breast pathology Flashcards
List three examples of non-proliferative breast changes
- Cyst formation , often with apocrine metaplasia
- Fibrosis
- Adenosis
What is fibrosis
cysts frequently rupture, with release of secretory material into the adjacent stroma. The resulting hronci inflammation and fibrous scarring contibute to the palpable firmness of the breast
What is adenosis
Adenosis is defined as an increase in the number of acini per lobule. The acini are often enlarged (blunt duct andosis) adn are not distorted as is seen in sclerosis adeosis.
WHta histology is associated with BRCA 1/2 breast cancers
- BRCA 1= commonly poorly differntiated, have medullary features and do not express hormone receptors or HER2/neu. Their gene profile signifture is similar to basal like breast cancers,.
- BRCA 2 = poorly differentiated but more commonly estrogen receptor positive
Descrieb the four moelcular sub types of breast clinic
Defien the hallmarks of lobular carcinoma
The morphologic features of lobular carcinoma differ from those of ductal carcinoma. ILC is characterized by small, round cells that are bland in appearance and have scant cytoplasm, which infiltrate the stroma in single file and surround benign breast tissues in a targeted manner
Important histopatholgoical features of invasive ductal carcinoma
nvasive ductal carcinoma is the most commonly diagnosed breast cancer and has a tendency to metastasize via lymphatics. This lesion, which accounts for 75% of breast cancers, has no specific histologic characteristics other than invasion through the basement membrane of a breast duct, as seen in the image below.
Mucinois (Colloid) carcinoma
The tumoru cells are seen as clusters and small islands o cells within large lakes of mucin that push into the adjacent stroma
Tubular carcinoma
These tumours consits exclusively of well formed tubules. However, a myoepthielial cell layer is absent and tumour cells ar ein direct contact with stroma
Invasive papillary carcinoma
Invasive carcinomas with a papillary architecture are rare and represent and represent 1% or fwer of all invasive cancers. Ppaillary architecture is more commonly seen is DCIS
Metaplastic carcinoma
“Metaplastic carcinoma” includes a wide variety of rare types of breast cancer (<1%), incluing conventional adenocarinomas with a chondroid stroma, squamous cell carcinomas amd carcinomas with a prominent spindle cell component that might be difficult to distinguish from sarcomas. Some of these carcinomas express genes in common with myoepithelial cells and likely ot arise from this cell type
WHta is the most commo breast symptom in cancer
- Pain (mastalgia or mastodynia)
- 2nd most is palpable masses
- The nipple discharge but concern when spontaneous and unilateral.
- Desnities - solid massess or calcifications.
Calcifications - whata re they associate with in the breast
Calcificaitons are associatd with secretory material. necrotic debris and hyalinalised stroma. They are associated with malignancy and are then commonly small, irregular, numerous and clustere dor linear and branching.
WHta is the most common malignancy associated with calcifications
DCIS
Most common breast cancer
Adenocarnimoas (95% ish)
Key prognostic features of breast cancer
Pagets disease
Infiltration of the nipple by large cells with clear cytoplasm is diagnostic of pagets disease. These cells are usually found both singly and in small clisters in the peidermis. Pagets disease is always associated with an undelrying intraductal carcnimoa that extends to infiltrate the skin of the nipple and areola. Paget cells may resemnle cells of superficisl spreading melanoma, but they are PAS positive and diastase resistan (despite resembling cells of superifcil spreading melanoma)
Poorest prognosis breats cancer
Intraductal carcinoma is most common carcinoma of breast and carries poor prognosis.
(What is a kruken berg tumour)
- Metastatic ovarian malignancy whose primary site arose in GI tarct or breast. Mucin secreting signet ring cells,
- Stoamch sit eh primary site in most of the cases of Krukenberg tumour
(Causes of secondary amenorrhea)
- Absent menses for 3m in a woman who previously had them
- Pregnancy, hypothalamic/pituitary abnormalities, ovarian disorders and end organ (uterine) disease. FSH/LSH levels.
(Ashermans syndrome)
- CLinical condition caused by numerous aggressive dilation and curettage of the endometrium for menorrhagia leading to removal of stratum basalis. Also assoicated with absence of glandular epithelium.
(Gestational trophoblastic diseases )
- Benign hydatidiform mole (partiala nd compelte)- composed avascular grape like structures that dont invade myometrium
- Invasive mole - moel that pentrares
- Placental site trophoblastic tumour - in implantation site an dplacental membranes
- Choriocarcinoma - malignant proliferations without villi.
Inflammation of the breast problems
- Acute masttitis - Almost all cases occur durign lactation usually caused by staphylococcus aureus.
- Periductal mastitis/zuska disease - recurrent subareolar abscess or suamous metaplasia od lactiferous ducts.
- Mammary duct ectasia -
- Fat ecrosis
2 types proliferative breast disease with atypia
atypical ductal hyperplasia
atypical lobular hyperplasia
Atypical hyperplasia is a cellular prolfieration resembling ductal carcinoma in situ (DCIS) or lobular carcinoma in situ but lacking sufficient qualitative or wuantitiative features for diagnosis of caricnoma in situ
Non proliferative disease do not icnrease risk cancr but proliferative diseases do liek atypia.
Tripel assessment breast cancer
CLinical exam
Radiologial exam (mammogrpahy)
FNAC
Most important prognostic factor for invasive carcinoma
Axillary lymph node stats for invasive caecinoma in absence of distant metasess.
BRCA1/2 what does it icnrease risk of
- BRCA2 - small risk ovarian cancer, but more frequentl male breast cancwr
- BRCA1/2 - suspceptible to olon, prostate, panceeas but lesser extent
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What is molecular classification of breast cancer based on
Gene expression profiling which major relative level of mRNA expression
Non invasie carcinomas (carcinoma in situ)
May be located within ducts (intraductal carcinoma) or within lobules )lobulr carcinoma in situ). Several variants. Comedocarcinoma, cribiform carcinoma, intraductla papillary carcinom.
Infitlration of nipple by large celsl with clear cytoplasm is diagnostic of pagets disease.
Type sinvasive breast carcinomas
No special type carcinoma intraductal (most common)
Special carcinoma - lobular, cribfirom, colloid, medullary, papillary, metaplastic
One of few carcinomas seen bilaterally
Lobular carcinoma.
Medullary carcinoma
Soft, fleshy consistency for tumour and wlel circumsided. Both lobular carcinoma of breast and signet ring carcinoma of GIT are characterised by loss of E-Cadherin.
Invasive (infiltrating carcinomas)
- Invasive
- Lobular
- medullary carcinoma
- mucuinous (colloid) carcinoma
- Tubular carcinoma
- Invasive papillary carcinom
- Metaplastic carcinoma
ER/HER2 classifications
How can the HER-2/neu gene cause breast cancer?
Overexpression
WHat chromosome is the BRCA1 gene located on?
Chromosome 17, position Q21
Which example of carcinoma below is frequently observed bilaterally.
Lobular
What are the 3 muscles the breast lays on
Pectoralis major
Serratus anterior
External oblique
What is the nerve supply to the breast
Branches of intercostalnerves from T4-T6
Arterial supply of the breast
- Internal ammary (throacic) artery - greates contribution
- External mammary artery (laterally)
- Anterior interocstal artiers
- Thoraco-acromial artery
Venous drainage of the breast
- Superficial venous plexus to subclavian, axillary and intercostal veins
Lymphtic drainage
- 70% axillary nodes
- Internal mammary chain
- Other lymphatic sites like deep cervical and supraclavicular fossa
3 hormones involved in preparation of lactation
- Oestrogen - promtoes duct development in high conc
- Prgesterone - high levels stimulate formaiton lobules
- Human palcental lactogen - prepares mammary glands for lactaton
2 hormones invovled in stimulating lactation
- Prolactin - causes milk secretion
- Oxytocin - causes contraction of the yoepithelial cells surrounding th emmaary alveoli to result in milk ejection from the breast
Which of the 4 quadrants is the most common area for malginancies to present in in the breast
Superior lateral
Most common type of breast cancer
Invasidve ductal carcinoma
