Breast Pathology Flashcards by Iseoluwa Ojo

DISEASES OF THE BREAST

INFLAMMATORY BREAST DISEASE
• _____,_________ ,_________

FIBROCYSTIC CHANGE
• _________ change
• ______ _________

BENIGN TUMORS OF BREAST
• ______________

BREAST CANCER
• _______ carcinoma
• _________ carcinoma
• carcinoma _________

Acute, Chronic, Fat necrosis

• fibrocystic change
• epithelial hyperplasia

fibroadenoma

• ductal carcinoma
• lobular carcinoma
• carcinoma in situ

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Anatomy of the breast
▪ A modified ________ gland; adapted for ________ production
▪ Composed of ________ and ________ organized into (small or large?) subdivisions - ________.

sweat ; milk

ducts and glands

small; lobules.

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Anatomy of the breast

Glands drain into (small or large?) ducts that merge into (small or large?) ___________ ducts at the _________ .

The stroma is mostly _________ plus network of (thin or thick?) _________ ligaments.

small

large lactiferous

nipple.

fat ; thin

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Anatomy of the breast

Stroma and glands are Both sensitive to cyclical female hormones (________ and _________ )

accounts for increase in size at _________ and changes during the __________________

oestrogen ; progesterone

puberty ;menstrual cycle

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Anatomy/Physiology of the breast

The breast lymphatic network mostly drains to the _________ nodes

Lymphatics from the medial aspect drain into the _________ _________ nodes

axillary nodes

internal mammary nodes

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Anatomy/physiology of the breast

During pregnancy, _____-secreting cells develop (______ induced ) and secretion begins immediately after birth

If breast feeding fails to occur, _________ ___________ atrophies

milk ; prolactin

glandular epithelium

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INFLAMMATORY DISEASE
Acute mastitis
▪acute infection of the _______
▪ (Common or Uncommon?)
▪Most occur in _______ women
▪Typically caused by _______ or _______ organisms

breast; Uncommon

lactating ; staphylococcus

streptococcus

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INFLAMMATORY DISEASE
Acute mastitis

▪ Access usually through ________ breast ducts plugged with ________ ________
▪Staph infection usually produces ________
▪ strep infection tends to be more (focal or diffuse?) and produces generalized ________, ________, and ________.

dilated ; mammary secretions.

An abscess

diffuse ; generalized

swelling, tenderness, and pain.

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Inflammation
Chronic breast inflammation

▪Usually associated with _______ change
▪May present with _____ on _______
▪ Infectious causes include _____ in our environment

fibrocystic change

pain ; palpation

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Inflammation

Fat necrosis
▪ (Usual or Unusual?) type of necrosis that occurs only in fat (mimics _______)
▪Cause often unknown
▪ Many cases can be traced to _______

Unusual

cance

trauma

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Fibrocystic Change
▪Aka _______________
▪ Consists of _______ , _______ inflammation, and ____________
of breast ducts.
▪ ___% of women have some degree of fibrocystic change, only about _______ of these patients have any symptoms.

Fibrocystic Disease

fibrosis; chronic

cystic dilation
.
50% ; one quarter

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Fibrocystic Change

Classification
▪______________
▪ ___________
▪ ______
▪ ___________

Non-proliferative

Proliferative

Usual

Atypical

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Fibrocystic Change

Classification

____________ (increased risk of cancer)

____________– 5x increased risk of cancer

Proliferative

Atypical

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Common Benign Tumors
▪____________
▪ ___________ Tumour - Benign

Fibroadenoma

Phyllodes

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There is a spectrum from benign to ________ to ______ Phyllodes

Borderline

Malignant

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DIFFERENCES BETWEEN FIBROADENOMA AND FIBROCYSTIC CHANGE

FA VS FC

Neoplasm
Circumcision
Capsule
Stroma
Inflammation
Solid or Cystic
Epithelial/stromal elements

Benign neoplastic lesion; Benign non-neoplastic

Well circumscribed lesion; diffuse lesion

Encapsulated; Not Encapsulated

Cellular ; fibrotic

Inflammation is not a usual histologic feature; Usually associated with inflammation

Usually solid lesion, cysts not a classical feature; usually cystic

Proliferating epithelial and stromal elements; Proliferation usually limited to epithelial component

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Common Malignant Breast Tumors

▪Invasive ______ carcinoma

ductal

lobular

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Common Malignant Breast Tumors

Invasive ductal carcinoma
▪ Most are “ ____________(NST)”
▪ The remainder are given subtypes:

Invasive lobular carcinoma
▪ __________
▪ ___________

no specific type

Classic

Pleomorphic

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Breast cancer
Originates from breast tissue, from the (inner or outer?) lining of

▪ breast ducts (______ carcinomas)or
▪ Breast lobules (_______ carcinomas)

Inner

Ductal

Lobular

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________ cancer is the commonest cancer in women worldwide

The most commonly diagnosed cancer (surpassing ________ cancer) – Globocan 2020

▪___th leading cause of cancer death (6.9%)after ____________________________

▪ Accounts for ____% of all cancers and ____% of cancers in
women

Breast cancer; Lung

Lung and GI cancers (colorectal, liver, stomach)

15% ; 30%

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Breast cancer

It affects (men or women?) much less frequently but they tend to have
(poorer or better?) outcomes

men

poorer

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Epidemiology
• Breast cancer is a _____geneous disease with distinct subtypes that carry (same or different?) prognosis

• Racial and ethnic differences in incidence, molecular phenotype and prognosis do not exist (T/F)

• Number of cases worldwide has ____eased significantly since the 1970s

• Survival rates in the west has ____eased (84% 5yr survival in the UK); Much (lower or higher?) in developing countries

hetero; different

exist

increased ; increased

lower

Risk factors of breast cancer
• ________ sex
• _____easing age

• Race: incidence higher in ______
• Increased exposure to _________
– (Early or Late?) menarche, (early or late?) menopause, reduced _______, postmenopausal _______
–Exogenous oestrogen:_____ ,______

Female ;Increasing

Caucasians ; oestrogen

Early ;late

parity ; obesity

HRT, OCP

Risk factors to breast cancer

• (lower or higher?) socioeconomic status
• significant ________ exposure
• Chemicals: pesticides, organic solvents, polycyclic hydrocarbons etc
• Family history. Mutation __________ genes. Also, _____ and ________
• Smoking
• Alcohol intake
• ________ life style
• Diet: high fat, high calorie, intake of red meat and low intake of fruits and vegetables
• Previous history of certain _____________ diseases

higher ; radiation

BRCA1 &2 genes.

p53 ; CHEK2

Sedentary; benign breast diseases

Clinical presentation of breast cancer 1. Small __________ ▪ On _________ examination/ USS (Screening) ▪ _____ examination 2. Breast mass with or without ____ changes ▪ _________ ▪ ___________ 3. Peri-areolar _________ changes

Breast lump; radiologic Self ; skin changes Puckering; ulceration eczematous

Clinical presentation of breast cancer 4. _______________ discharge 5. (Enlarged or Shrunken?) breast with signs of _________ 6. _________ lump 7. ________ metastases

Bloody nipples Enlarged ; inflammation Axillary Distant

Imaging is critical in the diagnosis of breast disease T/F

IMAGING ▪ It is required for ▪ ________ ▪ ________ ▪ ________ ▪ Usually done using _______graphy and ________ graphy (as well as _____)

Diagnosis ▪ Screening ▪ Staging Mammo Ultrasono MRI

Scoring system of breast cancer 1 _______ (or _______ cytology) 2 _______ (or _______ cytology) 3 _______ but probably _______ 4 ________ and probably ________ 5 ________

1 Normal (or inadequate cytology) 2 Benign (or normal cytology) 3 Suspicious but probably benign 4 Suspicious and probably malignant 5 Malignant

The World Health Organization has suggested that for a mammography screening program to be effective in the reduction of mortality, it needs to cover at least ____% of the population at risk.

Mammography ▪ Annual screening mammography is recommended starting at: ▪ 1) age ____ for general population; ▪ 2) Age __________ in some intermediate and high risk patients. OR ____ years earlier than the age of the _________ at diagnosis in some other high risk patients.

40 ; 25-30 10 ;affected relative

Mammography Mammography plus supplemental ________ is recommended in selected high-risk populations and those with _______ breast

screening dense breast

__________ is the only method of screening for breast cancer shown to decrease mortality .

Mammography

Molecular Classification of breast cancer ▪ _____ IHC markers (________________________) are used for molecular class distinction ▪ Three (______________) are used routinely for _______ , a fourth (________) is used in some resource rich countries for ___________

Five ; ER, PR, HER2, CK5/6, and EGFR ER, PR, HER2 ; all BC Ki67 ;mitotic index.

Molecular Classification of breast cancer ▪ They are predictive markers because they _________________ ▪ Resulting in targeted use of very specific treatments and less frequent use of chemotherapy ▪ Marked reduction in _________ (and sometimes ______)

they guide treatment use toxicity ;cost

Perou classification of breast cancer _______ type _______ type _______ type _______ type

Luminal Normal Her-2 Basal-like

Luminal A: ____,_____,_____,______ (<14%) ▪ Usually grade_______[ ▪ About ____% of breast cancers

ER+,PR+,HER2-,Ki67(<14%) 1 or 2 70

Luminal A: Metastasis: ▪ most commonly to ______ ▪ Least likely to ______, ______ or ______ ▪ ______ response to hormonal therapy ▪ Least likely to benefit from ______

bone brain, liver or lung Good ; chemo

Luminal B: (her2-) ____,_____,_____,_____ (>14%) ▪ Usually grade _______ ▪ About ____% of breast cancers

ER+,PR?,HER2-,Ki67(>14%) 2 or 3 10%

Luminal B: (her2-) Metastasis: ▪ most commonly to _______ , followed by _______ & _______ ▪ Benefits from _______ & _______ therapy

bone, followed by liver & lung chemo & hormonal therapy

Luminal B: (her2+) ____,______,_______,______ (>14%) ▪ Usually grade ____ ▪ About __% of breast cancers

ER+,PR?,HER2+,Ki67(>14%) 3 10%

Luminal B(HER2+) Metastasis: ▪ most commonly to _______ , _______, _______ & _______ More likely to have ▪ _______________ disease ▪ Multiple ____________ ▪ _______ recurrence ▪ Benefits from _______, _______ targeted therapy & _______ therapy

bone, brain, liver & lung multicentric disease; positive nodes Local ; chemo HER2 ; hormonal therapy

HER2: _____ ,_____,_____,________ (>14%) ▪ Usually grade ____ ▪ About __% of breast cancers Metastasis: ▪ most commonly to _______ , _______, _______ & _______

ER-,PR-,HER2+,Ki67(>14%) grade 3 10% bone, brain, liver & lung

HER2: More likely to have ▪ _________ disease ▪ Multiple _________ ▪ Local _________ ▪ Benefits from _________, _________ targeted therapy ▪ Affects (younger or older?) patients

multicentric disease positive nodes recurrence chemo; HER2 younger patients

Basal: More likely to have ______ recurrence ▪ (More or Less?) likely to have positive nodes ▪ Benefits from ______ ▪ Affects (younger or older ?) patients

local recurrence Less ; chemo younger

Basal: ______,______ ,______,______ ____% ER+, ____%HER2+ ▪ Usually grade ____ ▪ About ______% of breast cancers Metastasis: ▪ most commonly to ______, ______, ______ & ______

ER-,PR-,HER2-,CK5/6+ 10% ER+, 10%HER2+ 3 15% bone, brain, liver & lung

Basal Phenotype ▪ Mostly ____, few ___ ▪ CK5/6 ___ve ▪ ____ amplification ▪ C-KIT __ve ▪ (Low or High?) grade ▪ Associated with ———- mutation

TN ; ER+ +ve; amplification + ; High BRCA1 mutation

(Lethal or Non-lethal?) genetic damage is the basis of the excessive cellular proliferation that is the root-cause of tumourigenesis

Non-lethal

BRCA 1 & 2 ▪__________ genes ▪ Identified in the ________ ▪ Located on chromosomes ____ and ___ respectively ▪ Founder mutations in ________

Tumour suppressor genes 1990s 17 & 13 Ashkenazi Jews

BRCA 1 & 2 The cumulative risks of developing breast cancer by the age of 70 years approach ▪________% in BRCA1-mutation carriers ▪ _______% in BRCA2-mutation carriers

50–70% 40-50%

BRCA 1 & 2 ▪ Normal BRCA genes ________ ▪ _______ inheritance of ____zygous mutations present in _______ mutation carriers ▪ Loss of heterozygosity = _____zygous mutation. __________ function ceases ▪ This results in spontaneous _______ of the genome

inhibit proliferation Germline ; heterozygous BRCA 1 & 2 mutation homozygous mutation Growth inhibiting function instability of the genome

BRCA 1 & 2 ▪ Instability of genome activates __________ mechanisms. ▪ This results in _______ of affected cells ▪ However tissue specific survival/growth factors in breast and ovary predispose to _______________ of these cells ▪ Facilitating the acquisition of more mutations over time that increase _________ and cause tumours of the ________,________ and other tissues

check point elimination; prolonged viability proliferation breast, ovary and other tissues

Finally

Done