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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
What is the significant of breast cancer?
It is the most common non-skin malignancy in women, and the second leading cause of cancer death (1st is lung cancer)
26
What are some predisposing / risk factors for breast cancer?
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
Does individuals with breast cancer develops symptoms?
Often at the later stage of the disease.
28
Describe the tumor mass in breast cancer on palpation.
Poorly defined margin Solitary Firm Non-tender
29
Which is the most common site of breast cancer?
Upper Outer Quadrant > Subaerolar > Other Sites
30
Difference between benign lesion and malignant lesion on mammography (screening).
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
List the prognostic factors for breast cancer.
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
Does patient with HER2 over expression or hormone receptor positive breast CA has a better or worse prognosis?
HER2 over expression is associated with an increased risk of recurrence and poorer prognosis as compared to hormone receptor positive breast cancer.
33
10-15% of breast cancer are triple-negative. What does it mean? And what is its clinical significance?
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
Define non-invasive carcinoma / carcinoma in-situ
Carcinoma characterised by the absence of stromal invasion (intact basement membrane)
35
Which breast CA is associated with decreased E-cadherin (adhesion molecule) expression?
Lobular Carcinoma-In-Situ
36
What are 2 subtype of DCIS?
``` Comedocarcinoma DCIS Cribiform DCIS Micropapillary DCIS Papillary DCIS Solid DCIS ```
37
Describe and contrast DCIS and LCIS.
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
What is the most common type of invasive breast carcinoma?
Invasive ductal carcinoma.
39
Describe and contrast invasive ductal carcinoma and invasive lobular carcinoma.
Invasive ductal carcinoma - typically unilateral - typically unifocal - aggressive, result in formation of metastases Invasive lobular carcinoma - typically bilateral - typically multifocal - less aggressive
40
Describe and contrast the histological finding of invasive ductal carcinoma and invasive lobular carcinoma.
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
What is the most common tumour associated with BRACA1 mutation?
Medullary breast cancer (rare subtype of invasive ductal carcinoma)
42
What are some characteristics of medullary breast cancer?
- 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
List the subtypes of invasive ductal carcinoma
- Medullary carcinoma - Mucinous carcinoma - Mixed carcinoma - Tubular carcinoma - Papillary carcinoma - Micropapillary carcinoma - Secretory carcinoma
44
What is Paget disease of the breast?
It is a rare type of breast cancer (around 1%) that affects the lactiferous ducts and areola
45
Describe what you would see on punched/wedge or surface biopsy of the nipple tissue in Paget disease of the breast.
Paget cells
46
What are some causes of pathological gynecomastia?
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
List a few drugs that causes gynecomastia.
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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