Breast Pathology 2 Flashcards
What component of a Phyllodes tumour is malignant?
stromal element
What is classification of Phyllodes tumours?
sarcoma
What is the main risk factor for developing angiosarcoma of the breast?
radiotherapy
What are the most common metastases to the breast?
bronchial; ovarian serous carcinoma; clear cell carcinoma of the kidney
What does breast carcinoma arise from?
glandular epithelium of the terminal duct lobular unit
What is columnar cell change?
ductal epithelial proliferation with minor genetic changes
What is ductal carcinoma in situ?
malignant cells bounded by the BM
What two components used to make up lobular in situ neoplasia
atypical lobular hyperplasia and lobular carcinoma in situ
What is the difference between atypical lobular hyperplasia and lobular carcinoma in situ
atypical lobular hyperplasia <50% of lobule involved whereas LCIS has >50% of the lobule involved
What are the characteristics of cells in lobular in situ neoplasia?
small-intermediate sized nuclei; solid proliferation; intra-cytoplasmic lumens
What are the genetic features of lobular in situ neoplasia/
ER positive and E-cadherin negative
When does incidence of lobular in situ neoplasia decrease?
post-menopause
How is lobular in situ neoplasia usually diagnosed and why?
incidentally- not palpable and no visible grossly
What is the significance of finding lobular in situ neoplasia?
10-15% risk of higher grade lesion on diagnostic biopsy
What is the risk with lobular in situ neoplasia of progression to invasive carcinoma?
x8
What is the management for lobular in situ neoplasia?
excise or vacuum biopsy to exclude higher grade lesion; follow up
What is the risk of progression to invasive carcinoma with epithelial hyperplasia of the usual type?
x2
What is the risk of progression to invasive carcinoma with atypical ductal hyperplasia?
x4
What is the risk of progression to invasive carcinoma with ductal carcinoma in situ?
x10 (25% over following 10 years)
Where does DCIS arise?
TDLU
How many duct systems does DCIS typically affect?
single duct system- unicentric
What is cancerisation?
if DCIS involves the lobules
What is DCIS named if it also involves the nipple skin?
Paget’s disease of the breast
What is Paget’s disease of the nipple?
high grade DCIS extending along ducts to reach epidermis of nipple
What is the most important factor in classifying DCIS?
cytological grade- most important in prognosis
What is the significance of DCIS?
RF for development of invasive carcinoma and is a true precursor lesion for invasive carcinoma (75% will progress with incisional biopsy only)
What is the management for DCIS?
surgery and radiotherapy
What is microinvasive carcinoma?
high grade DCIS with invasion of <1mm
How is microinvasive carcinoma treated?
as high grade DCIS
What are the reproductive risk factors for carcinoma of the breast?
early menarche; >30 first birth; nulliparous; no breastfeeding; late menopause—–how many periods in a life
What exogenous hormones carry a risk for carcinoma of breast?
OCP and HRT
What lifestyle factors are implicated in carcinoma of the breast?
high BMI (>30 inc. risk 30%); low physical activity; alcohol and diet; smoking and NSAIDs (protective)
What does having an affected first degree relative do to your risk of carcinoma of breast?
x2
how is breast carcinoma graded?
tubular differentiation; nuclear polymorphism and mitotic activity
What is basal-like breast cancer known as?
triple negative- ER, PR and HER2 (basal CK +ve)
What does ER expression predict?
response to anti-oestrogen therapy
What is anti-oestrogen therapy?
oopherectomy; tamoxifen; aromatase inhibitors and GnRH analogues
What is HER2?
human epidermal growth factor receptor 2
What does overexpression or amplification of HER2 predict respone to?
trastuzamab (herceptin)
What is trastuzamab?
humanised mouse monoclonal antibody
What does the prognostic index PREDICT use ?
histopathology + ER + clinical factors + HER2 + mode of detection
What does the Nottingham prognostic index use?
0.2 x tumour diameter; tumour grade and lymph node status
What is the most common type of breast malignancy?
ductal
What are the common symptoms of breast cancer?
visible lump; dimpled or depressed skin; nipple change; bloody discharge; texture change; colour change
What are the indications for adjuvant RT?
involvement of >3 nodes; positive surgical margins and/or tumours >5cm
What is bevacizumab?
monoclonal antibody against VEGF
What is bevacizumab used for?
metastatic breast cancer
What is lapatinib?
dual inihibitor of epidermal growth factor receptor and HER-2 tyrosin kinases
What is the most common benign neoplasm of the breast?
fibroadenoma
How is diagnosis of fibroadenoma confirmed?
ultrasound core biopsy
When should aspiration of breast cysts be sent for cytology?
grossly bloody fluid
What can be associated iwth a bloody cyst fluid or residual mass after aspiration?
intracystic papillary proliferation: papilloma
What is normal nipple discharge for women of reproductive age?
clear, yellow and watery
What is the most common cause of spontaneous nipple discharge?
intraductal papilloma
What is the most common bug in mastitis?
S. aureus
What are the symptoms of mastitis?
fever; erythema; induration; tenderness and swelling
How often should a patient with mastitis be examined?
every 3 days
What is the prognosis of fat necrosis of the breast?
usually subsides spontaneously
What is Mondor’s disease?
phlebitis and subsequent clot formation in the superifical veins of the breast
What is Mondor’s disease usually associated with?
hx of trauma to the breast eg surgery
How long does it take Mondor’s disease to resolve?
8-12 weeks
