Breast pathology Flashcards
What is the most common histological type of breast cancer?
Invasive ductal cancer
What breast disorder is associated with vitamin A deficiency?
Periductal mastitis
A postmenopausal woman discovers a breast mass close to the areola of her left breast along with green brown nipple discharge. What condition is she most likely suffering from?
Mammary duct ectasia
What is mammary duct ectasia?
A condition in which the lactiferous duct becomes blocked or clogged
What is sclerosing adenosis?
Extra tissue growth within the breast lobules
What is the most common benign breast tumour in a premenopausal woman?
Fibroadenoma
What is Pagets disease of the breast and what is it associated with?
Eczema of the nipple
Associated with ductal carcinoma in situ
What is inflammatory carcinoma of the breast?
Inflammatory carcinoma involves the dermal lymphatic channels producing an inflamed breast due to the blocked drainage
How does inflammatory carcinoma present?
Hot, erythematous, swollen breast
Peu d’orange
Fails to resolve with antibiotic treatment
What is a phyllodes tumour?
Large, fast-growing masses that form from the periductal stromal cells of the breast
They can be benign (50-60%), borderline or malignant
What breast disease is associated with a lack of E cadherin and a single file pattern on histology?
Invasive lobular carcinoma
Distinguished by its characteristic single file pattern( invasive neoplastic cells line up in orderly rows, also known as ‘Indian file’)
This is as a result of an E cadherin mutation leading to an absence of gland/duct formation
What samples of the breast can be taken for cytology?
Fine Needle Aspiration (FNA)
Fluid
Nipple discharge
Nipple scrape
How is cytology from FNA classfied?
C1 - Unsatisfactory
C2 - Benign
C3 - Atypia, probably benign
C4 - Suspicious of malignancy
C5 - Malignant
How is a needle core biopsy sample classified in results?
B1 - Unsatisfactory / normal
B2 - Benign
B3 - Atypia, probably benign
B4 - Suspicious of malignancy
B5 - Malignant
–B5a - carcinoma in situ
–B5b - invasive carcinoma
What is the difference between core biopsy and vacuum biopsy?
Core biopsy must be inserted for every sample taken
Vacuum biopsy only needs to be put in once, and can be used to remove some lesions
What tissue growth occurs in gynaecomastia?
Ductal growth without lobular development
What are some of the causes of gynaecomastia?
– Exogenous/endogenous hormones
– Cannabis
– Prescription drugs e.g. spironolactone
– Liver disease
What age is fibrocystic change most common in?
Occurs from age 20-50 but most common in 40-50
How might fibrocystic change present?
Cyclical pain
Smooth, discrete lumps
Lumpy breast
Sudden pain
How would a fibroadenoma present?
Small, discrete, firm, mobile mass
What age is fibroadenoma most common?
30’s
What is the cause of fat necrosis?
Local trauma e.g. seatbelt injury
What is the main risk factor for duct ectasia?
Smoking
How is duct ectasia managed?
Antibiotics
Stop smoking
What are the two main aetiologies of acute mastitis/abscess?
Duct ectasia
Lactation
What bacteria affects lactation to cause mastitis/abscess?
Staph. aureus
Strep pyogenes
Do Phyllodes tumours tend to metastasise?
Rarely
What is the risk of failing to adequately excising a phyllodes tumour?
High chance of local recurrence
Which malignant tumour of the breast is associated with post operative radiotherapy?
Angiosarcoma
From which cancers do metastasis to the breast occur?
Bronchial
Ovarian serous carcinoma
Clear cell carcinoma of kidney
How can simple epithelial hyperplasia progress to ductal carcinoma in situ?
- Epithelial hyperplasia
- Columnar cell change
- Atypical ductal hyperplasia
- DCIS
What three things are assessed to give breast carcinoma a grading?
–Tubular differentiation (1-3)
–Nuclear pleomorphism (1-3)
–Mitotic activity (1-3)
What are the gradings for breast carcinoma?
3, 4 or 5 = Grade 1
6 or 7 = Grade 2
8 or 9 = Grade 3
Is lobular carcinoma more or less common after the menopause?
Less
Which type of cancer tends to affect both breast or can give diffuse disease in one breast?
Lobular
Which type of breast cancer tends to affect young people or BRCA positive?
Triple negative
Which type of breast cancer has the worst prognosis?
Triple negative
What chromosome is the BRCA1 gene located on?
17
What chromosome is the BRCA2 geen located on?
Chromosome 13
Which type of cancer has the second worst prognosis?
Her2 +ve
What breast condition typically causes bloody discharge from the nipple?
Intraductal papilloma
What is the most common type of breast cancer?
ER +ve
PR +ve
Her2 -ve
Which type of breast cancer has the best prognosis?
ER +ve
PR +ve
Her2 -ve
When is sclerosing adenosis classified as a radial scar?
When the lesions is <1cm
What bacteria causes mastitis in smokers?
Anaerobes
