BREAST PATHOLOGY Flashcards
What is the position of the breast ?
- extend from 2nd to 6th rib
- transversely extend from lateral border of sternum to midaxillary line
- lies over the pectoralis major
Blood supply of the breast
Arterial (PAI)
1. Posterior Intercostal artery
2. Axillary artery
3. Internal Thoracic artery
Venous
1. Intercostal vein
2. Axillary vein
3. Internal thoracic vein
Nerve supply of the breast
anteromedial and anterolateral branches of thoracic intercostal nerves T3-T5
Lymphatic drainage of the breast
drain into axillary lymph node
lady presented with breast lump . Differential diagnosis ?
Fibroadenoma
Fibrocystic breast tissue
Phyllodes tumour
What is triple assessment ?
- Clinical examination
- Imaging (BI-RADS)
- Pathology
Clinical examination consist of what
History taking
Physical examination
Imaging consists of what
- Ultrasound of the breast
*useful in young woman ( < 35yo) - Mammography
*Sensitive increases with age (breast is less dense = more fat, less
glandular tissue)
* Taken in two views (craniocaudal view, mediolateral oblique view)
Malignant findings in ultrasound
- hypoechoic (dark) lesion,
- poorly defined margin,
- taller than wide,
- microlobulation,
- internal calcification
Malignant findings in mammography
- irregular border and shape,
- clustered microcalcifications,
- spiculated mass,
- localized architectural distortion
For pathology ( triple assessment ) what do we do ?
- Fine needle aspiration cytology
* Pros: least invasive; rapid and very accurate, less painful, does not
require analgesia
- Cons: false negatives can occur; cannot distinguish between invasive
cancer and in situ disease
- Trucut biopsy
*Definitive pre-operative diagnosis
* Pros: able to differentiate between DCIS and invasive disease; can
identify cell type and the grading; allows specimen to be stained for
ER, PR status and HER-2 status
Risk factors of breast carcinoma
➢ Early menarche <12 years old
➢ Late menopause >55 years old
➢ First full-term pregnancy at late age (>30 years old)
➢ Nulliparity
➢ Oral contraceptive pill
➢ Hormonal replacement therapy (>10 yrs)
➢ High alcohol consumption
➢ Exposure to ionizing radiation (previous breast disease)
➢ Family history of cancer (breast, ovary, colon, prostate, gastric, pancreatic)
➢ Obesity
➢ Age > 50 yo
➢ No breast-feeding
Breastfeeding - protective factor
Clinical features of locally advanced breast carcinoma
➢ Peau d’ orange
➢ Ulceration and fungating
➢ Fixed axillary lymph node
➢ Tethering, skin dimpling and puckering
➢ Cancer-en-cuirasse
```
~~~
Criteria for Breast Conserving Surgery
✓ Criteria of BCS:
* Tumour size less than 5cm
* No skin or chest wall involvement
* No metastatic disease
* Appropriate tumour size-to-breast ratio
* Only 1 tumour, not multi-centric, unless within same quadrant
* Patient must agree to have post-operative radiotherapy
Complication od mastectomy and axillary clearance
✓ Neuropathy (long thoracic nerve [wing scapula], thoracodorsal nerve [latissimus
dorsi muscle -> limitation of arm & shoulder movement], medial pectoral nerves
[partial atrophy of pectoralis minor])
✓ Hematoma (POD1)
✓ Wound infection (POD3)
✓ Seromas (collection of serous fluid in a surgically created cavity)
✓ Skin flap necrosis
✓ Restricted shoulder mobility
✓ Pain and numbness in the upper arm and axilla
✓ Lymphedema (either cause by post-radiation, post-operation, pre-operative [locally
advance])
Characteristics of phyllodes tumour
▪ Large massive tumour
▪ Fast growing mass
▪ Unevenly bosselated surface
▪ Mobile despite size
▪ Skin may show ulcerations dt pressure necrosis
Characteristics of fibroadenoma
▪ In young women (15-30 yo)
▪ Smooth, firm, well-circumscribed
▪ Very mobile (breast mice)
Characteristic of fibrocystic breast changes
▪ Mobile
▪ Not fixed
▪ Cyclical mastalgia
Pathophysiology of peau d’orange
The primary cause of peau d’orange in the breast is fluid buildup within the breast tissue
* cutaneous lymphatic obstruction by tumour leads to oedema of skin with intact sweat glands.
Pathophysiology ofskin dimpling , puckering and tethering
Infiltration of Cooper’s ligament by tumour causing it to be shortened and
inelastic, pulling the skin inwards, puckering the skin surface.
Chemotherapy drug
o 5-Florouracil, Epirubicin, Cyclophosphamide for 6-8 cycles
o Anthracycline (epirubicin) + taxanes (paclitaxel)
5-Fluorouracil (5-FU): Antimetabolite that disrupts DNA synthesis.
Epirubicin: Anthracycline that damages DNA and interferes with cell division.
Cyclophosphamide: Alkylating agent that damages DNA and kills cancer cells.
Anthracycline (epirubicin) + taxanes (paclitaxel): This refers to a sequential therapy combining two types of drugs:
