissue

younger; more glandular tissue

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3
Q

describe the lobules of the breast

A

main secretory component
lined by epithelial cells
produce milk products under appropriate stimulation

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4
Q

what is the function of myoepithelial cells of the breast?

A

contractile; move the secretions along the lobules

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5
Q

where does most secretion take place in the breast?

A

the lobules

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6
Q

describe the movement of secretions within the lobules

A

the secretions move into the intralobular duct
one duct supplies each lobular unit
this moves to the extralobular ducts, the larger lactiferous ducts and the lactiferous sinuses

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7
Q

what are the most common breast symptoms?

A

pain; often cyclical, varying with the menstrual cycle
lump
discharge; clear, coloured, blood stained, almost constantly or at irregular times

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8
Q

describe cyclical mastalgia

A

usually greatest in the premenstrual phase
usually relieved once menstruation begins
sometimes improved by evening primrose oil and simple analgesics
may require mastectomy; relatively uncommon
very low risk for malignancy

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9
Q

describe nipple discharge

A

single duct; accentuated by pressing on one area
multiple ducts; expressed by pressing anywhere around the nipple
clear; usually physiological, may be a prolactin-secreting tumour of the pituitary gland
opaque
blood stained

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10
Q

describe mammary duct ectasia

A

opaque discharge from multiple ducts
commonly in women 35-45
almost always in smokers
defect in the elastic tissue surrounding the larger ducts causing secretions to pool and an inflammatory response
not associated with risk of underlying malignancy

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11
Q

what are the causes of opaque discharge from a single duct?

A

papilloma
papillary lesion
rarely underlying malignancy; ductal carcinoma-in-situ

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12
Q

what is the management of mammary duct ectasia?

A

usually not necessary
unless the discharge is causing particular problems or prone to superinfection
may require duct excision

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13
Q

describe intraductal papilloma

A

usually single duct
may be bloodstained; papilloma will twist, undergo partial infarction and break off or the surface will ulcerate
rarely malignancy arises within central fibrovascular core
covered by multi-layered epithelial cells
mixture of epithelial and contractile myoepithelial cells expected in any benign condition

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14
Q

what questions should be asked in a history of a breast lump?

A 
when it was first noticed
if it comes and goes with their menstrual cycle
associated with pain
if they've had lumps before
increasing/decreasing size
FHx of breast cancer
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15
Q

what investigations should be performed for a breast lump?

A

mammography; older women
USS; younger women
needle biopsy; FNA or core needle biopsy

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16
Q

what are the symptoms and signs of a non-pathological breast lump?

A

decreasing in size
appears just before menstruation or diminishes significantly after it
associated with pain
upper outer quadrant
fatty and soft on examination
firm; fibroadenomas
firm/hard depending on the pressure of fluid; cysts
vague and poorly defined; normal benign changes
smooth outline; benign

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17
Q

what are the symptoms and signs of a malignant breast lump?

A 
overlying skin changes; inflammation
tethered skin causing a dimple
medial
hard consistency
focal
very irregular edge; malignant
large fixed mass in the axilla; axillary nodal metastases
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18
Q

describe mammography in breast pathology

A

the breast is placed between 2 plates and the beam is shone from above to below
2 angles; craniocaudal and oblique
something real will appear on both views
composite shadowing will appear on one view
medial part is not shown well
particularly effective in older patients; more fatty and less glandular breast tissue

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19
Q

what can be seen on mammography?

A

breast tumour; spiculation, contraction and fibrosis
skin dimpling
pectoralis major muscle
metastatic lymph nodes; not confirmed until examined pathologically

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20
Q

describe the use of USS and its advantages in breast pathology

A

not useful as a screening tool; very labour intestine and get a lot of false positives
can tell if a lesion is cystic (almost always benign) or solid
can show the outline of the lesion; smooth (reassuring)
can see needles; useful for image-guided biopsy

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21
Q

what are the causes of benign breast lumps?

A 
simple cysts
fibrocystic change
fibroepithelial lesions
papilloma
fat necrosis
22
Q

describe breast cysts

A

usually deep-seated
mostly arise in a dilated duct or lobule which is either developed abnormally or contains entrapped secretions
often lined by apocrine epithelium; metaplastic process
epithelium usually attenuated due to the pressure of the secretion

23
Q

describe epidermal inclusion cysts

A

can arise anywhere in the skin
fired by an in-folding of squamous epithelium that contains trapped keratin
usually near the skins surface

24
Q

describe fibrocystic change

A

usually doesn’t produce signs or symptoms
present in about 50% of women
clinical presentation; lumps, bumps, vague thickening
can calcify; usually picked up on mammogram screening
form as lobules unfold and coalesce
can be caused by duct blockages leading to a holdup of secretions

25
Q

describe the histology of fibrocystic change

A

cyst formation, fibrosis and adenosis
a form of non-proliferative abnormality
calcification can occur in the area of cyst formation or adenosis

26
Q

describe breast cyst rupture

A

chronic inflammatory response in the surrounding tissue, leading to adjacent fibrosis

27
Q

define adenosis

A

an increase in the number of acini or glands in a lobule without any proliferation of the epithelium in each acinus

28
Q

what are the types of fibroepithelial lesions?

A

fibroadenoma; completely benign
benign phyllodes tumour
malignant phyllodes tumour

29
Q

describe fibroadenoma

A

a very common cause of breast lumps
most common benign breast tumour
usually in women <30yrs
contains dense interlobular stroma and looser intralobular stroma
rarely contains fat, smooth muscle or bone

30
Q

describe the clinical features of fibroadenomas

A

usually multiple and bilateral
painless, palpable mass which is very mobile; breast mouse
can fluctuate with the menstrual cycle and pregnancy
well circumscribed

31
Q

describe the diagnosis and treatment of fibroadenomas

A

needle core biopsy

surgical excision; curative
many do not opt for treatment once they discover it is benign

32
Q

describe the histology of fibroadenomas

A

obvious biphasic pattern
epithelial lined spaces surrounded by loose fibrous stroma
no nuclear pleomorphism, increased cellularity, mitotic activity and necrosis

33
Q

what is the difference between fibroadenomas and phyllodes tumours?

A

fibroadenoma; balanced proliferation of benign epithelial and stromal tissue
phyllodes; stromal component proliferates out of proportion of the epithelial component resulting in stromal overgrowth

34
Q

describe benign and malignant phyllodes tumours

A

benign stroma overgrowth which has a tendency for local recurrence
or
frankly malignant and sarcomatous

35
Q

describe papillomas in breast

A

a lesion composed of fibroascular cores lined by benign epithelium
arise within the wall of a breast duct
usually cause blockage and duct widening/dilation
richly vascular

36
Q

what are the clinical features of breast papilloma?

A

lump

nipple discharge; can be blood stained

37
Q

what is the difference between solitary and multiple papillomas?

A

solitary; in large ducts near the nipple, can produce discharge easily
multiple; occur further from the nipple, more deep Ito the breast parenchyma

38
Q

what features of a papilloma suggest malignancy?

A

epithelial atypia on core biopsy

multiple

39
Q

describe fat necrosis

A

well circumscribed and discrete to a diffuse area of vague thickening
usually caused by trauma; can be minor
damage to the fatty tissue of the breast with an inflammatory response
infiltration of macrophages which take on a foamy appearance
can form an oily cyst or can calcify

40
Q

describe the histology of fat necrosis

A

large coalescing globules of fat
surrounded by foamy macrophages
multinuclear giant cells

41
Q

what are the risk factors for breast cancer?

A 
FHx; BRCA1 and BRCA2
PMHx
increased breast density; increased proportion of glandular tissue, more difficult to detect subtle abnormalities (more negative screening)
increased levels of oestrogen and progesterone
early age at menarche
late menopause
age at first childbirth
OCP use
lack of breastfeeding
obesity
alcohol
smoking
ionising radiation; ipsilateral or contralateral
42
Q

describe the clinical presentation of breast cancer

A 
symptomatic or screening pathway
lump
skin tethering
rash; especially around nipple
nipple discharge
mass lesion on x-ray
cluster of calcifications on x-ray
43
Q

what is the triple assessment of breast cancer?

A

clinical, radiological and pathological assessment

44
Q

describe the clinical assessment of breast cancer

A 
Hx;
lumps or bumps
skin changes
nipple discharge
systemic symptoms; weight loss, fatigue, lethargy, anaemia
FHx of breast cancer; very important
risk factors
examination;
overall physical condition
lumps
tethering
appears fixed or free to move within the breast
skin and nipple changes
metastatic spread within the axilla
45
Q

describe the radiological assessment of breast cancer

A

mammography
USS
MRI; difficult cases, certain age groups, dense lesion
biopsy of lesion

46
Q

describe the pathological assessment of breast cancer

A

fine needly aspirate

core biopsy

47
Q

what are the advantages and disadvantages of fine needle aspirate of breast cancer?

A

advantages; quick, minimal technical difficulty, cheap equipment, relatively painless, few complications

disadvantages; difficult to subtype benign or malignant lesions, cannot give a position benign diagnosis, cannot differentiate between invasive and in-situ carcinoma

48
Q

describe a benign breast FNA

A

cells forming cohesive groups
well-defined outlines
dark-coloured dots; myoepithelial cells that line the ducts
look like bare nuclei as they lose their cytoplasm

49
Q

describe a malignant breast FNA

A 
larger cells
much more pleomorphic; nuclei different shapes and sizes
more discohesive
no formation of well-defined groups
necrotic material in the background
50
Q

what are the advantages and disadvantages of core biopsy of breast cancer?

A

advantages; can make a specific benign diagnosis, low false positive rate, can distinguish in-situ from invasive carcinomas, can identify invasive subtypes, can provide hormone receptor status and HER2 status

disadvantages; more technically complex, requires a radiologist, local anaesthetic required, more complications (haematoma), expensive

51
Q

describe a core biopsy histology of DCIS (malignant)

A

basement membrane surrounding pleomorphic malignant cells
calcification
area of necrosis

52
Q

describe a core biopsy of an invasive carcinoma

A

dark purple malignant cells infiltrating the light pink fibrosis tissue
infiltration of fatty breast tissue

Scientific Basis of Clinical Practice (10 decks)

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