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MD2 Ambulatory Care and Emergency Medicine > Breast Pathology > Flashcards

Breast Pathology Flashcards

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1
Q

What proportion of breast cancers are diagnosed over the age of 50?

A

75%

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2
Q

What are the risk factors for breast cancer?

A

Increasing age
1st degree relative with breast cancer
Genetic susceptibility: BRAC1 and BRAC2

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3
Q

What is a spiculate mass?

A

Small septae radiating outwards from mass

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4
Q

What mammogram findings are suspicious for carcinoma?

A

Hypoechoic
Taller than wide
Acoustic shadow
Christmas tree appearance

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5
Q

What is the advantage of a core biopsy over a fine needle aspirate in diagnosing breast lesions?

A

FNA can’t give diagnosis of invasive carcinoma vs in situ carcinoma because no tissue architecture

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6
Q

When is a sentinel node biopsy considered?

A

When there’s no suspicion of metastatic infiltration of lymph nodes

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7
Q

Why are breast lesions hookwire localised?

A

To help surgeon find and excise lesion

Reorient lesion for examination

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8
Q

What are the complications of full lymph node clearance?

A

Lymphoedema
Pain
Loss of function

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9
Q

How is the sentinel node localised in a sentinel node biopsy?

A

Radioactive tracer and blue dye

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10
Q

What happens if a sentinel node biopsy is positive for malignancy?

A

Consideration for axillary dissection

- Depends on number and size of metastases

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11
Q

What happens if a sentinel node biopsy is negative for malignancy?

A

No further node dissection

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12
Q

What are the prognostic factors for invasive carcinoma of the breast?

A 
Tumour size
Histological type
Histological grade
Margins of excision
Lymphovascular space invasion
Lymph node involvement
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13
Q

What are the predictive factors for invasive carcinoma of the breast?

A

Hormone receptor status
- ER
- PR
HER2 status

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14
Q

What are the two main histological types of breast carcinoma?

A 
Ductal = 80%
Lobular = 10%
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15
Q

What other histological types of breast carcinoma have a better prognosis?

A

Tubular
Cribriform
Mucinous

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16
Q

What other histological types of breast carcinoma have a worse prognosis?

A

Basal

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17
Q

What are the histological grades for breast carcinoma?

A

Grade 1 = low grade
Grade 2 = intermediate grade
Grade 3 = high grade

18
Q

What is histological grade for breast carcinoma based on?

A

Tubule differentiation
Nuclear morphology
Mitotic rate

19
Q

What does distance of malignancy from the margins influence?

A

Whether further surgery needed

If close, may receive adjuvant therapy

20
Q

Why is lymphovasscular space invasion important?

A

Likelihood of nodal metastases

Higher risk of local recurrence

21
Q

What sort of information is included when assessing lymph node involvement?

A

How many nodes

Extranodal spread into adjacent fatty tissue

22
Q

What does lymph node involvement influence?

A

Decision to use adjuvant therapy

23
Q

In which tumours is hormone receptor status more likely to be positive?

A

Lower grade tumours

24
Q

What therapies are available if breast carcinomas are positive for hormone receptors?

A

Tamoxifen
Aromatase inhibitors
Ovarian ablation in pre-menopausal women

25
Q

In which tumours is HER2 status more likely to be positive?

A

High grade tumours

26
Q

What therapies are available if breast carcinomas are positive for HER2 overexpression?

A

Herceptin = trastuzumab

27
Q

In which ways can HER2 overexpression be shown?

A

Immunohistochemistry
In situ hybridisation
- Fluorescent = FISH
- Silver = SISH

28
Q

In mammography, which features are suspicious for ductal cell carcinoma in situ?

A

Malignant appearing calcifications = branching

29
Q

What are some features seen histologically in low grade ductal cell carcinoma in situ?

A

Punched out cribriform

Small, regular nuclei

30
Q

What are some features seen histologically in high grade ductal cell carcinoma in situ?

A

Large, irregular nuclei

Central necrosis

31
Q

What is the treatment for ductal carcinoma in situ?

A 
Wide local excision
If extensive > mastectomy
No lymph node dissection needed
Post-operative radiation therapy
No adjuvant hormonal/chemotherapy
32
Q

What is Paget’s disease of the nipple?

A

Infiltration of breast carcinoma into epidermis of nipple

33
Q

What are mimics of breast cancer clinically and in mammography?

A

Most common
- Fat necrosis
- Radial scar
Diabetic mastopathy

34
Q

What does diabetic mastopathy look like histologically?

A

Extensive fibrosis

Lymphocytic infiltrate

35
Q

What is the clinical presentation of fat necrosis in the breast?

A

Hard lump

History of trauma; eg: seat belt injury

36
Q

What is the clinical presentation of fibrocystic disease?

A

Lumpy breasts

Painful

37
Q

What is the appearance of fibrocystic disease on ultrasound?

A

Hypoechoic lesion

Well defined margin

38
Q

What is the clinical presentation of fibroadenoma?

A

Younger women
Breast mouse = mobile lump
May be multiple

39
Q

What is the appearance of a fibroadenoma on ultrasound?

A

Well circumscribed

Hypoechoic

40
Q

Does fibroadenoma need surgical excision?

A

Not if has no atypia on FNA/core biopsy

41
Q

What is the clinical presentation of intraduct papillary lesion?

A

Nipple discharge
- May be blood stained
Lump if large

42
Q

What is the appearance of intraduct papillary lesion on imaging?

A

Microcalcification on mammography

Dilated duct with intraductal mass on ultrasound

MD2 Ambulatory Care and Emergency Medicine (29 decks)

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