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Histopathology > Breast Pathology > Flashcards

Breast Pathology Flashcards

1
Q

What are the main investigations of breast disease?

A

Clinical examination
Imaging-sonography,mammography, MRI (sensitive and specific)
Biopsy-cytopathology or histopathology

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2
Q

Is ultrasound more specific than mammogram?

A

Yes, picks up more echoes and shadows

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3
Q

What kind of cancers are normally detected by MRI.

A

Lobular cancers, tend to be bilateral, small. High resolution.

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4
Q

What is involved in a FNA.

A

Insert a 16 gauge needle into the lesion, material is aspirated,ms eared onto a slide, dip into fixative.
Slides are stained.

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5
Q

What are the benefits of cytopathology?

A

Good cellular detail
Quick to prepare, but no architecture
Used in nvestigation of nipple discharge and palpable lumps

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6
Q

How are aspirates of breast lumps coded for cytology?

A 
C1- inadequate
C2- benign
C3- atypia, probably benign. Lesions which surgeons chase and repeat
C4- suspicious of malignancy
C5- malignant
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7
Q

What is the gold standard to prove diagnosis?

A

Biopsy

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8
Q

What happens once the biopsy is taken?

A 
Intact tissue is removed
fixed in formalin to preserve 
embedded in paraffin wax 
Thinly sliced and stained with H&E
Takes 24-36 hrs 
Cellular AND architecture
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9
Q

What is in a breast histology slide?

A

Duct in the centre and acinar in the periphery.
The terminal duct lobular unit
breast cancers arise from this structure.

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10
Q

What cells are in the ducts?

A

Myopethelial cells and luminal cells.

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11
Q

What does duct ectasia mean?

A

Inflammation and dilation of large breast ducts.

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12
Q

How do patients with duct ectasia present?

A

Nipple discharge
Breast pain
Breast mass
Nipple retraction

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13
Q

What does the cytology show in duct ectasia?

A

Proteinaceous material and inflammatory cells only (foamy macrophages)

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14
Q

Is there an increased risk of malignancy with duct ectasia?

A

No

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15
Q

What is acute mastitis?

A

Inflammation of the glandular tissue

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16
Q

Why is acute mastitis often seen in women?

A

Often seen in lactating women due to cracked skin and stasis of milk.

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17
Q

What disease may mastitis complicate?

A

Duct ectasia

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18
Q

What is the usual causative organism for acute mastitis?

A

Staphylococci

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19
Q

How does acute mastitis present?

A

With a painful red breast

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20
Q

What is the cure for acute mastitis?

A

Drainage and abx

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21
Q

How can fat necrosis present?

A

Breast mass, can be worrying

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22
Q

What is fat necrosis a response to?

A

Trauma
Surgery
Radiotherapy

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23
Q

What is fat necrosis?

A

Inflammatory reaction to damaged adipose tissue

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24
Q

What is fibrocystic disease?

A

Group of alterations in breast which reflect normal, albeit exaggerated responses to hormonal influences

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25
Q

How do patients with fibrocystic disease present?

A

Breast lumpiness, very common, no risk of carcinoma

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26
Q

What can happen to the fluid that accumulates in fibrocystic disease?

A

It can become calcified and is picked up on mammogram

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27
Q

What is fibroadenoma?

A

Benign, fibroeptheilial lesion, very common.

Proliferation of the stroma and the glandular ducts

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28
Q

How does fibroadenoma present?

A

Circumcised mobile lump in young women 20-30

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29
Q

How can you cure fibroadenoma?

A

Simple ‘shelling out’.

30
Q

What category does fibroadenoma belong to?

A

C2

31
Q

What do the glands look like in fibroadenoma?

A

Slit like

32
Q

What does phyllodes mean?

A

Latin for leaf like

33
Q

What are phyllodes tumours?

A

Potentially aggressive fibroeptheilial neoplasms, uncommon

34
Q

How do phyllodes tumours present?

A

Enlarging mass in women aged over 50

35
Q

What may phyllodes tumours arise with?

A

Pre-existing fibroadenoma

36
Q

Are phyllodes tumours cancerous?

A

Most are benign, a small proportion behave aggressively

37
Q

What makes phyllodes benign, borderline or malignant?

A

Stromal cellularity and stromal overgrowth

38
Q

What is an intraductal papilloma?

A

Benign papillary tumour, arising within duct system
small terminal ductules (peripheral)
Larger lack ferrous ducts (Central)
Multiple- increased risk of cancer

39
Q

What do intraductal papilloma have in the core?

A

Fibrovascuale tissue

40
Q

What is a radial scar?

A

A benign sclerosing lesion

Central zone of scarring, surrounded by radiating zone of proliferate glandular tissue

41
Q

What size are radial scars?

A

Tiny microscopic lesions to large clinically apparent masses

42
Q

What are lesions more than 1cm called?

A

Complex sclerosing lesions

43
Q

Where can you get malignancy in radial scar?

A

The edges

44
Q

What is radial scar thought to represent?

A

An exuberant reparative phenomenon in response to areas of tissue damage in the breast.

45
Q

How do radial scars present?

A

Stellate masses on screening mammograms

Excision is curative

46
Q

What are proliferating breast disease?

A

Intraductal proliferation lesions associated with increased risk, different magnitudes, subsequent development of carcinoma

47
Q

Do proliferative breast diseases cause symptoms?

A

No, they are microscopic lesions

48
Q

When are proliferative breast diseases diagnosed?

A

When breast tissue is removed for other reasons

On screening mammograms if they calcify

49
Q

What is epithelial hyperplasia?

A

Not considered a direct precursor to invasive breast cancer but marker for slightly increased risk for subsequent carcinoma

50
Q

What is flat epithelial atypia?

A

Represents morphological precursor to low grade ductal carcinoma in situ
4 times relative risk of developing cancer

51
Q

What is in situ lobular neoplasia?

A

Risk factor for subsequent invasive breast carcinoma in either breast, 7-12 fold.

52
Q

What is ductal carcinoma in situ?

A

Neoplastic intraductal epithelial proliferation in the breast with an inherent but not inevitable risk of progression to invasive breast carcinoma (non invasive)
Common
Can be excised

53
Q

What percentage of DCIS are detected on mammography as areas of microcalcifaction?

A

85%

54
Q

What percentage of DCIS produce clinical findings like a lump, nipple discharge, Paget’s disease of nipple?

A

10%

55
Q

What percentage of DCIS are diagnosed incidentally in breast specimens removed for other reasons?

A

5%

56
Q

What are DCIS classified into?

A

Low
Intermediate
High grade

57
Q

What is treatment like for DCIS?

A

Surgical excision, clear margins/mastectomy

Recurrence more likely with extensive disease and high grade DCIS

58
Q

What is invasive breast carcinoma?

A

Cancer has come out of basement membrane and into stroma.
Epithelial
1 in 8 risk

59
Q

What percentage of lifetime risk is there for invasive breast carcinoma with BRCA mutation?

A

85%

60
Q

Where do low grade carcinomas tend to arise from?

A

Low grade DCIS or in situ lobular neoplasia and show 16q loss

61
Q

Where do high grade breast carcinoma arise from?

A

High grade DCIS and show complex karyotypes with many unbalanced chromosomal aberrations

62
Q

What pattern is seen invasive lobular carcinoma?

A

Indian fine pattern

63
Q

What is basal-like carcinoma?

A

Characterised by sheets of markedly atypical cells, with a prominent lymphocytic infiltrate
Central necrosis

64
Q

What is the immunohistochemistry of basal like carcinoma?

A

Positivity for basal cytokeratin ck5/6 and ck14
BRCA mutation
Propensity for vascular invasion and mets

65
Q

How are cancers histologically graded?

A

Tubule formation
Nuclear pleomorphism
Mitotic activity
Each is scored 1-3

66
Q

What are the grade/points for histology grading?

A 
3-5= grade 1
6-7= grade 2
8-9= grade 3
67
Q

What is the receptor status for the different grades of carcinoma?

A

Low grade- ER and PR positive, Her2 negative
High grade- ER and PR negative, Her2 positive
Basal like- triple negative

68
Q

What is the single most important prognostic factor for carcinoma?

A

Status of axillary lymph nodes

Tumour size, histological type, and grade

69
Q

What is the coding system for biopsy?

A 
B1- normal
B2- benign abnormality
B3- lesion of uncertain malignant potential 
B4- suspicious of malignancy 
B5- malignant (a is DCIS, b is invasive)
70
Q

What does gynaecomastia look like?

A

Breast ducts show epithelial hyperplasia with finger like projections extending into the duct lumen.
Periductal stroma is cellular and oedematous

71
Q

What are the common presentations of best disease?

A

Breast lump
Abnormal screening mammogram-incidental
Nipple discharge from lactiferous ducts

Histopathology (4 decks)

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