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PathY5 > Breast Pathology > Flashcards

Breast Pathology Flashcards

1
Q

How may breast disease present?

A

Lump
Abnormal screening mammogram
Nipple discharge

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2
Q

How do you examine breast disease?

A

Clinical examination

Imaging- sonography, mammography and MRI

Pathology- cytopathology and/ or histopathology

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3
Q

How do you take an FNA?

A

16/18G needle

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4
Q

How do you take a cytopathology sample?

A

Cells spread across a slide and stained.

Good cellular detail & quick to prepare but no
architecture.

In breast disease used in the investigation of nipple
discharge and palpable lumps.

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5
Q

How do you code aspirates of breast lumps?

A

C1 = inadequate

C2 = benign

C3 = atypia, probably benign

C4 = suspicious of malignancy

C5 = malignant

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6
Q

What does this show?

A

Breast FNA samples. Top right is normal. Top left is C2. Middle left is C3. Middle right is C4. Bottom is C5 (Malignant).

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7
Q

How do you take histopathology samples?

A

Intact tissue removed, fixed in formalin, embedded in paraffin wax, thinly sliced, stained with H&E.

Core biopsies, surgical excisions.

Takes 24 hours to process.

Architectural & cellular detail.

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8
Q

What are the inflammatory breast diseases?

A

Duct ectasia
Acute mastitis
Fat necrosis

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9
Q

What are the benign breast diseases?

A

Fibrocystic disease
Fibroadenoma
Phyllodes tumour
Intraductal papilloma
Radial scar

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10
Q

What are the proliferative breast diseases?

A

Usual epithelial hyperplasia
Flat epithelial atypia/ atypical ductal carcinoma
In situ lobular neoplasia

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11
Q

What are the malignant breast diseases?

A

Ductal carcinoma in situ
Invasive breast carcinomas

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12
Q

What is duct ectasia?

A

Benign inflammation and dilation of large breast ducts. No malignancy risk.

Aetiology unclear.

Usually presents with nipple discharge. Sometimes causes breast pain, breast mass and nipple retraction.

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13
Q

What is the cytology of duct ectasia?

A

Nipple discharge shows proteinaceous material and inflammatory cells only.

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14
Q

What is acute mastitis?

A

Acute inflammation of the breast often seen in lactating women due to cracked skin and milk stasis. Therefore it presents with painful red breasts.

It is associated with duct ectasia and STAPHYLOCCI.

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15
Q

What is the treatment of acute mastitis?

A

Drainage and antibiotics

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16
Q

What is Fat necrosis?

A

Inflammatory damage to adipose tissues caused by trauma, malignancy, surgery or radiotherapy.

BENIGN breast mass.

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17
Q

What is fibrocystic disease?

A

A group of alterations in the breast which reflect normal, albeit exaggerated, responses to hormonal influences.

It is very common and causes breast lumpiness but there is no risk of breast carcinoma.

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18
Q

What is a fibroadenoma?

A

Common benign fibroepithelial neoplasm of the breast.

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19
Q

How does a fibroadenoma look?

A

A well circumscribed mobile breast lump in young women aged 20-30

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20
Q

How do you treat a fibroadenoma?

A

Shelling out

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21
Q

What is a Phyllodes tumours?

A

A group of potentially aggressive fibroepithelial neoplasms of the breast which are uncommon.

Can be benign, borderline and malignant.

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22
Q

How do Phyllodes tumours present?

A

Enlarging masses in women >50 and may arise within pre existing fibroadenomas.

Mostly benign but some can be more aggressive.

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23
Q

What is an intraductal papilloma?

A

A benign papillary tumour arising within the duct
system of the breast.

Arise within small terminal ductules (peripheral

papillomas) or larger lactiferous ducts (central
papillomas) .

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24
Q

How does an intraductal papilloma present?

A

Common.

Seen mostly in women aged 40-60.

Central papillomas present with nipple discharge.

Peripheral papillomas may remain clinically silent if
small.

Excision of involved duct is curative.

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25
Q

What is a radial scar?

A

A benign sclerosing lesion characterised by a central
zone of scarring surrounded by a radiating zone of
proliferating glandular tissue.

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26
Q

How big are radial scars?

A

Range in size from tiny microscopic lesions to large
clinically apparent masses.

Lesions >1 cm are sometimes called “complex sclerosing
lesions”.

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27
Q

How do radial scars present?

A

Reasonably common lesions.

Thought to represent an exuberant reparative
phenomenon in response to areas of tissue damage in
the breast.

Usually present as stellate masses on screening
mammograms which may closely a carcinoma.

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28
Q

How do you repair a radial scar?

A

Excision

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29
Q

What are proliferative breast diseases?

A

A group of intraductal proliferative lesions associated with an increased risk of invasive breast carcinoma.

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30
Q

How do proliferative breast diseases present?

A

Microscopic lesions which usually produce no
symptoms.

Diagnosed in breast tissue removed for other reasons or
on screening mammograms if they calcify.

31
Q

What is usual epithelial hyperplasia?

A

Not considered a direct precursor lesion to invasive
breast carcinoma but is a marker for a slightly
increased risk (relative risk of 1.5-2.0) for subsequent
invasive carcinoma.

32
Q

What is flat epithelial atypia?

A

Emerging genetic data suggests FEA may represent the earliest morphological precursor to low grade ductal carcinoma in situ.

4 times relative risk of developing cancer

33
Q

What is an in situ lobular neoplasia?

A

Current evidence suggests that in situ lobular
neoplasia is a risk factor for subsequent invasive breast
carcinoma in either breast in a minority of women.

The relative risk is quoted as between 7-12 times that
expected in women without lobular neoplasia.

34
Q

What is ductal carcinoma in situ?

A

A common neoplastic intraductal epithelial proliferation with risk of progression to invasive breast carcinoma.

Picked up more because of screening.

35
Q

How are DCIS detected on mammography?

A

85% are detected on mammography as areas of
microcalcification.

10% produce clinical findings such as a lump, nipple
discharge, or eczematous change of the nipple (Paget’s
disease of the nipple).

5% are diagnosed incidentally in breast specimens
removed for other reasons.

Subclassified histologically into low, intermediate and
high grade.

36
Q

What is the treatment of DCIS?

A

Surgical excision with clear margins

Recurrence more likely with extensive/ high grade disease

37
Q

What are invasive breast carcinomas?

A

A group of malignant epithelial tumours which
infiltrate within the breast and have the capacity to
spread to distant sites.

The most common cancer in women with a lifetime
risk of 1 in 8.

Incidence rates rise rapidly with increasing age, such
that most cases occur in older women.

38
Q

What is the aetiology of invasive breast carcinomas?

A

Early menarche, late menopause, increased weight, high
alcohol consumption, oral contraceptive use, and a
positive family history are all associated with increased
risk.

About 5% show clear evidence of inheritance. BRCA
mutations cause a lifetime risk of invasive breast
carcinoma of up to 85%.

39
Q

How do genetics impact invasive breast carcinomas?

A

Genetic studies suggest there are two distinct pathways
leading to invasive breast cancer.

“Low grade” breast carcinomas tend to arise from low
grade DCIS or in situ lobular neoplasia and show 16q
loss.

“High grade” breast carcinomas arise from high grade
DCIS and show complex karyotypes with many
unbalanced chromosomal aberrations.

40
Q

What is the presentation of invasive breast carcinoma?

A

Most cases present symptomatically with a breast lump.

An increasing proportion of asymptomatic cases are
detected on screening mammography.

41
Q

What is a basal like carcinoma?

A

Recently described type of carcinoma discovered following genetic
analysis of breast carcinomas.

Often associated with BRCA mutations.

Seem to have particular propensity to vascular invasion and distant
metastatic spread.

42
Q

What is basal like carcinoma like histologically?

A

Histologically characterised by sheets of markedly atypical cells with a prominent lymphocytic infiltrate.

Central necrosis is common.

43
Q

How is basal like carcinoma immunohistochemically?

A

Immunohistochemically characterised by positivity for “basal”
cytokeratins CK5/6 and CK14.

44
Q

How does histological grading work in invasive breast cancers?

A

All invasive breast cancers are graded histologically by
assessing 1) tubule formation 2) nuclear pleomorphism,,
and 3)mitotic activity.

Each parameter is scored from 1-3 and the three values
are added together to produce total scores from 3-9.

45
Q

What are the different grades?

A

3-5 points = grade 1 (well differentiated).
6-7 points = grade 2 (moderately differentiated).
8-9 points = grade 3 (poorly differentiated).

46
Q

What does receptor status indicate?

A

All invasive breast carcinomas are assessed for oestrogen receptor (ER), progesterone receptor (PR) and Her2
status.

Low grade tumours tend to be ER/PR positive and Her2
negative.

High grade tumours tend to be ER/PR negative and Her2
positive.

Basal-like carcinomas are often ER/PR/Her2 negative
(“triple negative”).

47
Q

What are prognostic indicators in breast cancer?

A

No. 1: Axillary lymph nodes

Other: tumour size,
histological type, and histological grade.

48
Q

How do we follow breasts?

A

The aim of screening is to pick up DCIS or early
invasive carcinomas.

Women aged 47-73 (BUT most places do 50-70) are invited for screening every
three years.

The screening test is a mammogram which looks for
abnormal areas of calcification or a mass within the breast.

49
Q

Who gets picked up by the NHS breast screening programme?

A

About 5% of women have an abnormal mammogram
and are recalled to an assessment clinic for further
investigation.

This may include more mammograms or an
ultrasound followed by sampling of the abnormal area,
usually by core biopsy.

50
Q

How are core biopsies coded?

A

B1 = normal breast tissue.

B2 = benign abnormality.

B3 = lesion of uncertain malignant potential.

B4 = suspicious of malignancy.

B5 = malignant (B5a = DCIS, B5b = invasive carcinoma).

51
Q

What is gynaecomastia?

A

Refers to enlargement of the male breast.

Pubertal boys and older men aged over 50.

Idiopathic or associated with drugs (both therapeutic and recreational).

Histologically the breast ducts show epithelial hyperplasia with
typical finger-like projections extending into the duct lumen. The
periductal stromal is often cellular and oedematous.

Benign, no risk of malignancy.

52
Q

Who gets male breast cancer?

A

Carcinoma of the male breast is rare (0.2% of all
cancers).

Median age at diagnosis 65 years old.

Most present with a palpable lump.

Histologically the tumours show similar features to
female breast cancers.

53
Q

Why is mammography useful?

A

Can be used in pregnant women
It is an x ray modality

54
Q

What is the most common malignant breast tumour?

A

Ductal carcinoma

55
Q

How many parameters are used in breast tumour grading?

A

3

56
Q

What does this show?

A

Breast Histology samples. Terminal duct lobules (behind the nipple) in the tope left. Bottom = high power duct (have myoepithelial cells in wall and epithelia around lumen)

57
Q

What does this show?

A

Duct ectasia

58
Q

What does this show?

A

Acute mastitis

59
Q

What does this show?

A

Fat necrosis

60
Q

What does this show?

A

Fibrocystic disease

61
Q

What does this show?

A

Fibroadenoma- sesame shaped cells which means its benign.

62
Q

What does this show?

A

Phyllodes tumour

63
Q

What is this?

A

Intraductal papilloma

64
Q

What is this?

A

Radial scar

65
Q

What is this?

A

Usual epithelial hyperplasia

66
Q

What is this?

A

Flat epithelial atypia- punched out margins

67
Q

What is this?

A

In situ lobular neoplasia

68
Q

What is this?

A

Low grade DCIS

69
Q

What is this?

A

High grade DCIS

70
Q

What is this?

A

Invasive ductal carcinoma

71
Q

What is this?

A

Invasive lobular carcinoma

72
Q

What is this?

A

Invasive tubular carcinoma

73
Q

What is this?

A

Invasive mucinous carcinoma

74
Q

What is this?

A

Basal like carcinomas

PathY5 (98 decks)

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