Breast pathology

Question 1

what is the functional unit of the breast?

Answer 1

The terminal duct lobular unit

Question 2

What Is the breast lobule composed of?

Answer 2

multiple acini glands

Question 3

In the breast what is the entire duct and lobular system lined by?

Answer 3

epithelium surrounded by a basement membrane.

Question 4

How do you assess ANY breast lump?

Answer 4

Using the triple assessment

Question 5

In a young woman what is a breast lump likely to be?

Answer 5

a Fibroadenoma or fibrocystic change

Question 6

what is the triple assement?

Answer 6

1. clinical; history and exam
2. radiological; US or mammogram
3. pathological: FNA or core biopsy

Question 7

what is the difference between a mammogram and USS?

Answer 7

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

Question 8

When reporting needle tests what is the prefix before FNA and core biopsy results?

Answer 8

Before the core biopsy result is a B

before a FNA cytology is a C

Question 9

If a lump is reported as C2/B2 what does this mean?

Answer 9

its benign

Question 10

what could a benign lump of the breast be?

Answer 10

A fibroadenoma or fibrocystic change

Question 11

If a lump is reported as C5/B5 what could it be?

Answer 11

Malignant

DCIS

Question 12

what is the most common benign breast tumour?

Answer 12

A fibroadenoma

Question 13

How does a fibroadenoma normally present?

Answer 13

• firm
• mobile
• painless

Question 14

what age group are fibrocystic changes often seen in?

Answer 14

25-45

Question 15

how do fibrocystic changes normally present?

Answer 15

breast pain, tenderness, lumps.

especially during 2nd half of cycle

Question 16

what are the major risk factors for breast cancer?

Answer 16

• increasing lifetime oestogren exposure
• family history
• alcohol

Question 17

Increasing oestrogen is a risk factor for breast cancer, what can cause this?

Answer 17

• gender of female
• age
• obesity
• early menarchy and late menopause
  HRT

Question 18

why does obesity lead to increase breast cancer risk?

Answer 18

it leads to higher oestrogen elvels because of peripheral aromatisation of androgens to oestrogen in adipose tissue.

Question 19

in what region do most breast cancers exist?

Answer 19

upper outer quadrant of the breast

Question 20

what features on clinical exam make you suspect malignant?

Answer 20

A hard painless lump
nipple inversion or skin dumpling
Ulceration and fungation
Peau d'orange
Nipple eczema
- palpable axillary nodes

Question 21

what causes peau d’orange?

Answer 21

Blocking of the lymphatic system means oedema.

Question 22

what is most common type of breast cancer?

Answer 22

Invasive adenocarcinoma

Question 23

What are the two most common specific types of breast cancer?

Answer 23

ductal carcinoma- 3/4

lobular carcinoma- 1/4

Question 24

what is ductal carcinoma in situ?

Answer 24

the epithelial cells show cytological changes of malignancy but haven’t invaded the basement membrane
- considered pre-cancer

Question 25

what is invasive ductal carcinoma?

Answer 25

tumour cells that have invaded through the basement memrbane

Question 26

Why is invasive ductal carcinoma considered cancer?

Answer 26

Because the two defining criteria for cancer is ability to invade and metastasise. This has broken to basement membrane so can do those things.

Question 27

why is ductal carcinoma in situ often detected on mammography?

Answer 27

because it is often associated with microcalcifications

Question 28

why are ductal carcinoma in situ normally found?

Answer 28

On just one area of the breast

Question 29

what is pagets disease due to?

Answer 29

Ductal carcinoma in situ cells being in the epidermis

Question 30

what is seen in pagets disease?

Answer 30

an eczema clinical appearance of the nipple

Question 31

how does invasive lobular carcinoma appear microscopically?

Answer 31

tumour cells infiltrating normal breast tissue in a single file pattern

Question 32

what does the growth pattern in invasive lobular carcinoma reflex?

Answer 32

the loss of function of the e-cadherin catenin cell adhesion

Question 33

in breast prognosis what is especially important?

Answer 33

The lymph node status as part of staging.

Question 34

How does ER positivity of a tumour affect prognosis?

Answer 34

They tend to be lower grade and less aggressive

also more likely to respond to hormone therapy

Question 35

what is HER 2?

Answer 35

An oncogene that encodes a transmembrane tyrosine kinase receptor

Question 36

how does HER2 over expression change prognosis?

Answer 36

It means a poor prognosis despite a better response to Herceptin.

Question 37

what is the sentinel lymph node?

Answer 37

the first node the cancer will drain into

Question 38

what does it mean if the sentinel node doesn’t contain cancer?

Answer 38

A high likelihood the cancer hasn’t spread. Axillary clearance not needed.

Question 39

If the sentinel node is positive for cancer how does this affect clearance?

Answer 39

auxillary clearance will be needed as there is a risk of spread.

Question 40

what are advantages of the sentinel node technique?

Answer 40

Provides good prognostic information

patients with a negative sentinel node are spared auxillary clearance

Question 41

what are the two techniques for identifying a sentinel lymph node?

Answer 41

Using a dye or isotope and injecting it into the tissue. when inspecting the nodes the sentinel node wouldn’t taken this up.

Question 42

As part of the NHS screening programme who is offered a mammogram/

Answer 42

Women aged 50-70 every 3 years