Breast Pathology Flashcards
What proportion of breast cancers are diagnosed over the age of 50?
75%
What are the risk factors for breast cancer?
Increasing age
1st degree relative with breast cancer
Genetic susceptibility: BRAC1 and BRAC2
What is a spiculate mass?
Small septae radiating outwards from mass
What mammogram findings are suspicious for carcinoma?
Hypoechoic
Taller than wide
Acoustic shadow
Christmas tree appearance
What is the advantage of a core biopsy over a fine needle aspirate in diagnosing breast lesions?
FNA can’t give diagnosis of invasive carcinoma vs in situ carcinoma because no tissue architecture
When is a sentinel node biopsy considered?
When there’s no suspicion of metastatic infiltration of lymph nodes
Why are breast lesions hookwire localised?
To help surgeon find and excise lesion
Reorient lesion for examination
What are the complications of full lymph node clearance?
Lymphoedema
Pain
Loss of function
How is the sentinel node localised in a sentinel node biopsy?
Radioactive tracer and blue dye
What happens if a sentinel node biopsy is positive for malignancy?
Consideration for axillary dissection
- Depends on number and size of metastases
What happens if a sentinel node biopsy is negative for malignancy?
No further node dissection
What are the prognostic factors for invasive carcinoma of the breast?
Tumour size Histological type Histological grade Margins of excision Lymphovascular space invasion Lymph node involvement
What are the predictive factors for invasive carcinoma of the breast?
Hormone receptor status
- ER
- PR
HER2 status
What are the two main histological types of breast carcinoma?
Ductal = 80% Lobular = 10%
What other histological types of breast carcinoma have a better prognosis?
Tubular
Cribriform
Mucinous
What other histological types of breast carcinoma have a worse prognosis?
Basal
What are the histological grades for breast carcinoma?
Grade 1 = low grade
Grade 2 = intermediate grade
Grade 3 = high grade
What is histological grade for breast carcinoma based on?
Tubule differentiation
Nuclear morphology
Mitotic rate
What does distance of malignancy from the margins influence?
Whether further surgery needed
If close, may receive adjuvant therapy
Why is lymphovasscular space invasion important?
Likelihood of nodal metastases
Higher risk of local recurrence
What sort of information is included when assessing lymph node involvement?
How many nodes
Extranodal spread into adjacent fatty tissue
What does lymph node involvement influence?
Decision to use adjuvant therapy
In which tumours is hormone receptor status more likely to be positive?
Lower grade tumours
What therapies are available if breast carcinomas are positive for hormone receptors?
Tamoxifen
Aromatase inhibitors
Ovarian ablation in pre-menopausal women
In which tumours is HER2 status more likely to be positive?
High grade tumours
What therapies are available if breast carcinomas are positive for HER2 overexpression?
Herceptin = trastuzumab
In which ways can HER2 overexpression be shown?
Immunohistochemistry
In situ hybridisation
- Fluorescent = FISH
- Silver = SISH
In mammography, which features are suspicious for ductal cell carcinoma in situ?
Malignant appearing calcifications = branching
What are some features seen histologically in low grade ductal cell carcinoma in situ?
Punched out cribriform
Small, regular nuclei
What are some features seen histologically in high grade ductal cell carcinoma in situ?
Large, irregular nuclei
Central necrosis
What is the treatment for ductal carcinoma in situ?
Wide local excision If extensive > mastectomy No lymph node dissection needed Post-operative radiation therapy No adjuvant hormonal/chemotherapy
What is Paget’s disease of the nipple?
Infiltration of breast carcinoma into epidermis of nipple
What are mimics of breast cancer clinically and in mammography?
Most common
- Fat necrosis
- Radial scar
Diabetic mastopathy
What does diabetic mastopathy look like histologically?
Extensive fibrosis
Lymphocytic infiltrate
What is the clinical presentation of fat necrosis in the breast?
Hard lump
History of trauma; eg: seat belt injury
What is the clinical presentation of fibrocystic disease?
Lumpy breasts
Painful
What is the appearance of fibrocystic disease on ultrasound?
Hypoechoic lesion
Well defined margin
What is the clinical presentation of fibroadenoma?
Younger women
Breast mouse = mobile lump
May be multiple
What is the appearance of a fibroadenoma on ultrasound?
Well circumscribed
Hypoechoic
Does fibroadenoma need surgical excision?
Not if has no atypia on FNA/core biopsy
What is the clinical presentation of intraduct papillary lesion?
Nipple discharge
- May be blood stained
Lump if large
What is the appearance of intraduct papillary lesion on imaging?
Microcalcification on mammography
Dilated duct with intraductal mass on ultrasound
