Breast pathology Flashcards
Where do the majority of malignancies arise in the breast?
Epithelial cells - therefore, CARCINOMAS
Where do the majority of malignancies arise in the breast?
Epithelial cells - therefore, CARCINOMAS
What is the breast comprise?
Mammary glands (lobes) - where epithelium are
Lactiferous ducts
Fat (adipose tissue)
Epithelial tissue - fibrous bis of breast
Why are breast in younger people more lumpy?
More glandular and fibrous - therefore mammograms = less useful in young people
What age of people are more likely to get breast CARCINOMAS?
Peri/post menopausal - below 35yrs lumps = benign mostly!
What do mobile lumps of the breast indicate in different age groups
Fibroadenoma in 55 yrs
What do ill defined lumps/lump areas indicate in different age groupo?
Fibrocycstic changes in perimenopausal women
What do firm lump +/- tethering indicate in different age groups?
Carcinoma (>25yrs)
What does clear nipple discharge indicate in different age groups?
Duct ectasia
What does bloody nipple discharge indicate in different age groups?
Duct papiloma Duct carcinoma (in situ)
What are the risk factors for breast cancer?
- Genetic - first degree relative (BRCA1/2)
- Obesity
- Oestrogenic environment e.g. oestrogen-progesterone contraceptive, HRT (oestrogen
- obesity
- Radiation
What are the risk factors for breast cancer?
- Obesity
- Oestrogenic environment e.g. oestrogen-progesterone contraceptive, HRT (oestrogen
- obesity
- Radiation
What is protective for breast cancer?
Breast feeding
What is the breast comprise?
Mammary glands (lobes) - where epithelium are
Lactiferous ducts
Fat (adipose tissue)
Epithelial tissue - fibrous bis of breast
Why are breast in younger people more lumpy?
More glandular and fibrous - therefore mammograms = less useful in young people
What are duct papillomas? How do they present and what population do they mostly effect?
-Middle aged women
- Nipple discharge (bloody)
- Solitary lesion in large breast duct
- Papillary structures, with fibrovascular core covered by
benign epithelium
- Benign
What are phyllodes tumours?
- Occur at any age
- Discrete lump with firm and soft areas
- rare fibroepithelial neoplasm - stroma can become aggressive
How are great biopsies graded?
B grade
Name so presentations for breast disease
- puckered skin/withdrawn nipple fibroblasts pull structures inwards
Peau d’orange - inflammatory breast cancer - lots of tumour blocking lymphatics - lumpy
Inflammation e.g. TB, carcinoma, mastitis following breast feeding
Nipple discharge
Pain (rare though!)
What gene is overexpressed with paget’s disease/invasive breast carcinoma? How is it characterised in the nipple?
HER2
Eczema like irritation of nipple - associated with underlying carcinoma
What is protective for breast cancer?
Breast feeding
What is the nickname for fibroadenomas?
Breast mouse
Where do fibroadenomas arise from?
Lobules - involve proliferation of connective tissue stroma and glands
What are the characteristics of fibroadenomas?
- Non-malignant
- Untethered (therefore, mobile)
- compression of overlying breast tissue
What are duct papillomas? How do they present and what population do they mostly effect?
- Middle aged women
- Nipple discharge (bloody)
- Solitary lesion in large breast duct
- Non-malignant
What are phyllodes tumours?
- Occur at any age
- Discrete lump with firm and soft areas
- stroma and epithelial parts - stroma can become aggressive and reoccurrence
If a breast lump is found, what 3 investigative parameters should be performed? (triple assessment)
Clinical - exam and palpation
Radiological
Pathological - cytological/histopathology
What investigations can be performed to diagnose breast malignancies?
- imaging – mammography and ultrasonography
- fine-needle aspiration cytology
- core biopsy or vacuum-assisted biopsy
How are great biopsies graded?
B grades B1 - normal B2 - benign B3 - Atypical, prob benign B4 - atypical, prob malignant B5 - malignant a) in situ; b) invasive
What characterised fibrocystic changes?
Physiological changes
- ductal hyperplasia
- cysts
- apocrine metaplasia
- micro calcifications
- oestrogenic environment
Name so presentations for breast disease
- puckered skin/withdrawn nipple fibroblasts pull structures inwards
Peau d’orange - inflammatory breast cancer - lots of tumour blocking lymphatics - lumpy
Inflammation e.g. TB, carcinoma, mastitis following breast feeding
Nipple discharge
What gene is overexpressed with pages disease?
HER2
