Breast Pathology Flashcards
How is breast cytology/biopsy classified?
C1/B1 = unsatisfactory C2/B2 = benign C3/B3 = Atypical probably bening C4/B4 =suspicious of malignancy C5 = Malignant B5a = carcinoma in situ B5b = invasive carcinoma
What are the causes of gynaecomastia?
Hormones
Cannabis
Drugs (spironolactone)
Liver disease
What age group does fibrocystic change in the breast tend to present?
Majority 40-50 but can be any age 20-50
How does fibrocystic change in the breast tend to present?
Smooth discrete lumps
Sudden pain
Cyclical pain
Describe a fibrocystic change cyst
Blue domed cyst filled with fluid lined by apocrine epithelium
What is a breast hamartoma?
Circumscribed lesion of normal breast cells but in abnormal proportion or distribution
When is the peak incidence of fibroadenomas?
In 30’s (& in black women)
How does a breast fibroadenoma present?
“Breast mouse”
Painless, firm, rubbery, mobile mass
How does sclerosing adenossi present on the breast?
Pain
Tenderness or lumpiness/thickening
What is a radial scar composed of?
Fibroelastic core with fibrocstic change
How does fat necrosis end to present?
History of previous trauma
What are “foamy macrophages present in?
Fat necrosis
How does duct ectasia present?
Affects subareolar ducts Pain Blood and/or purulent discharge Nipple retraction & distortion Acute episodic inflammation Periductal inflammation/fibrosis
What is duct ectasia associated with?
Smoking
How is mastitis treated in pregnancy?
Symptomatic relief (NSAIDs or warm compresses) If no improvement in 12-24 hours = Flucloxacillin (4 days)
Treatment of isolated nipple fissure with discharge?
Topical fusidic acid (if spread use same antibiotics as mastitis)
What is the treatment for thrush on the nipple in a breast feeding woman?
Miconadazole cream
How does phyllodes tumour present?
40-50 y/o with slow growing unilateral breast mass
Prone to local recurrence
How does intraduct papilloma present?
Age 35-60
Nipple discharge +/- blood
In subareolar ducts
What organism usually causes of lactation breast abscess?
Staph aureus
When might apatient get a angiosarcomaof the breast?
Post XRT
What are the features of DCIS?
Columnar cell change
Atypical ductal hyperplasia
How is an in-situ carcinoma defined?
Confined within basement membrane of acini& ducts
How is atypical lobular hyperplasia (ALH) differentiated from LCIS?
ALH = <50% oflobuleinvolved LCIS = >50% of lobule involved
What are the characteristics of LCIS?
Small-immediate sized nuclei
Not palpable/visible
Solid proliferation intracytoplasmic lumens/vacuoles
How is LCIS investigated?
ER positive
E-caherin negative
How should LCIS be managed?
Excise!!!
Where does DCIS arise?
Terminal duct lobular unit (characterstically unicentric_
What is the termfor DCIS involving the nipple?
Paget’s
How is DCIS managed?
Surgery + adjuvant radioto whole breast
What is microinvasive carcinomaofthebreast?
are
DCIS (high grade) with invasion of <1mm
What are the risk factors for invasive breast cancer?
Age Repro history (nulliparity, first child >30y/o) Hormones Lifestyle Genetics (BRCA, TP53, PTEN)
Which lymph nodes does the breast drain to?
Internal mammary
Supraclavicular
Aillary
How is invasive breast crcinoma classified?
Ductal = 70% Lobular = 10%
How are invasive breast carcinomas graded?
Tubular differentiation (1-3) Nucleur pleomorphism (1-3) Mitotic activity (1-3)
Grade I = 3, 4 or 5
Grade II = 6 or 7
Grade III = 8 or 9
How can breast cancers that are ER positive (80%) be treated?
Oophrectomy
Tamoxifen
Letrozole
Zoladex
How can breast cancers that are HER2 positive be treated?
Trastuzamab (Herceptin)
What tools are used to determine prognosis in breast cancer?
Nottingham prognostic index
Adjuvant
How is breast cancer treated?
Surgery + radio
How is the amount of radiotherapy determined for breast cancer?
Breast alone if negative SNB
Tumour bed if < 54 y/o
When is neoadjuvant chemo more effective?
When cancer is grade 3
In what symptoms is breast imaging not indicated?
Pain
Tenderness
Symmetrcal nodularity
How are masses in the breastimaged?
US <40 y/o
XRM +/- US if >40 y/o
What shape should lymph nodes be on a normalmammogram?
Oval/horseshoe
What are the 2 best single views on a mammogram?
Mediolateral oblique then craniocaudal
What should be used if unsure about images having tried mediolateral oblique & craniocaudal?
Paddle (localised compression) view
What form do malignant calcifications take on a mammogram?
Rhomboid forms
Individual linear branching
Y shaped forms
Benign = "wider than tall" Malignant = "taller than wide"
What is the first line imaging for women with implants?
US
What investigation is used for monitoring response to chemo?
US
