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Clinical Pathology in Action > Breast Pathology > Flashcards

Breast Pathology Flashcards

1
Q

What does the normal breast tissue consist of

A
  • Glandular (parenchymal)
  • Supporting (stroma)
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2
Q

What is the glandular element divided into

A

Branching duct system and Terminal Duct Lobular Units (TDLU)

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3
Q

What is TDLU formed by

A

Lobule and terminal ductule and represents the secretory portion of the gland

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4
Q

What is the structure of TDLU

A

TDLU connects with the sub-segmental duct, which in turn leads to a segmental duct.

The segmental duct connects to a collecting/lactiferous duct which empties into the nipple.

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5
Q

What are the two cell types that line the entire ductal-lobular system

A
  • The inner epithelial cells
  • The outer myoepithelial cells
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6
Q

What are the markers used to identify myoepithelial cells

A
  • SMM
  • p63
  • ck5/6
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7
Q

What are the inflammatory diseases of the breast

A
  • Acute mastitis
  • Chronic mastitis
  • Fat necrosis
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8
Q

What are the proliferative diseases of the breast

A
  • Fibrocystic change
  • Radial Scar
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9
Q

What is the histology of fat necrosis

A
  • Variably sized fat cells lacking nuclei
  • Dystrophic calcification

Due to the irregular border, density and calcium on mammogram this lesion can mimic breast cancer

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10
Q

What is the histology of the radial scar

A
  • stellate lesion on mammogram which mimics breast cancer
  • Occasionally may be associated with tubular carcinoma, therefore scored as a B3 lesion for adequate sampling
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11
Q

What are the neoplastic benign diseases of the breast

A
  • Adenoma
  • Fibroadenoma
  • Papilloma
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12
Q

What are the neoplastic malignant diseases of the breast

A
  • Carcinoma
  • Sarcoma
  • Paget’s Disease
  • Phylloides tumour
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13
Q

What does the Lump symptom in the breast indicate

A

Diffuse: Fibrosis/Fibrocystic change

Discrete: Neoplasm/ cyst/ abscess/ hamartoma

Mobile: Benign neoplasm

Tethered: Carcinoma

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14
Q

What are the disease symptoms that can manifest in the nipple

A
  • Bloody discharge: papilloma or carcinoma
  • Retraction: carcinoma
  • Skin changes: Paget’s disease
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15
Q

What can these two different breast pains indicate

A
  • Cyclical: Benign breast diseases
  • On palpitation: inflammatory
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16
Q

What are the skin symptoms of diseased breasts

A

Oedema and peau d’orange indicates carcinoma

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17
Q

What does microcalcification show in diseased breasts

A

DCIS (Ductal Carcinoma in-situ)

Fat Necrosis

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18
Q

What is Fibrocystic Change

A

Common in 25-45 yrs age group

Benign (non-cancerous) condition where the breast tissue feels lumpy, nodular, or rope-like.

It happens because of hormonal fluctuations, mainly estrogen, affecting the breast tissue

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19
Q

What can be seen in a fibrocystic change histology slide

A

Develops from the TDLU

  • Calcification
  • Cysts
  • Fibrosis
  • Apocrine Metaplasia
  • Epithelial Hyperplasia
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20
Q

What is Fibroadenoma

A
  • Most common benign breast tumour
  • affects women between 20-35 yrs
  • Increases in size during pregnancy
  • Decreases in size with age
  • Composed of both proliferating ducts and connective tissue stroma
21
Q

What are the risk factors of breast carcinoma

A
  • Female sex and age
  • Reproductive history
    • Early menarche
    • Late menopause
    • Nulliparous women
    • 1st pregnancy after 30yrs of age
  • Obesity
  • Geography
  • Atypical hyperplasia
22
Q

What are the aetiological mechanisms

A
  • Hormonal factors
  • Genetic factors
    - BRCA 1, ch17, ovary and breast
    - BRCA 2, ch13
  • Environmental influences
23
Q

What are the two classifications of breast carcinoma

A

Invasion of the basement membrane:
- In-situ
- Invasive

Morphology
- Ductal
- Lobular

24
Q

What is the significance of diagnosis of carcinoma in-situ

A

It cannot metastasise:

  • can cure the patient by complete local excision
  • Lymph node excision is not required
  • Better prognosis
25
What are the classifications of breast carcinomas
In-situ carcinoma: - Ductal carcinoma in-situ - Lobular carcinoma in-situ Invasive carcinoma: - Invasive ductal carcinoma NST - Invasive lobular carcinoma
26
What is ductal carcinoma in-situ
- dilated ducts filled with neoplastic epithelial cells - Myoepithelial cell layer is intact (no invasion of the basement membrane) - Sometimes show central necrosis and calcification, a marker for diagnosis on mammogram - Classified into high, intermediate and low nuclear grades
27
What is Lobular carcinoma in-situ
- Lobules with distended acini filled with neoplastic epithelial cells - The cells are round and regular - Myoepithelial cell layer is intact - Immunostaining for e-cadherin is negative (a feature which helps in differentiation of LG DCIS from LCIS)
28
What are the features of invasive lobular carcinoma with LCIS
- Small, uniform cells — they look alike, with small round nuclei. - Single-file arrangement — cells invade the stroma in thin linear patterns instead of forming big solid masses. - Loss of cohesion between cells — because of E-cadherin loss (E-cadherin is a cell adhesion molecule; when it's gone, cells don't stick together well). - Targetoid/ concentric patterns — cells sometimes wrap around normal ducts in a "bullseye" shape. - Minimal desmoplastic response — unlike invasive ductal carcinoma, which often triggers lots of stromal fibrosis.
29
What is invasive ductal carcinoma with DCIS
The invasive tumour consists of small tubular structures lacking myoepithelial cell layer meaning the cells have invaded the basement membrane
30
What are the carcinoma treatments
- surgery - chemotherapy - radiotherapy - hormonal treatment - immunotherapy
31
What are the two types of surgery treatments
Axillary Lymph Node Breast
32
What are the two types of breast treatment surgeries
- Breast conserving - Mastectomy
33
What are the different types of Breast Conserving surgeries
- Wire-guided wide local excision - Lumpectomy - Segmentectomy - Quadrantectomy - Central wedge excision
34
What are the different types of mastectomy surgeries
- Simple mastectomy - Skin Sparing mastectomy - Sub-cutaneous mastectomy
35
What are the different types of Axillary lymph node surgeries
- Sentinel Lymph node - Axillary node sampling - Axillary lymph node clearance level 1, 2 and 3
36
What is the criteria for choosing chemotherapy
- Large Grade 3 tumours with nodal metastasis - Triple negative or Her2 positive tumours - Borderline cases have further genetic tests like Oncotype DX to decide chemotherapy
37
How is hormone therapy administered
All patients with Oestrogen receptor (ER) positive breast cancers receive anti-oestrogen treatment for 5 years Premenopausal - tamoxifen Post-menopausal - Aromatase inhibitors
38
How is prognosis determined in breast carcinoma
- Size of tumour - Grade of tumour - Histological type of tumour - Vascular invasion - Stage of tumour - nodal status - Receptor status of the tumour
39
What is the criteria for the breast cancer screening programme
- all women aged between 48-69 years whose names are in the Family Practitioner Committee Register are invited for mammographic examination - every three years
40
Why is there a need for a breast cancer screening programme
- increased incidence of breast cancer in the western world - It is estimated that in the high-risk areas that an y individual women have 1 in 8 chance of developing the disease in her lifetime - the rationale of the breast screening programme was the 5 year survival related to stage of the disease: - Stage 1 (<2cm lesion): 84% - Stage 4 (>5cm lesion): 18%
41
What is the marker for breast cancer
Microcalcification
42
What is microcalcification associated with histologically
It is usually associated with DCIS mostly high grade with central necrosis
43
Is microcalcification always malignant
No, it can be associated with benign fibrocystic change
44
What other mammographic appearance can one have with breast cancers
Stellate lesion Circumscribed soft tissue density/mass lesion
45
What other lesions can mimic breast cancer radiologically
Microcalcification: - Fibrocystic change - Fat necrosis - Calcified fibroadenoma - Calcified eggs of parasites Stellate lesion: - radial scar Circumscribed soft tissue density - Fibroadenoma and phylloides tumour
46
What is the role of the pathologist
1) make a histological/cytological diagnosis 2) To help clinicians in the management of a patient by assessing: - By assessing the extent o the lesion and completeness of excision - By evaluating the oestrogen receptor status 3) Help in predicting the prognosis: - Type of tumour - Grade of the tumour - Stage of the tumour - Size of the tumour
47
What are the categories of cytological diagnosis
C1 - Inadequate C2 - Benign C3 - Atypia, probably benign C4 - Suspicious of malignancy C5 - Malignancy
48
What are the categories of histological diagnosis
B1 - Normal B2 - Benign B3 - Benign but of uncertain malignant potential B4 - Suspicious of malignancy B5 - Malignant a: in-situ b: invasive

Clinical Pathology in Action (18 decks)

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