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MB3 Obstetrics and Gynaecology > Breast pathology > Flashcards

Breast pathology Flashcards

1
Q

methods of cytopathology biopsy

A

FNA
fluid
nipple discharge
nipple scrape

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2
Q

FNA grading of breast lumps

A 
C1 - unsatisfactory 
C2 - benign 
C3 - atypical, probably benign 
C4 - suspicion of malignancy 
C5 - malignant
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3
Q

diagnostic histopathology methods

A

core biopsy
vacuum assisted biopsy
skin biopsy
incisional

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4
Q

needle core biopsy grading of breast lumps

A 
B1 - unsatisfactory/normal 
B2 - benign 
B3 - atpical but probably benign
B4 - suspicious of malignancy 
B5a - CIS 
B5b - invasive carcinoma
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5
Q

therapeutic histopathology methods

A

vacuum assisted excision
excision biopsy
resection

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6
Q

developmental anomalies causing benign breast disease?

A

hypoplasia
juvenile hypertrophy
accessory breast tissue
accessory nipple

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7
Q

inflammatory conditions causing benign breast disease?

A

mastitis
abscess
duct ectasia
fat necrosis

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8
Q

benign disease causing breast disease?

A

phyllodes tumour

intraduct papilloma

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9
Q

non-neoplastic disease causing benign breast disease?

A

gynaecomastia
fibrocystic change
hamartoma
sclerosing lesions

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10
Q

what is gynaecomastia

A

ductal growth without lobular development leading to breast development in males

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11
Q

causes of gynaecomastia

A

liver disease
endogenous or exogenous steroid
prescription medication
cannabis

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12
Q

who is fibrocystic change more common in

A

40-50 but can be as early as 20
late menopause of early menarche
often resolve of diminish after

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13
Q

presentation of fibrocystic change

A 
asymptomatic 
smooth or discrete lump
sudden pain 
cyclical change 
hormonal variation 
lumpiness
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14
Q

microscopic appearance of fibrocystic change

A

thin walled
fibrotic
apocrine epithelia

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15
Q

management of fibrocystic change

A

exclude malignancy
reassure
remove if needed

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16
Q

what is a hamartoma

A

circumscribed lesion of cell types normal to breast but in abnormal proportion

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17
Q

who is fibroadenoma more common in

A

20s
black afrocaribbean women
often incidental

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18
Q

how does fibroadenoma present

A

painless firm, discrete, mobile mass

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19
Q

describe the biphasic appearance of fibroadenoma

A

appearance of epithelia and stroma

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20
Q

treatment of fibroadenoma

A

diagnose and reassure

excise if needed

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21
Q

who is sclerosing adenosis more common in and how may it present

A

20-70

often asymptomatic but may be pain, tenderness, lumpiness

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22
Q

how big is a radial scar

A

1-9mm

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23
Q

how big is a complex sclerosing lesion

A

> 10mm

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24
Q

how may a CSL or radial scar appear

A

stellate

fibroelastic core and dilated ductules with epithelial proliferation

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25
Q

causes of fat necrosis

A

local trauma

warfarin

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26
Q

describe method of fat necrosis

A

damage and disruption to adipocyte leading to infiltration by inflammatory cells

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27
Q

what is duct ectasia

A

widening of subaraeolar duct(s) leading to possible block, inflammation, fistulation

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28
Q

presentation of duct ectasia

A

bloody/purulent discharge
fistulation
nipple retraction

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29
Q

causes of duct ectasia

A

smoking

older age

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30
Q

management of duct ectasia

A

treat infection
exclude cancer
stop smoking
surgical removal of duct

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31
Q

causes of acute mastitis and organisms

A

lactation - staph aureus and strep pyogenes

duct ectasia - mixed or anaerobes

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32
Q

management of acute mastitis

A

abx
percutaneous drain
incise and drain
treat cause

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33
Q

what age does a phyllodes tumour affect and presentation

A

40-50

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34
Q

classification of phyllodes tumour and recurrence?

A

benign, borderline, malignant

recurs if not adequately excised and rarely can metastasise

35
Q

what age does intraduct papilloma affect

A

35-60

36
Q

presentation of intraduct papilloma

A

nipple discharge± blood

nodules or calcification

37
Q

treatment of intraduct papilloma

A

excise if benign

if malignant excise with margins

38
Q

classification of epithelial proliferative activity in intraduct papilloma

A

no proliferation - benign
usual type hyperplasia - benign
atypical ductal hyperplasia - IDP with ADH
ductal CIS - IDP with CIS

39
Q

what is breast carcinoma and where does it arise in the breast

A

malignant adenocarcinoma of breast epithelial cells

glandular epithelia of TDLU

40
Q

ductal precursor lesions?

A

usual type hyperplasia
columnar cell change
atypical duct hyperplasia
ductal CIS

41
Q

lobular precursor lesions?

A

atypical lobular hyperplasia

LCIS

42
Q

describe what an in situ breast carcinoma is

A

carcinoma confined to the basement membrane of acini and duct
cytologically malignant but not invasive and a precursor of invasive cancer

43
Q

what is atypical lobular hyperplasia

A

lobular in situ neoplasia involving <50% lobule

44
Q

what is LCIS

A

lobular in situ neoplasia involving >50% lobule

45
Q

lobular in situ neoplasia - characteristic cell features

A 
small-intermediate nuclei
solid proliferation 
ER+ve 
intra-cytoplasmic vacuoles
Ed cadherin -ve
46
Q

true/false - lobular in situ neoplasia is ER+ve

A

true

47
Q

features of LCIS

A

multifocal and bilateral
incidence decreases post menopause
not palpable or visible
often incidental as a calcification on mammogram

48
Q

is LCIS a true precursor lesion for invasive cancer

A

yes, it increases risk 8x

49
Q

management of LCIS

A

if on core biopsy - excision biopsy or vacuum assisted to exclude higher grade
if discovered on vacuum or excision then follow up
NO mastectomy

50
Q

grading of ductal CIS

A

low
intermediate
high

51
Q

what can high grade ductal CIS be characterised by and describe how this process occurs

A

comedo necrosis

when epithelial proliferated quicker than vascular supply leading to necrosis of the inside of the inner tumour

52
Q

pathological features DCIS

A

unicentric from one TDLU
malignant epithelial cells but confined to basement membrane
can involve lobule

53
Q

what is pagets disease of the breast

A

high grade DCIS extending along ducts to reach epidermis of nipple
still present in situ and non invasive

54
Q

what % of DCIS progress to invasive cancer

A

75%

55
Q

management of DCIS

A

diagnosis
surgery
adjuvant radiotherapy
chemoprevention/endocrine therapy

56
Q

what is microinvasive carcinoma

A

rare classification of DCIS which is high grade with invasion <1mm

57
Q

describe the process of healthy cell breast tissue becoming a low grade invasive carcinoma

A

low grade DCIS, LCIS, columnar cell change or atypical duct hyperplasia results from healthy cells
leads to tubular ca, grade 1 ductal ca or lobular ca

58
Q

describe the process of healthy cell breast tissue becoming a intermediate grade invasive carcinoma

A

intermediate grade DCIS results from health tissue or from low grade DCIS
pleo-LCIS results from healthy tissue
either can progress to either grade 2 ductal ca or pleo lobular ca

59
Q

describe the process of healthy cell breast tissue becoming a high grade invasive carcinoma

A

high grade DCIS develops from healthy breast tissue or from intermediate DCIS
leads to grade 3 ductal ca

60
Q

what is the definition of malignant invasive breast carcinoma

A

malignant cells that have breached basement membrane and infiltrate normal tissues

61
Q

incidence of breast cancer

A

increasing
male incidence low
increases with age and more common in white women

62
Q

risk factors for breast cancer

A 
age 
reproductive hx 
hormones 
lifestyle 
cancer syndromes and genes
63
Q

reproductive risk factors leading to breast ca

A 
age at menarche 
age at first birth 
parity 
age of menopause 
breastfeeding
64
Q

hormonal risk factors leading to breast ca

A

endogenous
previous breast disease
OCP
HRT

65
Q

lifestyle risk factors leading to breast ca

A 
body weight 
exercise - protective 
Diet 
alcohol 
NSAIDs lower risk 
smoking
66
Q

cancer syndromes that may cause breast cancer

A

BRCA1/2
TP53 li fraumeni
PTEN cowdens

67
Q

what cancers does BRCA 1 lead to

A

Breast, ovarian, colon, prostate

68
Q

what cancers does BRCA 2 lead to

A

breast inc men, ovarian, pancreatic, prostate

69
Q

what cancers does TP53 li fraumeni lead to

A

childhood sarcoma, brain, adrenocortical carcinoma, early onset breast

70
Q

mortality of breast cancer and survival?

A

2nd biggest killer but decreasing with increasing incidence
1yr avg 96%
5yr 85%
10yr 76%

71
Q

natural hx of breast cancer - tumour factors

A

spread to stromal tissue
spread to chest wall
spread to skin

72
Q

natural hx of breast cancer - nodal factors

A

spread to regional lymph nodes

73
Q

where does breast cancer spread to

A 
brain 
liver 
abdominal viscera
female genital tract 
bone
74
Q

what are the two most common morphological types of breast cancer

A

ductal

lobular

75
Q

objective grading of morphological breast cancer

A 
tubular differentiation
nuclear pleomorphism
mitotic activity 
all graded 1-3 
3-5 are grade 1 
6-7 are grade 2
8-9 are grade 3
76
Q

intrinsic subtypes of breast cancer?

A

luminal A/B/C
Normal breast like
HER2+ve
Basal like

77
Q

ER is -ve in all luminal subtypes of breast cancer?

A

false, it is +ve

78
Q

what is ER and HER2 in basal like breast cancer

A

-ve for both

79
Q

is ER+Ve or -ve for HER2+vve breast cancer

A

-ve

80
Q

is ER+ve or -ve in normal breast like cancer

A

-ve

81
Q

what does a +ve ER tunour suggest

A

good response to anti-oestrogen therapy

82
Q

possible anti-oestrogen therapies in breast cancer?

A

oophorectomy
tamoxifen
aromatase inhibitors
GnRH antagonists

83
Q

what does a +ve HER2 predict in breast cancer

A

response to trastuzumab

84
Q

two possible prognostic indicators for breast cancer?

A

nottingham prognostic index

NHS predict

MB3 Obstetrics and Gynaecology (12 decks)

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