Breast pathology

Question 1

FNA classification

Answer 1

• C1 = unsatifactory
• C2 = benign
• C3 = atypical, probably benign
• C4 = Suspicious of malignancy
• C5 = malignant

Question 2

Resection of cancer options include?

Answer 2

• wide local excision

- mastectomy

Question 3

Explain normal histology of the breast

Answer 3

• myo-epithelial cells on basement membrane

- epithelial cells more luminal

Question 4

Define gynaecomastia?

Answer 4

• breast development in males without lobular development

Question 5

Causes of gynacomastia?

Answer 5

• exogenous/endogenous hormones
• cannabis
• prescription drugs
• liver disease

Question 6

Fibrocystic disease of breast presentation

Answer 6

• smooth discrete lumps
• sudden pain
• cyclical pain
• lumpiness

Question 7

Types of fibrocystic disease

Answer 7

• apocrine metaplasia
• sclerosing adenosis
• atypical hyperplasia

Question 8

Define metaplasia?

Answer 8

• change from one differentiated cell into another

Question 9

What is a hamartoma?

Answer 9

• circumscribed lesions composed of cell types normal to the breast but abnormal proportion or distribution

Question 10

Fibroadenoma is ___ dependant

Answer 10

• oestrogen

Question 11

Typical presentation of fibroadenoma?

Answer 11

• painless
• discrete
• mobile mass
• solid on USS

Question 12

Typical age presentation of fibroadenoma?

Answer 12

• 20-30s

- afro-carribean

Question 13

Why is a fibroadenoma called a biphasic tumpour

Answer 13

• epithelial and stroma tissue

Question 14

Radial scars presentation

Answer 14

• usually < 10mm

- fibroelastic core with radiating fibrosis

Question 15

Causes of fat necrosis

Answer 15

• breast trauma

- warfarin

Question 16

Histological appearance of fat necrosis of the breast

Answer 16

• giant cells

- calcification

Question 17

Features of duct ectasia?

Answer 17

• sub-alveolar ducts
• pain
• inflammatory
• purulent / bloody discharge
• nipple retraction

Question 18

Aetiologies of mastitis?

Answer 18

• lactation

- duct ectasia

Question 19

Age of presentation for a phyllodes tumour?

Answer 19

• 40-50s

Question 20

Phyllodes tumour is what ___ overgrowth

Answer 20

• stromal

- rare to metastasis

Question 21

Explain symptoms of intraductal papilloma?

Answer 21

• nipple discharge
• sub alveolar ducts
• fibrovascular core
• epithelial proliferation

Question 22

Where does breast adenocarcinoma arise?

Answer 22

• glandular epithelium of the terminal duct lobular unit (TDLU)

Question 23

Precursor lesions of breast cancer?

Answer 23

• epithelial hyperplasia
• columnar cell change
• ductal carcinoma in situ
• lobular in situ neoplasia

Question 24

What does in situ carcinoma refer to?

Answer 24

• confined within the membrane of acini and ducts

- can be lobular or ductal

Question 25

Lobular in situ hyperplasia can be divided into what 2 types?

Answer 25

- atypical lobular hyperplasia | - lobular carcinoma in situ

Question 26

Explain the histological findings in lobular in situ neoplasia?

Answer 26

- E-cadherin negative | - bilateral

Question 27

What is a precursor of invasive ductal carcinoma?

Answer 27

- ductal carcinoma in situ

Question 28

Management of ductal carcinoma in situ?

Answer 28

- surgery | - adjuvent radiotherapy

Question 29

Explain Padgett disease of the nipple

Answer 29

- high grade DCIS - extends to epidermis - carcinoma in situ

Question 30

Define microinvasive carcinoma?

Answer 30

- rare | - DCIS high grade, invasion <1mm

Question 31

Risk factors for invasive breast cancer

Answer 31

- age - parity - OCP - HRT - Early menarche, late menopause - lifestyle

Question 32

What familial mutation is associated with breast cancer?

Answer 32

- BRCA 1 and BRCA 2

Question 33

ER and PR meaning when describing breast cancer

Answer 33

- oestrogen receptor positive - progesterone receptor positive - can indicate potential therapies

Question 34

Name a prognostic index used in breast cancer?

Answer 34

- NHS Predict