Breast Pathology Flashcards
function of the breast
production and expression of milk
what happen to the breast in pregnancy
lobules proliferate
epithelial cells differentiate - secretion of milk
what happens to the breast in ageing
lobules decrease in size and number and interlobular stroma is replaced by adipose tissue
diagnostic methods to breast cancer
Mammography- Densities, Calcification
Ultrasonography– Solid v cystic lesion
Biopsy– FNAB– Core biopsy
Screening– every 2y for women 50-69y
4 developmental abnormalities of the breast
Failure of development– Rare: ovarian agenesis, eg Turner Syndrome
Juvenile hypertrophy– Rapid, disproportionate development during puberty
– Surgery
Milkline Remnants– Supernumerary nipples, hormone responsive
Nipple Inversion– Congenital: usually revert during pregnancy– Acquired: concerning
3 causes of breast inflammation
- Infection
- Mammary duct ectasia
- Fat necrosis
what is Squamous metaplasia of lactiferous ducts
Painful erythematous subareolar mass
Keratin plugs, block ducts -> dilation, rupture
Chronic inflammation
what is duct ectasia
post-menopausal, parous women
periareolar palpable mass - painless
duct dilation, rupture
fibrosis leads to nipple retraction
what cells are seen in necrotic tissue
macrophages, giant cells, fibrosis,
what are fibrocystic changes
non proliferating breast changes
normal but exaggerated response to hormones in pre menopausal women
types of fibrocystic changes
- cystic change
- fibrosis
- adenosis - normal in pregnancy
proliferative breast changes without atypia
- epithelial hyperplasia
- sclerosing adenosis
- complex sclerosing lesion
- papilloma
what is sclerosing adenosis
over double number of acini in terminal ducts
complex sclerosing lesion
epithelial hyperplasia, sclerosing adenosis, papillomas
proliferative breast changes with atypical hyperplasia
Atypical ductal hyperplasia (ADH)
Duct filled with cells
Spaces: some round, regular, some slit like
Atypical lobular hyperplasia (ALH)
Population of cells partially fill lobule
Some intracellular lumens
Usually incidental finding
heterogenous disease in breast carcinoma
oestrogen receptor ER and HER2 expression
hereditary breast cancer genes
BRCA1 gene - 50% hereditary
BRCA2 gene - 30% hereditary
main risk of sporadic breast cancer
hormone exposure - menopause, pregnancy, breastfeeding
what type of cancer is most common in the breast
adenocarcinomas (95%)
types of carcinoma in situ
ductal carcinoma in situ
lobular carcinoma in situ
types of invasive carcinoma
invasive carcinoma no special type
invasive lobular carcinoma
medullar, mucinous, metaplastic, papillary, tubular
what is ductal carcinoma in situ
malignant clonal proliferation of epithelial cells limited to ducts and lobules by the basement membrane
presentation of ductal carcinoma in situ
calcifications (50%) and rarely nipple discharge
what is paget disease of the nipple
unilateral erythematous eruption with scale crust
do malignant cells breach the basement membrane in pagets disease of the nipple
no
what is lobular carcinoma in situ
clonal proliferation of cells within ducts and lobules that grow in a discohesive fashion usually due to acquired loss of e cadherin
what is seen on a mammography of lobular carcinoma in situ
no calcifications of densities
histology of lobular carcinoma in situ
loosely cohesive clusters within lobules, mucin positive signet ring cells, e cadherin loss
treatment of lobular carcinoma in situ
chemoprevention with tamoxifen, bilateral prophylactic mastectomy
indications of invasive carcinoma
palpable mass
nipple retraction
blocked lymphatics
radiodense mass detected by mammography
histological features of invasive ductal carcinoma
firm, irregular border, grating sound when cut, chalky areas of stroma, foci of calcification
histological feature of invasive lobular carcinoma
poorly defined, irregular border, loose clusters of tumour cells, invade dense fibrous stroma, signet ring shape, absence of e cadherin
prognostic factors for breast cancer survival
lymph node status - >10 nodes - 10-15%
tumour size - >2cm 77%
invasive in situ - 50%
distant metastases
locally advanced disease
histological subtype
what is the most common benign tumour in young women
fibroadenoma
what is a phyllodes tumour
stromal tumour arises from intralobular stroma - leaflike architecture
what is gynaecomastia
benign enlargement of male breast caused by hormones, liver cirrhosis, klinefelter syndrome
