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Reproduction > Breast Pathology 2 > Flashcards

Breast Pathology 2 Flashcards

1
Q

What component of a Phyllodes tumour is malignant?

A

stromal element

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2
Q

What is classification of Phyllodes tumours?

A

sarcoma

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3
Q

What is the main risk factor for developing angiosarcoma of the breast?

A

radiotherapy

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4
Q

What are the most common metastases to the breast?

A

bronchial; ovarian serous carcinoma; clear cell carcinoma of the kidney

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5
Q

What does breast carcinoma arise from?

A

glandular epithelium of the terminal duct lobular unit

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6
Q

What is columnar cell change?

A

ductal epithelial proliferation with minor genetic changes

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7
Q

What is ductal carcinoma in situ?

A

malignant cells bounded by the BM

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8
Q

What two components used to make up lobular in situ neoplasia

A

atypical lobular hyperplasia and lobular carcinoma in situ

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9
Q

What is the difference between atypical lobular hyperplasia and lobular carcinoma in situ

A

atypical lobular hyperplasia <50% of lobule involved whereas LCIS has >50% of the lobule involved

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10
Q

What are the characteristics of cells in lobular in situ neoplasia?

A

small-intermediate sized nuclei; solid proliferation; intra-cytoplasmic lumens

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11
Q

What are the genetic features of lobular in situ neoplasia/

A

ER positive and E-cadherin negative

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12
Q

When does incidence of lobular in situ neoplasia decrease?

A

post-menopause

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13
Q

How is lobular in situ neoplasia usually diagnosed and why?

A

incidentally- not palpable and no visible grossly

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14
Q

What is the significance of finding lobular in situ neoplasia?

A

10-15% risk of higher grade lesion on diagnostic biopsy

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15
Q

What is the risk with lobular in situ neoplasia of progression to invasive carcinoma?

A

x8

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16
Q

What is the management for lobular in situ neoplasia?

A

excise or vacuum biopsy to exclude higher grade lesion; follow up

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17
Q

What is the risk of progression to invasive carcinoma with epithelial hyperplasia of the usual type?

A

x2

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18
Q

What is the risk of progression to invasive carcinoma with atypical ductal hyperplasia?

A

x4

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19
Q

What is the risk of progression to invasive carcinoma with ductal carcinoma in situ?

A

x10 (25% over following 10 years)

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20
Q

Where does DCIS arise?

A

TDLU

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21
Q

How many duct systems does DCIS typically affect?

A

single duct system- unicentric

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22
Q

What is cancerisation?

A

if DCIS involves the lobules

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23
Q

What is DCIS named if it also involves the nipple skin?

A

Paget’s disease of the breast

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24
Q

What is Paget’s disease of the nipple?

A

high grade DCIS extending along ducts to reach epidermis of nipple

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25
Q

What is the most important factor in classifying DCIS?

A

cytological grade- most important in prognosis

26
Q

What is the significance of DCIS?

A

RF for development of invasive carcinoma and is a true precursor lesion for invasive carcinoma (75% will progress with incisional biopsy only)

27
Q

What is the management for DCIS?

A

surgery and radiotherapy

28
Q

What is microinvasive carcinoma?

A

high grade DCIS with invasion of <1mm

29
Q

How is microinvasive carcinoma treated?

A

as high grade DCIS

30
Q

What are the reproductive risk factors for carcinoma of the breast?

A

early menarche; >30 first birth; nulliparous; no breastfeeding; late menopause—–how many periods in a life

31
Q

What exogenous hormones carry a risk for carcinoma of breast?

A

OCP and HRT

32
Q

What lifestyle factors are implicated in carcinoma of the breast?

A

high BMI (>30 inc. risk 30%); low physical activity; alcohol and diet; smoking and NSAIDs (protective)

33
Q

What does having an affected first degree relative do to your risk of carcinoma of breast?

A

x2

34
Q

how is breast carcinoma graded?

A

tubular differentiation; nuclear polymorphism and mitotic activity

35
Q

What is basal-like breast cancer known as?

A

triple negative- ER, PR and HER2 (basal CK +ve)

36
Q

What does ER expression predict?

A

response to anti-oestrogen therapy

37
Q

What is anti-oestrogen therapy?

A

oopherectomy; tamoxifen; aromatase inhibitors and GnRH analogues

38
Q

What is HER2?

A

human epidermal growth factor receptor 2

39
Q

What does overexpression or amplification of HER2 predict respone to?

A

trastuzamab (herceptin)

40
Q

What is trastuzamab?

A

humanised mouse monoclonal antibody

41
Q

What does the prognostic index PREDICT use ?

A

histopathology + ER + clinical factors + HER2 + mode of detection

42
Q

What does the Nottingham prognostic index use?

A

0.2 x tumour diameter; tumour grade and lymph node status

43
Q

What is the most common type of breast malignancy?

A

ductal

44
Q

What are the common symptoms of breast cancer?

A

visible lump; dimpled or depressed skin; nipple change; bloody discharge; texture change; colour change

45
Q

What are the indications for adjuvant RT?

A

involvement of >3 nodes; positive surgical margins and/or tumours >5cm

46
Q

What is bevacizumab?

A

monoclonal antibody against VEGF

47
Q

What is bevacizumab used for?

A

metastatic breast cancer

48
Q

What is lapatinib?

A

dual inihibitor of epidermal growth factor receptor and HER-2 tyrosin kinases

49
Q

What is the most common benign neoplasm of the breast?

A

fibroadenoma

50
Q

How is diagnosis of fibroadenoma confirmed?

A

ultrasound core biopsy

51
Q

When should aspiration of breast cysts be sent for cytology?

A

grossly bloody fluid

52
Q

What can be associated iwth a bloody cyst fluid or residual mass after aspiration?

A

intracystic papillary proliferation: papilloma

53
Q

What is normal nipple discharge for women of reproductive age?

A

clear, yellow and watery

54
Q

What is the most common cause of spontaneous nipple discharge?

A

intraductal papilloma

55
Q

What is the most common bug in mastitis?

A

S. aureus

56
Q

What are the symptoms of mastitis?

A

fever; erythema; induration; tenderness and swelling

57
Q

How often should a patient with mastitis be examined?

A

every 3 days

58
Q

What is the prognosis of fat necrosis of the breast?

A

usually subsides spontaneously

59
Q

What is Mondor’s disease?

A

phlebitis and subsequent clot formation in the superifical veins of the breast

60
Q

What is Mondor’s disease usually associated with?

A

hx of trauma to the breast eg surgery

61
Q

How long does it take Mondor’s disease to resolve?

A

8-12 weeks

Reproduction (52 decks)

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