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High Yield Review: Phase II MEQ Pros > Breast Pathology > Flashcards

Breast Pathology Flashcards

1
Q

How are breast conditions usually diagnosed?

A

Using the TRIPLE TEST

  • Clinical Examination
  • Pathology
  • Radiology

CPR near the BREAST

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2
Q

In which group of individuals are mastitis more common in?

A

Lactating women (e.g. nursing mom)

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3
Q

What is the most common cause of mastitis?

A

Staphylococcus aureus

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4
Q

Briefly describe the pathophysiology of acute mastitis.

A

Milk stagnant / milk stasis (e.g. due to inadequate feeding, quick weaning) -> creates a favourable environment for the bacteria to grow within the lactiferous ducts -> proliferation of staphylococci -> acute inflammation with neutrophils (bacterial infection) -> mastitis

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5
Q

What is the main complication of mastitis?

A

Breast abscess

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6
Q

How do you reduce the risk of complication of mastitis?

A

Continue with breastfeeding to reduce the risk of breast abscess.

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7
Q

What are the four treatment strategies for breast abscess?

A
  1. Needle aspiration: for breast abscess with intact overlying skin
  2. Incision and drainage: for breast abscess if overlying skin necrosis is present
  3. Antibiotic treatment (e.g. cephalexin, clindamycin, trimethoprim-sulfamethoxazole)
  4. Excision: if severe
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8
Q

What is the most common benign breast lesion?

A

Fibrocystic changes (benign epithelial condition)

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9
Q

In which age group does fibrocystic change usually occurs in?

A

Female in reproductive age/premenopausal

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10
Q

What are the 2 histological subtypes of benign epithelial condition (fibrocystic change)?

A
  • Non-proliferative lesions

- Proliferative lesions

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11
Q

Describe grossly how the breast will look (non-proliferative lesion).

A

Cysts (dilated, fluid filled ducts)

Stromal fibrosis

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12
Q

Is there a risk of malignancy for non-proliferative lesion (fibrocystic change)

A

No malignant potential

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13
Q

Describe grossly how the breast will look (proliferative lesion).

A

Sclerosing adenosis

Ductal epithelial hyperplasia (ductal hyperplasia) -> atypical cells

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14
Q

Is there a risk of malignancy for proliferative lesion (fibrocystic change)

A

Proliferative lesions with atypical cells (e.g. ductal epithelial hyperplasia) are associated with an increased risk of cancer

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15
Q

What is the most common cause of bloody or serous nipple discharge?

A

Intraductal papilloma

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16
Q

What is the most common breast tumour in women < 35 y/o (young)

A

Fibroadenoma

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17
Q

Define fibroadenoma

A

A benign breast tumour with fibrous and glandular tissue

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18
Q

Describe the clinical characteristics of fibroadenoma.

A

Most commonly solitary; well-defined firm, non-tender, mobile mass with a rubbery consistency

Solitary
Mobile
Non tender
Rubbery consistency

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19
Q

Describe the microscopic findings of fibroadenoma

A

Usually well-circumscribed

Biphasic (fibroepithelial) tumour

Relatively hypocellular stroma

Prolfieration of glandular and stromal elements

Pericanalicular pattern

20
Q

How does fibrous tissue appears grossly and microscopically?

A

Grossly: white

Microscopically: pink

21
Q

What is phyllodes tumour?

A

Rare, most commonly benign, fibroepithelial tumour with histology similar to phyllodes tumour.

Note: 25% are malignant (usually stroma component undergo malignant changes)

22
Q

Describe the microscopic findings of phyllodes tumour.

A

Usually well circumscribed

Biphasic (fibroepithelial) tumour

Moderately cellular stroma

Broad leaf-like architecture with papillary projection of epithelium-lined stroma

Intracanalicular pattern

Note: grossly: leaf-like architecture of the clefts

23
Q

What is the next-step management upon discovering phyllodes tumour?

A

Surgical excision due to its high recurrence rate and malignant potential.

24
Q

Describe and contrast fibroadenoma and phyllodes tumour.

A

Similarity:

  • Both are fibroepithelial tumour (biphasic)
  • Both are usually benign
  • Both are usually well-circumscribed

Differences:

  • Fibroadenoma: 15-35 y/o
  • Phyllodes: 40-50 years old
  • Fibroadenoma: relatively hypocellular
  • Phyllodes: more cellular (moderate)
  • Fibroadenoma: predominantly pericanalicular pattern
  • Phyllodes: predominantly intracanalicular pattern
25
Q

What is the significant of breast cancer?

A

It is the most common non-skin malignancy in women, and the second leading cause of cancer death

(1st is lung cancer)

26
Q

What are some predisposing / risk factors for breast cancer?

A

Hormonal

Increased exposure to endogenous estrogen

  • early menarche and/or late menopause
  • nulliparity
  • absence breast feeding
  • obesity (lipocytes converts androstendione to estrone)

increased exogenous estrogen
- hormonal replacement therapy

Genetic / Hereditary

  • Positive family history
  • Autosomal dominant BRACA1 and BRACA2 tumour suppressor gene mutation

Others

  • European descent
  • Low fiber, high fat diet
  • Smoking
  • Alcohol consumption
  • Presence of benign breast condition with atypia
  • Radiation therapy during childhood
27
Q

Does individuals with breast cancer develops symptoms?

A

Often at the later stage of the disease.

28
Q

Describe the tumor mass in breast cancer on palpation.

A

Poorly defined margin
Solitary
Firm
Non-tender

29
Q

Which is the most common site of breast cancer?

A

Upper Outer Quadrant > Subaerolar > Other Sites

30
Q

Difference between benign lesion and malignant lesion on mammography (screening).

A

Appearance:

  • Benign: well-defined, circumscribed mass
  • Malignant: focal lesion or density

Margins:

  • Benign: surrounding radiolucent ring (halo sign)
  • Malignant: irregular, poorly defined, spiculated margin

Calcifications:

  • Benign: diffuse or coarse calcifications
  • Malignant: clustered calcifications
31
Q

List the prognostic factors for breast cancer.

A
  1. Hormonal receptor status (immunohistochemical staining)
    - estrogen-receptor
    - progresterone-receptor
  2. Human Epidermal Growth Factor 2 (HER2/neu, c-erbB2)
    (immunohistochemical staining / fluorescence in-situ hybridisation)
  3. Histological Types
  4. TNM Staging
    - Vascular Invasion
    - Lymph node involement
    - Metastases
32
Q

Does patient with HER2 over expression or hormone receptor positive breast CA has a better or worse prognosis?

A

HER2 over expression is associated with an increased risk of recurrence and poorer prognosis as compared to hormone receptor positive breast cancer.

33
Q

10-15% of breast cancer are triple-negative. What does it mean? And what is its clinical significance?

A

A triple negative breast cancer is a hormone receptor negative and HER2 negative.

They are typically more aggressive, high-grade tumour, and should be treated with chemotherapy.

34
Q

Define non-invasive carcinoma / carcinoma in-situ

A

Carcinoma characterised by the absence of stromal invasion (intact basement membrane)

35
Q

Which breast CA is associated with decreased E-cadherin (adhesion molecule) expression?

A

Lobular Carcinoma-In-Situ

36
Q

What are 2 subtype of DCIS?

A 
Comedocarcinoma DCIS
Cribiform DCIS
Micropapillary DCIS
Papillary DCIS
Solid DCIS
37
Q

Describe and contrast DCIS and LCIS.

A

Presentation

  • DCIS: incidental finding, palpable mass, nipple discharge
  • LCIS: incidental finding

Location

  • DCIS: ducts
  • LCIS: lobules

Cell size:

  • DCIS: medium to large
  • LCIS: small

Calcifications (mammography)

  • DCIS: pattern of grouped calcification
  • LCIS: usually absent

Risk of invasive carcinoma

  • DCIS: higher
  • LCIS: lower

Location of subsequent invasive carcinoma

  • DCIS: ipsilateral
  • LCIS: ipsilateral or contralateral
38
Q

What is the most common type of invasive breast carcinoma?

A

Invasive ductal carcinoma.

39
Q

Describe and contrast invasive ductal carcinoma and invasive lobular carcinoma.

A

Invasive ductal carcinoma

  • typically unilateral
  • typically unifocal
  • aggressive, result in formation of metastases

Invasive lobular carcinoma

  • typically bilateral
  • typically multifocal
  • less aggressive
40
Q

Describe and contrast the histological finding of invasive ductal carcinoma and invasive lobular carcinoma.

A

Invasive ductal carcinoma

  • Cohesive cluster of cells
  • Tubular/gland formation
  • Desmoplastic stroma reaction: infiltrative, distorted, hypercellular stroma

Invasive lobular carcinoma:

  • Less cohesive, rows/cords of cells (single filing)
  • Single cells
41
Q

What is the most common tumour associated with BRACA1 mutation?

A

Medullary breast cancer (rare subtype of invasive ductal carcinoma)

42
Q

What are some characteristics of medullary breast cancer?

A
  • Usually TRIPLE negative
  • May appear benign as it is well-circumscribed soft tumour with smooth border
  • Lymphadenopathy most commonly due to hyperplasia and not metastasis

Differential diagnosis: fibroadenoma

43
Q

List the subtypes of invasive ductal carcinoma

A
  • Medullary carcinoma
  • Mucinous carcinoma
  • Mixed carcinoma
  • Tubular carcinoma
  • Papillary carcinoma
  • Micropapillary carcinoma
  • Secretory carcinoma
44
Q

What is Paget disease of the breast?

A

It is a rare type of breast cancer (around 1%) that affects the lactiferous ducts and areola

45
Q

Describe what you would see on punched/wedge or surface biopsy of the nipple tissue in Paget disease of the breast.

A

Paget cells

46
Q

What are some causes of pathological gynecomastia?

A

Due to estrogen excess

  • Malignancies (e.g. leydig cell tumour, sertoli cell tumour)
  • Liver cirrhosis: increased conversion of adrenal androgen precursors to estrogen
  • Hyperthyrodism: increased peripheral conversion of androgens to estrogens and increased hepatic production of sex-hormone binding globulin (SHBG)

Due to decreased testosterone

  • Klinefelter syndrome
  • Testicular disorders (e.g. mumps orchitis, castration, trauma)
47
Q

List a few drugs that causes gynecomastia.

A

Some Hormones Cause Fulminant Kleavage: Spironolactone, Hormones, Cimetidine, Finasteride, Ketoconazole causes gynecomastia

  • Anti-androgens (e.g. finasteride)
  • high dose cimetidine (H2 receptor blocker)
  • Spironolactone (aldosterone-receptor antagonists; potassium-sparing diuretics)
  • Ketoconazole (antifungal agent)
  • Exogenous androgens and androgenic steroids

High Yield Review: Phase II MEQ Pros (10 decks)

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