Breast pathology

Question 1

The majority of malignancies in the breast are what type?

Answer 1

Arise from epithelial cells so are carcinomas

Question 2

Aswell as carcinomas what other type of malignancy can be found in the breast?

Answer 2

Arising from connective tissue - sarcomas

Question 3

What is the main factor which is associated with the development of breast cancer?

Answer 3

Oestrogenic environment

Question 4

What is the NHS breast screening programme?

Answer 4

Free breast screening every 3 years for all women aged 50 and over

Question 5

What are the 7 possible presentations of breast disease?

Answer 5

1) Lumps
2) Puckered skin/ indrawn nipple
3) Pain
4) Inflammation/ infection
5) Nipple discharge
6) Abnormal/ sore nipple
7) Can be identified using radiology/ screening

Question 6

All breast abnormalities should be investigated using what?

Answer 6

The triple assessment - should be considered in 3 parameters, the results of which should be triangulated at an MDT meeting

Question 7

What are the 3 parameters of the triple assessment?

Answer 7

1) Clinical - ie clinical examination and palpation
2) Radiological
3) Pathological - either cytology or histopathology

Question 8

What are fibroadenomas, are they dangerous?

Answer 8

They are fibroepithelial neoplasms in which there is coordinated growth of the glandular and connective tissue (Stromal) element. Common and present as mobile lumps or radiological masses, they are not dangerous and if confirmed by biopsy should be left alone.

Question 9

What are phyllodes tumours, are they dangerous?

Answer 9

Rare fibroepithelial neoplasm which form a spectrum of lesions - more aggressive phyllodes tumours show overgrowth of the stromal element which can be sarcomatous

Question 10

Name 4 benign structures which can cause breast lumps?

Answer 10

1) Physiological lumps
2) Lipoma
3) Fibroadenoma
4) Fibrocystic change

Question 11

Name a structure which can be sometimes benign and other times malignant and cause a breast lump?

Answer 11

Phyllodes tumour

Question 12

What 3 things does fibrocystic change in the breast include?

Answer 12

1) Ductal hyperplasia
2) Apocrine metaplasia
3) Cysts

Question 13

Aswell as being associated with a lump, what 2 other radiological abnormalities can fibrocystic change of the breast be associated with?

Answer 13

Microcalcifications

Question 14

Is fibrocystic change related to breast cancer?

Answer 14

It may share some risk factors but its probably not a precursor to breast cancer

Question 15

Breast disease can present with puckered skin/ in drawn nipple, what are the 2 possible causes?

Answer 15

1) Fat necrosis

2) Carcinoma - get puckering and also peau d’orange (because tumour is deep to nipple)

Question 16

What is peu d’orange?

Answer 16

Cancer blocks up the lymphatics leading to oedema of the nipple but the skin is tethered where the sweat glands are so get an orange skin appearance

Question 17

Breast disease can present with inflammation, what are the 4 possible causes?

Answer 17

1) Mastitis during breast feeding
2) Breast abscesses and fistulae
3) TB
4) Carcinoma/ sarcoma

Question 18

Breast disease can present with nipple duct discharge, what are the 4 possible causes?

Answer 18

1) Duct ectasia
2) Intraductal papilloma - finger like growths in the ducts
3) In situ papillary carcinoma
4) Intracystic papillary carcinoma

Question 19

What are the 7 categories of breast carcinoma?

Answer 19

1) Ductal
2) Lobular
3) Tubular/ ciribiform
4) Medullary
5) Mucoid
6) Metaplastic
7) Others

Question 20

What 6 pieces of information should a pathological report tell you about malignancy?

Answer 20

1) In situ or invasive
2) Type
3) Grade
4) Vascular invasion
5) Nodal status - key stage indicator
6) Size - key stage indicator
7) Relationship to margins
8) ER (oestrogen receptor), PR (progesterone receptor) and HER2 status - indicators of which types of treatment they will respond to

Question 21

What 2 properties of a malignancy are key stage indicators?

Answer 21

1) Nodal status

2) Size

Question 22

If a malignancy has the ER what type of treatment will it respond to?

Answer 22

Oestrogen targeted chemo

Question 23

How can the ER, PR and HER2 status of a malignancy be identified?

Answer 23

Using molecular biology or immunohistochemistry

Question 24

The Nottingham prognostic index is used in breast malignancy - what 3 indicators does it use to calculate?

Answer 24

1) Grade
2) Nodal status
3) Tumour size