Breast Pathology Flashcards
State the 4 common conditions leading to formation of breast lumps. (4)
- acute mastitis
- fibroadenoma
- fibrocystic change
- invasive ductal carcinoma
State the histological feature of acute mastitis
- macroinflammatory tissue with collection of pus under skin
State everything you know about acute mastitis
Lactating breast > proliferation of staphylococci in stagnant milk > acute inflammation with accumulation of neutrophils > acute abscess
- associated with periductal mastitis, duct ectasia, fat necrosis, infammatory breast cancer
- treatment: I&D, antibiotics, excision
Presentation:
1. redness of nipple = erythema
2. pain and swelling
3. breast abscess (sc under skin, within breast parenchyma, retromammary areas near pectoralis major)
State histological features of idiopathic granulomatous mastitis.
- epitheloid granulomas
- collection of macrophages
- multinuclear giant cells
State everything you know about idiopathic granulomatous mastitis.
- rare, occurs in parous women
- d/dx = malignancy, TB
- treatment: steroids, immunosuppressants, surgery
Presentation:
1. hard firm mass within breast or sinus (lobulo-centric)
2. colour change of breast
State the histological features of paraffinoma
- multinucleated giant cell resection
- formation of granulomas
- scarring and fibrosis
State everything you know about paraffinoma
- paraffin injections > chronic inflammatory response in breast tissue
Presentation:
1. breast pain
2. breast tenderness
3. hard mass in breast
4. retraction of nipple
State the histological features of fibrocystic breast disease.
- apocrine change
- cysts
- fibrosis
- epithelial hyperplasia
State everything you know about fibrocystic breast disease
- common in reproductive age as lesions are hormone sensitive
- risk of malignancy is based on degree of epithelial hyperplasia
- symptomatic, lumps
State the histological features of intraduct papilloma (benign)
EPITHELIAL TUMOUR
- abnormal dilated duct with proliferating lesions
- finger-like projections into dilated space
State everything you know about intraduct papilloma (benign)
EPITHELIAL TUMOUR
- arises from lactiferous duct closer to nipple
- presentation: nipple discharge, lump under nipple
State the histological features of fibroadenoma
FIBROEPITHELIAL TUMOUR
- minimal epithelial hyperplasia
- compressed ducts lined by single epithelium
- well circumscribed
- stromal elements show low cellularity
- no necrosis
State everything you know about fibroadenoma.
FIBROEPITHELIAL TUMOUR
- common in young women
- arises from glandular and fibrous connective tissue
- shows up as well-circumscribed radiodense lesion on radiology
Gross:
1. circumscribed, uniform, lobulated, compressed ducts surrounding pink fibrous stroma with yellowish fat
State the histological features of Phyllodes tumour.
FIBROEPITHELIAL TUMOUR
1. leaflike architecture
2. stromal proliferation
3. significant atypia
4. high rate of mitosis
5. necrosis
State everything you know about phyllodes tumour
FIBROEPITHELIAL TUMOUR
- arises from stromal tissue of breast
- very rare
- can be benign, borderline (10%), malignant (5-10%)
- tumour is large and can occupy entire breast
Gross:
- haemorrhage and necrosis
- stromal proliferation
Presentation:
1. rapid growth into large, painless, palpable mass and lumps
State the difference between in-situ, invasive and metastatic
in-situ = epithelial cells proliferate within ductal space, BM intact
invasive = tumour cells invade stroma, BM disrupted
metastatic = vascular and lymphatic spread
State the risk factors of breast cancer
- race - caucasian/jew/parsi
- age - perimenopausal
- SES - high
- weight - obese
- previous breast disease - yes
- family history - PTEN, p53, BRCA1 and 2 mutations
- early menarche
- late menopause
Where are breast carcinomas usually found?
Upper outer > subareolar > other
What is a common accompanying presentation of breast carcinomas?
Paget’s disease of nipple (erythema, erosion, ulcers)
State the histological features of ductal carcinoma in-situ (DCIS)
NON-INVASIVE, MALIGNANT
1. presence of calcification
2. dilated ducts with malignant cells
3. cribiform appearance
4. intact BM
5. some necrosis
State everything you know about DCIS
- associated with milk ducts of breast
- precursor to invasive breast cancer (OCCURS IPSILATERALLY)
Gross:
- whitish specks of necrosis
- comedo appearance
State the histological features of Lobular carcinoma in-situ
NON-INVASIVE, MALIGNNAT
1. proliferating tumour cells fill secretory units -> dilate lobules
2. loss of e-cadherin
3. low nuclear grade
4. no necrosis
5. intact BM
6. some pagetoid spread (extending into ducts)
State everything you know about LCIS
- associated with terminal duct lobular units, not ducts
- lower risk of progression to invasive breast cancer as compared to DCIS (OCCURS IPSILATERALLY AND CONTRALATERALLY)
Gross:
- no distinct gross features due to incidental finding
State the differences between DCIS and LCIS.
Predominant location:
DCIS - ducts, LCIS - lobules
Cell size:
DCIS - large or medium, LCIS - small
Calcifications:
DCIS - present, LCIS - absent
Risk of subsequent invasive cancer:
DCIS - higher risk, LCIS - lower risk
Location of subsequent cancer:
DCIS - ipsiateral, LCIS - ipsilateral or contralateral
State the histological features of no special type cancer
INVASIVE, MALIGNANT
1. irregular islands of tumour cells invading stroma
2. nuclear atypia
3. necrosis
4. disorganised pattern of cells
State everything you know abut NST cancer
- associated with milk ducts -> ductal differentiation
State the 3 special type carcinomas
- tubular carcinoma
- mucinous carcinoma
- medullary carcinoma
State everything you know about tubular carcinoma (include histological features).
- associated with growth of small, well-formed tubular structures resembling normal breast ducts
- excellent prognosis
Histo:
1. small, well differentiated tubular formation
2. low nuclear atypia
3. minimal stromal invasion
State everything you know about muinous carcinoma (include histological features).
- associated with abundant production of mucin
- Gross; well circumscribed
- round grey dense mass on radiography
Histo:
1. invasive tumour floating in background of mucin
State everything you know about medullary carcinoma (include histological features).
- Gross: well circumscribed, soft, fleshy tumour
Histo:
1. prominent lymphocytic infiltrate
2. pleomorphic tumour cells arranged in sheets and with interweaving stroma containign lymphoplasmasitic immunological response
3. high nuclear atypia
4. necrosis
State the histological features of Paget’s disease (breast)
- intraepidermal extension of malignant ductal epithelial cells through lactiferous ducts and tubules into epidermis
- no invasion
- inflammatory infiltrate
- large, irregular cells with abundant cytoplasm
State everything you know about Paget’s disease
- proliferation of malignant glandular epithelialcells in nipple areolar epidermis
- associated with underlying DCIS
- tumour cells proliferate in underlying ducts -> migrate towards nipple along duct space and enters overlying squamous epithelium of nipple and areolar
State the prognostic factors of breast cancer.
- Stage of tumour - TNM
- Histologic grades 1-3
- Histologic type -NST, special type, lobular
- ER/PR (tamoxifen/aromatase inhibitors)
-> tamoxifen blocks body’s ability to use circulating estrogen
-> AI reduces the amount of estrogen in body - CerbB2 amplification (Herceptin)
- Vascular invasion
Expand on the TNM staging of breast cancer.
T = primary tumour
Tis - carcinoma in-situ
T1 - tumour <2cm
T2 - tumour 2-5cm
T3 - tumour >5cm
T4 - fixation to chest wall, peau d orange ulceration of skin, oedema, satellite skin nodules
N = lymphatic spread
N0 - no palpable LN
N1 - palpable ipsilateral axillary LN, movable
N2 - palpable ipsilateral axillary LN, fixed
N3 - metastasises to ipsilateral internal mammary nodes
M = metastatic spread
Mx - distant metastasis cannot be accessed
M0 - no distant metastases
M1 - distant metastases detectable by physical or radiographic examination (includes metastases to ipsilateral supraclavicular nodes)
Expand on the grading of breast cancer
Based on
- tubule formation
- nuclear pleomorphism
- mitotic count
State 5 causes of gynaecomastia in males.
- hormonal imbalance (estrogen excess vs androgens)
- testicular atrophy (klinefelters)
- cirrhosis
- estrogen secreting tumours of testis and adrenal
- increased prolactin levels
- drugs - digoxin, anabolic steroids
Breast screening is recommended to occur ___ time(s) every ___ year(s) in 40-49 year olds and ___ times every ____ year(s) in those above 50 years old.
Breast screening is recommended to occur** 1 time every 1 year in 40-49 year olds** and 1 time every 2 year(s) in those above 50 years old.
