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Reproduction SB > Breast Pathology > Flashcards

Breast Pathology Flashcards

1
Q

what is the assessment model for a patient with breast disease

A

Triple assessment

  1. Clinical
    - History and Examination
  2. Imaging
    - Mammography
    - Ultrasound
    - MRI
  3. Pathology
    - Cytopathology
    - Histopathology
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2
Q

how is breast cytopathology obtained

A

fine needle aspiration
fluid
nipple discharge
nipple scrape

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3
Q

what are the 5 stages of breast FNA cytology

A 
C1 - Unsatisfactory
C2 - Benign
C3 - Atypia, probably benign
C4 - Suspicious of malignancy
C5 - Malignant
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4
Q

what are the 5 stages of needle core biopsy

A 
B1 - Unsatisfactory / normal
B2 - Benign
B3 - Atypia, probably benign
B4 - Suspicious of malignancy
B5 - Malignant
B5a - carcinoma in situ
B5b - invasive carcinoma
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5
Q

what are developmental benign breast disease

A

Hypoplasia (one or both breasts don’t develop during puberty)

Juvenile hypertrophy (breasts continue to grow)

Accessory breast tissue

Accessory nipple

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6
Q

what are non-neoplastic benign breast disease

A 
Gynaecomastia
Fibrocystic change
Hamartoma
Fibroadenoma
Sclerosing lesions
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7
Q

what are inflammatory benign breast disease

A

Fat necrosis
Duct ectasia
Acute mastitis/abscess

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8
Q

what are benign breast tumours

A

Phyllodes tumour

Intraduct Papilloma

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9
Q

what is gynaecomastia

A

breast development in the male

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10
Q

what is the pathology of gynaecomastia

A

Ductal growth without lobular development

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11
Q

what can cause gynaecomastia

A

Exogenous/endogenous hormones
Cannabis
Prescription drugs
Liver disease

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12
Q

who are fibrocystic changes seen in

A

Women aged 20-50
Majority 40-50

very common

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13
Q

how does the breast appear with fibrocystic changes

A

lumpy, cobblestone appear

lumps are smooth with defined edges, and are usually free-moving in regard to adjacent structures

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14
Q

what is seen with fibrocystic changes of the breast

A

Menstrual abnormalities
Early menarche
Late menopause

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15
Q

what happens with fibrocystic changes after menopause

A

often resolve or diminish

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16
Q

how do fibrocystic changes often present

A

Smooth discrete lumps
Sudden pain
Cyclical pain
Lumpiness

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17
Q

what is the gross pathology of fibrocystic changes

A

Cysts

  • 1mm – several cm
  • blue domed with pale fluid
  • usually multiple
  • associated w/ other benign changes
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18
Q

what are the cysts in fibrocystic changes lined with

A

apocrine epithelium

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19
Q

Mx of fibrocystic changes

A

exclude malignancy
reassure
excise if necessary

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20
Q

what is a hamartoma

A

Circumscribed lesion composed of cell types normal to the breast but present in an abnormal proportion or distribution

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21
Q

what are features of a fibroadenoma

A

common
usually solitary
commoner in african women
peak incidence in 3rd decade

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22
Q

presentation of fibroadenoma

A

Painless, firm, discrete, mobile mass

sometimes called “breast mouse” as they move so freely

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23
Q

how do fibroadenomas present on USS

A

solid

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24
Q

what is the pathology of a fibroadenoma

A

Circumscribed

Rubbery

Grey-white colour

Biphasic tumour/lesion

  • Epithelium
  • Stroma
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25
Q

Tx of fibroadenoma

A

diagnose
reassure
excise

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26
Q

what often co-exists with fibrocystic changes

A

Sclerosing adenosis

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27
Q

what is Sclerosing adenosis

A

benign proliferative condition of the terminal duct lobular units characterised by an increased number of the storma, acini and their glands

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28
Q

what can Sclerosing adenosis cause

A

mass or calcification

may mimic carcinoma

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29
Q

presentation of Sclerosing adenosis

A

Pain, tenderness or lumpiness/thickening

Can be Asymptomatic

Age 20-70

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30
Q

what can detect a radial scar as they are not usually palpable

A

mammogram

- incidental finding

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31
Q

pathology of radial scar

A

central fibrous core with central puckering

stellate architecture

32
Q

histology of radial scar

A

Fibroelastotic core
Radiating fibrosis containing distorted ductules
Fibrocystic change
Epithelial proliferation

33
Q

why do radial scars get Ix when found

A

as they can mimic carcinomas radiologically

34
Q

what can cause fat necrosis in the breast

A

Local trauma

  • e.g. Seat belt injury
  • Frequently no history

Warfarin therapy

35
Q

what is the pathology of fat necrosis in the breast

A

Damage and disruption of adipocytes

Infiltration by acute inflammatory cells

“foamy” macrophages

Subsequent fibrosis and scarring

36
Q

what are clinical features of duct ectasia

A 
Affects sub-areolar ducts
Pain
Acute episodic inflammatory changes
Bloody and/or purulent D/C
Fistulation
Nipple retraction and distortion
37
Q

what is duct ectasia

A

lactiferous duct becomes blocked or clogged

most common cause of greenish discharge

38
Q

what is duct ectasia associated with

A

smoking

39
Q

what is the pathology of duct ectasia

A

Sub-areolar duct dilatation
Periductal inflammation
Periductal fibrosis
Scarring and distortion

40
Q

Mx of duct ectasia

A

Treat acute infections
Exclude malignancy
Stop smoking
Excise ducts

41
Q

what are the 2 main aetiologies of acute mastitis/abscess and the organisms associated with infection

A

Duct ectasia

  • Mixed organisms
  • Anaerobes

Lactation

  • Staph aureus
  • Strep pyogenes
42
Q

Mx of acute mastitis/abscess

A

Antibiotics
Percutaneous drainage
Incision & drainage
Treat underlying cause

43
Q

what are the clinical features of a phyllodes tumour

A

Age 40-50

Slow growing unilateral breast mass

44
Q

what are examples of papillary lesions

A

Intraduct papilloma
Nipple adenoma
Encysted papillary carcinoma

45
Q

what are the clinical features of an intraduct papilloma

A

Age 35-60

Nipple discharge +/- blood

46
Q

what are intraduct papillomas

A

benign breast lesions

47
Q

how are intraduct papillomas broadly classified

A

central or peripheral

48
Q

where are peripheral intraduct papillomas found

A

terminal duct lobular unit.

49
Q

what are potential complications of intraduct papillomas

A

if they are big enough they may block the ducts and causes cysts

50
Q

what is ductal carcinoma in situ

A

breast carcinoma limited to the ducts with no extension beyond the basement membrane
» cancer has not infiltrated the parenchyma of the breast + lymphatics
» cannot metastasise

51
Q

if there is no epithelial proliferation with Intraduct papilloma
 what is the Dx

A

Benign IDP

52
Q

if there is usual type hyperplasia of the epithelium with Intraduct papilloma
 what is the Dx

A

Benign IDP

53
Q

if there is atypical ductal hyperplasia of the epithelium with Intraduct papilloma
 what is the Dx

A

IDP with Atypical ductal hyperplasia

54
Q

what carcinomas often metastases to the breast

A

bronchial
ovarian serous carcinoma
clear cell carcinoma of the kidney
melanoma

55
Q

what is the definition of breast carcinoma

A

A malignant tumour of breast epithelial cells

56
Q

where does breast carcinoma arise from

A

glandular epithelium of the terminal duct lobular unit (TDLU)

57
Q

what are the 2 types of breast carcinomas

A

ductal carcinoma

lobular carcinoma

58
Q

what is the precursors of ductal carcinoma

A

Epithelial hyperplasia of usual type (lowest i.e. least worrying)

Columnar cell change (some premalignant potential)

Atypical Ductal Hyperplasia

Ductal Carcinoma in situ

59
Q

what is the precursors of lobular carcinoma

A

Atypical lobular hyperplasia

Lobular carcinoma in situ

60
Q

what is meant by in situ carcinoma

A

Confined within basement membrane of acini & ducts

Cytologically malignant but non (pre) - invasive

61
Q

what is the definition of atypical lobular hyperplasia (ALH)

A

<50% of lobule involved

62
Q

what is the definition of lobular carcinoma in situ (LCIS)

A

> 50% of lobule involved

63
Q

what is characteristic of the cells in LCIS

A

ER positive

64
Q

features of LCIS

A

Incidence decreases after menopause (because it is ER positive)

May calcify = can be seen mammogram

65
Q

Mx of a lobular carcinoma precursor

A

if discovered on core biopsy proceed to excision or vacuum biopsy to exclude higher grade lesion

66
Q

which intraductal precursor has the highest risk of progressing to cancer

A

highest risk

  1. Ductal Carcinoma in situ
  2. Atypical ductal hyperplasia
  3. Epithelial hyperplasia of usual type
67
Q

what are features of ductal carcinoma in situ

A 
Arises in TDLU 
Characteristically unicentric (single duct system)
68
Q

what is DCIS called when it invades the nipple skin

A

Paget’s disease

69
Q

what is Paget’s Disease of the nipple

A

High grade DCIS extending along ducts to reach the epidermis of the nipple

Still in situ carcinoma (ie non-invasive)

70
Q

Mx of DCIS

A

surgery + radiotherapy

71
Q

what its the definition of invasive carcinoma

A

Malignant epithelial cells which have breached the BM

Infiltration of normal tissues

72
Q

what factors affect prognosis of breast cancer

A

ER
- absence of receptors carries adverse prognosis

HER2
- absence of over expression carries adverse prognosis

73
Q

what Tx should be given if the tumour expresses HER 2

A

trastuzumab

74
Q

what is HER 2 and how does it related to breast cancer

A

Human Epidermal growth factor Receptor 2

overexpression and amplification seen in ~15%

75
Q

what other hormone receptors are almost all tumours that are ER positive are also seen

A

Progesterone Receptors (PgR)

Reproduction SB (30 decks)

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