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AY Reproduction > Breast Pathology > Flashcards

Breast Pathology Flashcards

1
Q

How is breast cytology/biopsy classified?

A 
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
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2
Q

What are the causes of gynaecomastia?

A

Hormones
Cannabis
Drugs (spironolactone)
Liver disease

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3
Q

What age group does fibrocystic change in the breast tend to present?

A

Majority 40-50 but can be any age 20-50

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4
Q

How does fibrocystic change in the breast tend to present?

A

Smooth discrete lumps
Sudden pain
Cyclical pain

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5
Q

Describe a fibrocystic change cyst

A

Blue domed cyst filled with fluid lined by apocrine epithelium

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6
Q

What is a breast hamartoma?

A

Circumscribed lesion of normal breast cells but in abnormal proportion or distribution

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7
Q

When is the peak incidence of fibroadenomas?

A

In 30’s (& in black women)

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8
Q

How does a breast fibroadenoma present?

A

“Breast mouse”

Painless, firm, rubbery, mobile mass

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9
Q

How does sclerosing adenossi present on the breast?

A

Pain

Tenderness or lumpiness/thickening

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10
Q

What is a radial scar composed of?

A

Fibroelastic core with fibrocstic change

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11
Q

How does fat necrosis end to present?

A

History of previous trauma

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12
Q

What are “foamy macrophages present in?

A

Fat necrosis

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13
Q

How does duct ectasia present?

A 
Affects subareolar ducts 
Pain 
Blood and/or purulent discharge 
Nipple retraction & distortion 
Acute episodic inflammation 
Periductal inflammation/fibrosis
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14
Q

What is duct ectasia associated with?

A

Smoking

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15
Q

How is mastitis treated in pregnancy?

A 
Symptomatic relief (NSAIDs or warm compresses)
If no improvement in 12-24 hours = Flucloxacillin (4 days)
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16
Q

Treatment of isolated nipple fissure with discharge?

A

Topical fusidic acid (if spread use same antibiotics as mastitis)

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17
Q

What is the treatment for thrush on the nipple in a breast feeding woman?

A

Miconadazole cream

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18
Q

How does phyllodes tumour present?

A

40-50 y/o with slow growing unilateral breast mass

Prone to local recurrence

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19
Q

How does intraduct papilloma present?

A

Age 35-60
Nipple discharge +/- blood
In subareolar ducts

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20
Q

What organism usually causes of lactation breast abscess?

A

Staph aureus

21
Q

When might apatient get a angiosarcomaof the breast?

A

Post XRT

22
Q

What are the features of DCIS?

A

Columnar cell change

Atypical ductal hyperplasia

23
Q

How is an in-situ carcinoma defined?

A

Confined within basement membrane of acini& ducts

24
Q

How is atypical lobular hyperplasia (ALH) differentiated from LCIS?

A 
ALH = <50% oflobuleinvolved
LCIS = >50% of lobule involved
25
Q

What are the characteristics of LCIS?

A

Small-immediate sized nuclei
Not palpable/visible
Solid proliferation intracytoplasmic lumens/vacuoles

26
Q

How is LCIS investigated?

A

ER positive

E-caherin negative

27
Q

How should LCIS be managed?

A

Excise!!!

28
Q

Where does DCIS arise?

A

Terminal duct lobular unit (characterstically unicentric_

29
Q

What is the termfor DCIS involving the nipple?

A

Paget’s

30
Q

How is DCIS managed?

A

Surgery + adjuvant radioto whole breast

31
Q

What is microinvasive carcinomaofthebreast?

A

are

DCIS (high grade) with invasion of <1mm

32
Q

What are the risk factors for invasive breast cancer?

A 
Age 
Repro history (nulliparity, first child >30y/o)
Hormones 
Lifestyle 
Genetics (BRCA, TP53, PTEN)
33
Q

Which lymph nodes does the breast drain to?

A

Internal mammary
Supraclavicular
Aillary

34
Q

How is invasive breast crcinoma classified?

A 
Ductal = 70%
Lobular = 10%
35
Q

How are invasive breast carcinomas graded?

A 
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

36
Q

How can breast cancers that are ER positive (80%) be treated?

A

Oophrectomy
Tamoxifen
Letrozole
Zoladex

37
Q

How can breast cancers that are HER2 positive be treated?

A

Trastuzamab (Herceptin)

38
Q

What tools are used to determine prognosis in breast cancer?

A

Nottingham prognostic index

Adjuvant

39
Q

How is breast cancer treated?

A

Surgery + radio

40
Q

How is the amount of radiotherapy determined for breast cancer?

A

Breast alone if negative SNB

Tumour bed if < 54 y/o

41
Q

When is neoadjuvant chemo more effective?

A

When cancer is grade 3

42
Q

In what symptoms is breast imaging not indicated?

A

Pain
Tenderness
Symmetrcal nodularity

43
Q

How are masses in the breastimaged?

A

US <40 y/o

XRM +/- US if >40 y/o

44
Q

What shape should lymph nodes be on a normalmammogram?

A

Oval/horseshoe

45
Q

What are the 2 best single views on a mammogram?

A

Mediolateral oblique then craniocaudal

46
Q

What should be used if unsure about images having tried mediolateral oblique & craniocaudal?

A

Paddle (localised compression) view

47
Q

What form do malignant calcifications take on a mammogram?

A

Rhomboid forms
Individual linear branching
Y shaped forms

Benign = "wider than tall"
Malignant = "taller than wide"
48
Q

What is the first line imaging for women with implants?

A

US

49
Q

What investigation is used for monitoring response to chemo?

A

US

AY Reproduction (23 decks)

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