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M2 Pathology > Breast Pathology > Flashcards

Breast Pathology Flashcards

1
Q

State the 4 common conditions leading to formation of breast lumps. (4)

A
  1. acute mastitis
  2. fibroadenoma
  3. fibrocystic change
  4. invasive ductal carcinoma
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2
Q

State the histological feature of acute mastitis

A
  1. macroinflammatory tissue with collection of pus under skin
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3
Q

State everything you know about acute mastitis

A

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)

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4
Q

State histological features of idiopathic granulomatous mastitis.

A
  1. epitheloid granulomas
  2. collection of macrophages
  3. multinuclear giant cells
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5
Q

State everything you know about idiopathic granulomatous mastitis.

A
  • 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

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6
Q

State the histological features of paraffinoma

A
  1. multinucleated giant cell resection
  2. formation of granulomas
  3. scarring and fibrosis
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7
Q

State everything you know about paraffinoma

A
  • paraffin injections > chronic inflammatory response in breast tissue

Presentation:
1. breast pain
2. breast tenderness
3. hard mass in breast
4. retraction of nipple

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8
Q

State the histological features of fibrocystic breast disease.

A
  1. apocrine change
  2. cysts
  3. fibrosis
  4. epithelial hyperplasia
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9
Q

State everything you know about fibrocystic breast disease

A
  • common in reproductive age as lesions are hormone sensitive
  • risk of malignancy is based on degree of epithelial hyperplasia
  • symptomatic, lumps
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10
Q

State the histological features of intraduct papilloma (benign)

A

EPITHELIAL TUMOUR
- abnormal dilated duct with proliferating lesions
- finger-like projections into dilated space

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11
Q

State everything you know about intraduct papilloma (benign)

A

EPITHELIAL TUMOUR
- arises from lactiferous duct closer to nipple
- presentation: nipple discharge, lump under nipple

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12
Q

State the histological features of fibroadenoma

A

FIBROEPITHELIAL TUMOUR
- minimal epithelial hyperplasia
- compressed ducts lined by single epithelium
- well circumscribed
- stromal elements show low cellularity
- no necrosis

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13
Q

State everything you know about fibroadenoma.

A

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

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14
Q

State the histological features of Phyllodes tumour.

A

FIBROEPITHELIAL TUMOUR
1. leaflike architecture
2. stromal proliferation
3. significant atypia
4. high rate of mitosis
5. necrosis

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15
Q

State everything you know about phyllodes tumour

A

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

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16
Q

State the difference between in-situ, invasive and metastatic

A

in-situ = epithelial cells proliferate within ductal space, BM intact

invasive = tumour cells invade stroma, BM disrupted

metastatic = vascular and lymphatic spread

17
Q

State the risk factors of breast cancer

A
  1. race - caucasian/jew/parsi
  2. age - perimenopausal
  3. SES - high
  4. weight - obese
  5. previous breast disease - yes
  6. family history - PTEN, p53, BRCA1 and 2 mutations
  7. early menarche
  8. late menopause
18
Q

Where are breast carcinomas usually found?

A

Upper outer > subareolar > other

19
Q

What is a common accompanying presentation of breast carcinomas?

A

Paget’s disease of nipple (erythema, erosion, ulcers)

20
Q

State the histological features of ductal carcinoma in-situ (DCIS)

A

NON-INVASIVE, MALIGNANT
1. presence of calcification
2. dilated ducts with malignant cells
3. cribiform appearance
4. intact BM
5. some necrosis

21
Q

State everything you know about DCIS

A
  • associated with milk ducts of breast
  • precursor to invasive breast cancer (OCCURS IPSILATERALLY)

Gross:
- whitish specks of necrosis
- comedo appearance

22
Q

State the histological features of Lobular carcinoma in-situ

A

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)

23
Q

State everything you know about LCIS

A
  • 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

24
Q

State the differences between DCIS and LCIS.

A

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

25
Q

State the histological features of no special type cancer

A

INVASIVE, MALIGNANT
1. irregular islands of tumour cells invading stroma
2. nuclear atypia
3. necrosis
4. disorganised pattern of cells

26
Q

State everything you know abut NST cancer

A
  • associated with milk ducts -> ductal differentiation
27
Q

State the 3 special type carcinomas

A
  1. tubular carcinoma
  2. mucinous carcinoma
  3. medullary carcinoma
28
Q

State everything you know about tubular carcinoma (include histological features).

A
  • 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

29
Q

State everything you know about muinous carcinoma (include histological features).

A
  • associated with abundant production of mucin
  • Gross; well circumscribed
  • round grey dense mass on radiography

Histo:
1. invasive tumour floating in background of mucin

30
Q

State everything you know about medullary carcinoma (include histological features).

A
  • 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

31
Q

State the histological features of Paget’s disease (breast)

A
  1. intraepidermal extension of malignant ductal epithelial cells through lactiferous ducts and tubules into epidermis
  2. no invasion
  3. inflammatory infiltrate
  4. large, irregular cells with abundant cytoplasm
32
Q

State everything you know about Paget’s disease

A
  • 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
33
Q

State the prognostic factors of breast cancer.

A
  1. Stage of tumour - TNM
  2. Histologic grades 1-3
  3. Histologic type -NST, special type, lobular
  4. ER/PR (tamoxifen/aromatase inhibitors)
    -> tamoxifen blocks body’s ability to use circulating estrogen
    -> AI reduces the amount of estrogen in body
  5. CerbB2 amplification (Herceptin)
  6. Vascular invasion
34
Q

Expand on the TNM staging of breast cancer.

A

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)

35
Q

Expand on the grading of breast cancer

A

Based on
- tubule formation
- nuclear pleomorphism
- mitotic count

36
Q

State 5 causes of gynaecomastia in males.

A
  1. hormonal imbalance (estrogen excess vs androgens)
  2. testicular atrophy (klinefelters)
  3. cirrhosis
  4. estrogen secreting tumours of testis and adrenal
  5. increased prolactin levels
  6. drugs - digoxin, anabolic steroids
37
Q

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.

A

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.

M2 Pathology (20 decks)

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