breast pathology Flashcards
What are examples of benign breast conditions?
Fibrocystic change
- Fibrosis, adenosis, cysts, apocrine metaplasia, ductal epithelial hyperplasia (usual type and atypical)Fibroadenoma
- Circumscribed mobile nodule in reproductive ageOther adenomas
- Tubular adenoma and lactating adenomaIntraduct papilloma
- Lactiferous ducts, nipple discharge
- Fat necrosis
- Duct ectasia
What are examples of fibrocystic changes to the breast?
- Fibrosis, adenosis, cysts, apocrine metaplasia, ductal epithelial hyperplasia (usual type and atypical)
What is fibroadenoma?
Proliferation of epithelial and stromal elements
What is the most common breast tumour in young adult woman?
Fibroadenoma
What are the different types of fibroadenoma?
Intracanalicular pattern
- Ducts distorted elongatedPericanalicular pattern
- Ducts not compressed
What are characteristics of fibroadenoma?
- Well-circumscribed, freely mobile, no painful mass
What is the management for fibroadenoma?
- May regress with age
Describe the epidemiology of tubular adenoma (how common compared to fibroadenoma, young/older woman)?
- Less common than fibro adenomas
* Young woman
What are characteristics of tubular adenoma?
- Uniform sized ducts
What is lactating adenoma?
Enlarging masses during lactation or pregnancy:
- Prominent secretory change
Describe the epidemiology of intraduct papilloma (young/middle/older woman)?
- Usually middle aged woman
What are characteristics of intraduct papilloma?
- Nipple discharge, bloody
What is the aetiology of fat necrosis?
- History of antecedent trauma, surgery
What is seen in the histology for fat necrosis of the breast?
- Histiocytes with foamy cytoplasm
- Lipid-filled cysts
- Fibrosis, calcifications, egg shell on mammography
What is a possible complication of fat necrosis?
- Can stimulate carcinoma
What are characteristics of phyllodes tumour?
- Fleshy tumour, leaf-like pattern and cysts on cut surface
* Circumscribed, connective tissue and epithelial elements
What are possible complications of phyllodes tumour?
Rapid growing so is borderline malignant
- Metastases are haematogenous
What are the 5 subtypes of molecular classification for breast carcinoma?
- ER and luminal A
- Luminal B
- Basal
- Her2
- Normal breast like
What molecular classification of breast carcinoma is most common?
Luminal A
For each molecular subtype of breast carcinoma, are they positive or negative for:
- ER
- PR
- HER2
What is the aetiology for breast carcinoma?
Different breast lesions have potential to become cancer
- Epithelial proliferation without atypia – RR 1.5-2x
- With atypia ductal or lobular – RR 4-5x
- LCIS – RR 8-10x
- DCIS – RR 8-10x
Describe the epidemiology for breat cancer (fraction of females, fraction of all female cancers)?
- 1/8 females, 22% all female cancer
What are the different histological classifications for breast carcinoma?
Non-invasive
Different types
- Ductal carcinoma in situ (DCIS)
- Lobular carcinoma in situ (LCIS/LISN)
- Not detected clinically (only x-ray)
Risk of invasion depending on grade - Low grade DCIS – 30% in 15 years
- High grade DCIS – 50% in 8 years
- LCIS - 19% in 25 years and bilaterallyInvasive
- Invasive ductal carcinoma 75%
- Invasive lobular carcinoma
Special types - Tubular carcinoma, mucinous carcinoma, carcinoma with medullary features, metaplastic carcinoma
What are different types of non-invasive breast carcinoma?
- Ductal carcinoma in situ (DCIS)
* Lobular carcinoma in situ (LCIS/LISN)
What does DCIS stand for?
Ductal carcinoma in situ
What does LCIS stand for?
Lobular carcinoma in situ
Risk of invasion for non-invasive breast carcinomas depends on what?
Risk of invasion depending on grade
- Low grade DCIS – 30% in 15 years
- High grade DCIS – 50% in 8 years
- LCIS - 19% in 25 years and bilaterally
What are different kinds of invasive breast cancers?
- Invasive ductal carcinoma 75%
- Invasive lobular carcinoma
Special types - Tubular carcinoma, mucinous carcinoma, carcinoma with medullary features, metaplastic carcinoma
What are risk factors for breast carcinoma?
- Gender
- Age
- Menstrual history
- Age at first pregnancy
- Radiation
- Family history
Genetic - BRCA1 and BRCA2
- Personal history
Hormonal treatment - Oestrogen exposureOther factors
- Obesity, lack of exercise, alcohol
What genes have biggest impact for developing breast carcinoma?
BRCA1 and BRCA2
What are characteristics of breast carcinoma (mammogram and macroscopic)?
Mammogram
- Soft tissue opacity, microcalcificationMacroscopic
- Hard lump, fixed mass, tethering to skin
How does breast cancer spread?
Local
- Skin, pectoral musclesLymphatic
- Axillary and internal mammary nodesBlood
- Bone, lungs, liver, brain
What organs does breast cancer commonly spread to through the blood?
- Bone, lungs, liver, brain
What investigations should be done for breast carcinoma?
- Examination
Imaging - Mammogram, USS, MRI
- Sensitivity of mammography reduced in younger woman due to more glandular tissue being presentBiopsy
- Fine needle aspiration cytology (FNA)
- Needle core biopsy
- Histology report looks at invasive vs non-invasive, histological type, grade, size, margins, lymph nodes, oestrogen/progesterone receptor, HER-2
Also do sentinel lymph node biopsy - If negative, rest of nodes are negative
What is the presentation of breast carcinoma?
- Asymptomatic
Symptomatic - Lump
- Mastalgia – persistent unilateral pain
- Nipple discharge – blood stained
- Nipple changes – Paget’s disease, retraction
- Change in size or shape of breast
- Lymphoedema – swelling of arm
- Dimpling of breast skin
Describe the managemnent for breast carcinoma?
- Staging
Surgery - Masectomy, breast conserving surgery with or without lymph nodes
- Radiotherapy
Antihormonal therapy - Tamoxifen
- Chemotherapy
What antihormonal therapy can be used for breast carcinoma?
Antihormonal therapy
Tamoxifen
What does the prognosis of breast carcinoma depend on?
Patient and tumour related, depends on
- Node status, tumour size, type, grade (1, 2, 3), age, lymphovascular space invasion
- Oestrogen receptors, progesterone receptors, HER-2, proliferative rate of tumour, gene expression profiling
- Can use Nottingham Prognostic Index (NPI) based on tumour size, grade and nodal status
- Overall 64% 5 year survival
What system is used to estimate prognosis of breast carcinoma?
- Can use Nottingham Prognostic Index (NPI) based on tumour size, grade and nodal status
What does NPI stand for?
Nottingham prognostic index
Is Paget’s disease of the nipple benign or malignant?
Malignant
What is the aetiology for Paget’s disease of the nipple?
- Intraepithelial spread of intraductal carcinoma
What is the presentation for Paget’s disease of the nipple?
- Large pale-staining cells within epidermis of nipple
- Limited to nipple or extend to the areola
- Pain or itching, scaling and redness
- Ulceration, crusting, serous or bloody discharge
What investigations are done for Paget’s disease of the nipple?
- Same as breast carcinoma
How is screening for breast cancer done?
Mammogram every 3 years for woman aged 50-70 years:
- 30% reduction in mortality
Indicators on mammogram - Masses
- Microcalfications
What age group qualifies for breast cancer screening and how often do they get this?
Mammogram every 3 years for woman aged 50-70 years:
- 30% reduction in mortality
Indicators on mammogram - Masses
- Microcalfications
What are indicators on a mammogram of breast cancer?
- Masses
* Microcalfications
What are examples of pathology of the male breast?
- Gynecomastia
* Carcinoma of male breast
What is gynecomastia?
Increase in subareolar tissue
What is the most common pathology of the male breast?
Gynecomastia
What are risk factors for gynecomastia?
- Hyperthyroidism
- Cirrhosis of liver
- Renal failure
- Chronic pulmonary disease
- Hypogonadism
Use of hormones - Oestrogens, androgens
What hormones increase the risk of gynecomastia?
- Oestrogens, androgens
