Breast pathology Flashcards
C1
Unsatisfactory
C2
Benign
C3
Atypia, probably benign
C4
Suspicious of malignancy
C5
Malignant
B1
Unsatisfactory/normal
B2
Benign
B3
Atypia, probably benign
B4
Suspicious of malignancy
B5
Malignant
B5a
Carcinoma in situ
B5b
Invasive carcinoma
This breast change is associated with:
- menstrual abnormalities
- early menarche
- late menopause
Fibrocystic change
When do fibrocystic changes resolve?
Usually resolve by themselves after menopause
Age group affected by fibrocystic change?
Women aged 20-50
Presentation of fibrocystic change
Presentation Smooth discrete lumps Sudden pain Cyclical pain Lumpiness Incidental finding Screening
Thin walled but may have fibrotic wall
Lined by APOCRINE epithelium
Cysts
Circumscribed lesion composed of cell types normal to the breast but present in an abnormal proportion or distribution
Hamartoma
Fibroadenomas are commoner in which race?
African women
Peak incidence of fibroadenoma?
3rd decade
Biphasic tumour
Fibroadenoma:
- epithelial tissue
- stromal tissue
(Phyllodes also biphasic)
Benign, disorderly proliferation of acini and stroma
Sclerosing lesions
Can cause a mass or calcification
May mimic a carcinoma
Sclerosing lesions
Damage and disruption of adipocytes
Infiltration by acute inflammatory cells
“foamy” macrophages
Subsequent fibrosis and scarring
Fat necrosis
What medication could cause fat necrosis?
Warfarin
Affects sub-areolar ducts Pain Acute episodic inflammatory changes Bloody and/or purulent D/C Fistulation Nipple retraction and distortion
Duct ectasia
Associated with smoking Sub-areolar duct dilatation Periductal inflammation Periductal fibrosis Scarring and distortion
Duct ectasia
What is duct ectasia associated with?
Smoking
Management for duct ectasia
Treat acute infections
Exclude malignancy
Stop smoking
Excise ducts
2 main causes of acute mastitis/abscess?
Duct ectasia:
Mixed organisms
Anaerobes
Lactation:
Staph aureus
Strep pyogenes
What age group are affected by phyllodes tumour?
Age 40-50
What does a biphasic tumour contain?
Epithelial and stromal components
Papillary fronds containing a fibrovascular core
Intraduct papilloma
Covered by myoepithlelium and epithelium
Intraduct papilloma
Phyllodes tumours are often benign but what can make them malignant?
If they have a sarcomatous stromal component
What could cause a breast angiosarcoma?
Radiation therapy
What type of ovarian cancer could metastasise to the breast?
Serous cell
What kidney cancer could metastasise to the breast?
Clear cell carcinoma
What soft tissue tumour could metastasise to the breast?
Leiomyosarcoma
Definition of breast sarcoma?
Malignant proliferation of breast epithelial cells
Significance of Lobular in situ neoplasia?
It is a marker of subsequent risk,
it is also a true precursor lesion
Difference between atypical lobular hyperplasia and lobular carcinoma in situ?
Atypical lobular hyperplasia - 50% of the lobule involved
ER finding in lobular carcinoma?
ER positive
E-cadherin finding in lobular carcinoma?
E-cadherin negative
Risk of epithelial hyperplasia of usual type progressing to cancer?
2x
Risk of atypical ductal hyperplasia progressing to cancer?
4x
Risk of ductal carcinoma in situ progressing to cancer?
10x
Where doe ductal carcinoma in situ arise from?
TDLU (terminal duct lobular unit)
What is pagets disease? Is it in situ?
Pagets disease is when DCIS extends along the ducts to reach the epidermis of the nipple
-still in site (i.e. non invasive)
Which common drug reduces the risk of breast cancer?
NSAIDS
Lifetime risk of breast cancer if you have BRCA 1 / BRCA 2
45-64% life-time risk (v high)
Commonest female cancer?
Invasive breast carcinoma
Breast cancer prognostic factors
ER positive (good response to hormonal therapy) HER 2 positive (good response to trastuzumab/herceptin)
What does the Nottingham prognostic index look at?
Histopathology only
What does the Adjuvant! Online prognostic index look at?
- histopathology
- ER
- clinical factors
What does the PREDICT prognostic index look at?
- histopathology
- ER
- clinical factors
- HER 2
- mode of detection
