Breast Pathology Flashcards
Breast Anatomy
15-20 lobes
Each composed of groups of lobules
What is the functional unit of the breast?
TDLU - terminal duct lobular unit
Triple Assessment
Clinical - history and examination
Radiological - mammography (>35y) USS
Pathological - FNA, core biopsy
Pathology reporting categories
C1/B1 - inadequate or not diagnostic C2/B2 - benign C3/B3 - favours benign C4/B4 - favours malignant C5/B5 - malignant
Fibroadenoma
Commonest benign tumour
Typically under the age of 30
Firm, painless, mobile lump - may be multiple
Well circumscribed
Reassurance, dischange, excision
Fibrocystic change
result of minor aberrations in the normal response to cyclical hormonal changes
Typically in women 25-45 years
Changes affect the TDLU - characterised by fibrosis and cyst formation
Breast pain, tenderness, lumps/cysts
Triple assessment
Reassurance, analgesics, cyst aspiration, excision (rare)
Major risk factors for breast cancer
Increasing lifetime oestrogen exposure
Family history
Alcohol consumption
Clinical features of breast cancer
50% in outer quadrant of breast Hard painless lump fixed to wall or overlying skin nipple incursion and skin dimpling ulceration/fungation peau d'orange nipple eczema (Paget's disease) palpable axillary nodes metastatic disease B symptoms
Breast cancer investigations
Triple assessment
Biopsy = grade
Staging needs to be done
Breast cancer pathophysiology
Most are invasive adenocarcinomas
75% are ductal carcinoma
10-15% are lobular carcinoma
Ductal Carcinoma In Situ (DCIS)
epithelial cells showing cytological changes of malignancy
present in the TDLE
basement membrane is in tact - cells have not invaded through
PRE CANCER
Invasive Ductal Carcinoma (IDC)
tumour cells have invaded through the basement membrane into adjacent tissue
CANCER
Paget’s disease of the nipple
due to the presence of DCIS cells in the epidermis which may extend along the major ducts and reach the nipple
the affected skin reacts to their presence and give the characteristic eczematous appearance
biopsy is required for a definite diagnosis
Invasion Lobular Carcinoma (ILC)
second most common type of invasive breast cancer
10-15% of cases
tumour cells infiltrating the normal breast tissues linear cords of cells (single file)
due to loss of E-cadherin-catenin cell adhesion system
What are the other less common types of breast cancer?
Tumular
Cribriform
Mucinous
What are the genetic subdivisions of invasive breast cancers?
Luminal A
Luminal B
HER-2-enriched
Basal-like
Prognostic factors of breast cancer
Tumour stage (TNM) Tumour grade Histological subtype Vascular invasion Excision markings Oestrogen receptor and HER2 status
Oestrogen receptors (ER)
correlates with aggressiveness and predicts response to therapy
ER +ve = lower grade, less aggressive, likely to respond to hormonal therapy
ER -ve = higher grad,e more aggressive, less likely to respond to hormonal therapy
HER2
oncogene that encodes transmembrane tyrosine kinase receptor
over expressed in about 15% of invasive breast cancers
over expression is associated with poorer prognosis, but good response to Herceptin
What is the sentinel lymph node
the first node draining a cancer
if it doesn’t contain cancer then there is a very high likelihood that the cancer has not spread to any other nodes or elsewhere
Advantages of the sentinel node technique
important prognostic information
patients with a negative sentinel node are spared an axillary node clearance
how is the sentinel node identified?
dye/isotope injected into the tissue around the tumour
visually inspect nodes for staining and uses a gamma prove to assess which nodes have taken up the radionuclide
can then be identified and removed
NHS breast screening programme
Identify premalignant or very early stage cancer
All women aged 50-70 (pushing to 47-73) are screened every 3 years
Further assessment following screening
Imaging e.g. ultrasound
clinical examination
needle test, usually core biopsy
