Breast pathology Flashcards
what is the functional unit of the breast?
The terminal duct lobular unit
What Is the breast lobule composed of?
multiple acini glands
In the breast what is the entire duct and lobular system lined by?
epithelium surrounded by a basement membrane.
How do you assess ANY breast lump?
Using the triple assessment
In a young woman what is a breast lump likely to be?
a Fibroadenoma or fibrocystic change
what is the triple assement?
- clinical; history and exam
- radiological; US or mammogram
- pathological: FNA or core biopsy
what is the difference between a mammogram and USS?
Mammograms are normally done in older patients over 35. they identify microcalcifications and density
USS is normally done in patients under 35, good for distinguishing solid and cystic lesions
When reporting needle tests what is the prefix before FNA and core biopsy results?
Before the core biopsy result is a B
before a FNA cytology is a C
If a lump is reported as C2/B2 what does this mean?
its benign
what could a benign lump of the breast be?
A fibroadenoma or fibrocystic change
If a lump is reported as C5/B5 what could it be?
Malignant
DCIS
what is the most common benign breast tumour?
A fibroadenoma
How does a fibroadenoma normally present?
- firm
- mobile
- painless
what age group are fibrocystic changes often seen in?
25-45
how do fibrocystic changes normally present?
breast pain, tenderness, lumps.
especially during 2nd half of cycle
what are the major risk factors for breast cancer?
- increasing lifetime oestogren exposure
- family history
- alcohol
Increasing oestrogen is a risk factor for breast cancer, what can cause this?
- gender of female
- age
- obesity
- early menarchy and late menopause
HRT
why does obesity lead to increase breast cancer risk?
it leads to higher oestrogen elvels because of peripheral aromatisation of androgens to oestrogen in adipose tissue.
in what region do most breast cancers exist?
upper outer quadrant of the breast
what features on clinical exam make you suspect malignant?
A hard painless lump nipple inversion or skin dumpling Ulceration and fungation Peau d'orange Nipple eczema - palpable axillary nodes
what causes peau d’orange?
Blocking of the lymphatic system means oedema.
what is most common type of breast cancer?
Invasive adenocarcinoma
What are the two most common specific types of breast cancer?
ductal carcinoma- 3/4
lobular carcinoma- 1/4
what is ductal carcinoma in situ?
the epithelial cells show cytological changes of malignancy but haven’t invaded the basement membrane
- considered pre-cancer
what is invasive ductal carcinoma?
tumour cells that have invaded through the basement memrbane
Why is invasive ductal carcinoma considered cancer?
Because the two defining criteria for cancer is ability to invade and metastasise. This has broken to basement membrane so can do those things.
why is ductal carcinoma in situ often detected on mammography?
because it is often associated with microcalcifications
why are ductal carcinoma in situ normally found?
On just one area of the breast
what is pagets disease due to?
Ductal carcinoma in situ cells being in the epidermis
what is seen in pagets disease?
an eczema clinical appearance of the nipple
how does invasive lobular carcinoma appear microscopically?
tumour cells infiltrating normal breast tissue in a single file pattern
what does the growth pattern in invasive lobular carcinoma reflex?
the loss of function of the e-cadherin catenin cell adhesion
in breast prognosis what is especially important?
The lymph node status as part of staging.
How does ER positivity of a tumour affect prognosis?
They tend to be lower grade and less aggressive
also more likely to respond to hormone therapy
what is HER 2?
An oncogene that encodes a transmembrane tyrosine kinase receptor
how does HER2 over expression change prognosis?
It means a poor prognosis despite a better response to Herceptin.
what is the sentinel lymph node?
the first node the cancer will drain into
what does it mean if the sentinel node doesn’t contain cancer?
A high likelihood the cancer hasn’t spread. Axillary clearance not needed.
If the sentinel node is positive for cancer how does this affect clearance?
auxillary clearance will be needed as there is a risk of spread.
what are advantages of the sentinel node technique?
Provides good prognostic information
patients with a negative sentinel node are spared auxillary clearance
what are the two techniques for identifying a sentinel lymph node?
Using a dye or isotope and injecting it into the tissue. when inspecting the nodes the sentinel node wouldn’t taken this up.
As part of the NHS screening programme who is offered a mammogram/
Women aged 50-70 every 3 years
