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Breast Pathology Flashcards

1
Q

Define gynaecomastia

A

Breast development in the male with ductal growth but no lobular development

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2
Q

Give 4 causes of gynaecomastia

A

Exogenous/endogenous hormones
Liver disease
Medication
Cannabis

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3
Q

List 4 benign developmental abnormalities in the breast

A

Hypoplasia
Juvenile hypertrophy
Accessory breast tissue
Accessory nipple

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4
Q

what age range of women are commonly affected by fibrocystic changes?

A

20-50 y/o

Majority 40-50

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5
Q

What 2 menstrual features are associated with fibrocystic changes

A

Early menarche

Late menopause

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6
Q

Fibrocystic changes resolve after menopause. True or false

A

True

Often is the case, or may diminish in size

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7
Q

Give 4 potential presenting symptoms seen in fibrocystic change

A

Smooth discrete lumps
Sudden pain
Cyclical pain
Lumpiness

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8
Q

On gross pathology, what two things are seen in fibrocystic change?

A

Cysts

Intervening fibrosis

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9
Q

What do fibrocystic cysts typically look like?

A

Blue domed with pale fluid
roughly 1 mm-several cm
Thin walled
Lined with apocrine epithelium

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10
Q

Define metaplasia:

A

The change from one fully differentiated cell type to another fully differentiated cell type

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11
Q

What management options are there for fibrocystic changes

A

Exclude malignancy
Reassure patient
Excise only if necessary

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12
Q

Define Hamartoma:

A

Circumcised lesion composed of cell types which are normal to the breast but present in an abnormal proportion or distribution

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13
Q

What ethnicity are fibroadenoma’s most common in?

A

African women

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14
Q

What % of fibroadenoma’s are solitary lesions?

A

90%

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15
Q

What age range are fibroadenoma’s most common?

A

3rd decade peak incidence

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16
Q

A painless but firm mobile mass which is discrete is a typical presentation of what?

A

Fibroadenoma

Often referred to as “breast mouse”

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17
Q

What is the appearance of a fibroadenoma on USS

A

Solid well circumcised solitary lesion

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18
Q

Management plan for fibroadenoma:

A

Diagnose, exclude malignancy
Reassure
Rarely excise unless absolutely necessary

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19
Q

What option is there for excision when a fibroadenoma is <2cm

A

Vacuum biopsy

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20
Q

Define sclerosing adenosis

A

A benign disorderly proliferation of the acini and stroma which may lead to calcification or a mass.
Can mimic carcinomas

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21
Q

Pain and tenderness along with lumpiness/thickening of the breast in an asymptomatic patient of any age range between 20 - 70 is a typical presentation of what?

A

Sclerosing Adenosis

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22
Q

Sclerosing adenosis has malignancy potential? True or False

A

False (for the most part)

there is negligible risk of subsequent carcinoma

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23
Q

What is a radial scar?

A

A form of sclerosing duct hyperplasia

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24
Q

What is the difference between a radial scar and a complex sclerosing lesion (CSL)

A

Radial scar 1-9mm

CSL >10mm

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25
Give three things seen on pathology of radial scar
Stellate architecture Central Puckering Radiating fibrosis
26
"Fibroelastotic core with radiating fibrosis containing distorted ductules Epithelial proliferation and fibrocystic change" would be a common histology report for what?
Radial scar/CSL
27
treatment for radial scars
Excise or extensive sample via vacuum biospy
28
Give three examples of inflammatory lesion causing pathologies
Fat necrosis Duct ectasia Acute mastitis
29
What is a common cause of fat necrosis
Seat belt trauma
30
What medication is thought to cause fat necrosis of the breast
Warfarin therapy
31
What is the mechanism behind fat necrosis
Damage and disruption to the adipocytes leading to the infiltration of inflammatory cells and "foamy" macrophages Leads to fibrosis and scarring
32
List some clinical features of duct ectasia
``` Affecting sub areolar ducts Pain Acute episodic inflammatory changes Bloody/purulent nipple discharge Fistula Nipple distortion/retraction ```
33
What social factor is associated with duct ectasia?
Smoking
34
``` Sub areolar duct dilation Periductal inflammation Periductal fibrosis Scarring and distortion Are all common examination findings of what? ```
Duct ectasia
35
What is the appropriate management for duct ectasia?
Treat any acute infection Exclude malignancy Smoking cessation Excise the ducts if necessary
36
What are the two main aetiologies of mastitis/abscess?
Duct ectasia - mixed organisms and anaerobes Lactation - staph aureus and strep pyogenes
37
List appropriate management for acute mastitis/abscess
Antibiotics (must have metronidazole if duct ectasia) Percutaneous drainage Incision & drainage Treat underlying cause
38
What are the clinical features of a phyllodes tumor
Leaf like Affects roughly 40-50y/o Slow growing unilateral breast mass
39
Stromal overgrowth is common in what benign breast tumor?
Phyllodes tumor
40
Phyllodes tumor is prone to recurrence. True/False
True | Must be adequately excised
41
Phyllodes commonly metastasizes true/false?
False | Very rarely
42
State three benign papillary lesions
Intraduct papilloma Nipple adenoma Encapsulated papillary carcinoma
43
What age range does an intraduct papilloma tend to affect?
35-60
44
What can be seen on screening for an intraduct papilloma
Nodules and calcification
45
Sub areolar ducts ranging from 2-20 mm in diameter with papillary fronds containing a fibrovascular core Covered by myoepithelium and epithelium with potential proliferation" Is a histology report for what breast pathology
Intraduct papilloma
46
What type of tissue is found in a malignant phyllodes tumour?
Sarcomatous stromal soft tissue
47
What cancers commonly metastasize to the breast?
``` Bronchial Ovarian serous carcinoma Kidney clear cell carcinoma Malignant melanoma Leiomyosarcoma ```
48
What is the definition of breast carcinoma?
A malignant tumour of the epithelial cells of the breast
49
Where does a breast carcinoma arise?
Glandular epithelium or the TDLU | terminal duct lobular unit
50
What type of cancer is a breast carcinoma?
An adenocarcinoma | Tends to be referred to as breast cancer
51
What two types of precursor legions are there for breast carcinoma?
Ductal | Lobular
52
List 4 types of ductal precursor lesions
Epithelial hyperplasia Columnar cell change Atypical ductal hyperplasia Ductal carcinoma in situ
53
Define an in situ carcinoma
Confined within the basement membranes of the acini and ducts and non invasive but is cytologically malignant.
54
What two types of in situ carcinomas of the breast are there
Ductal (DCIS) | Lobular (LCIS)
55
What is the difference between atypical lobular hyperplasia (ALH) and Lobular carcinoma in situ (LCIS)?
Atypical Lobular hyperplasia involves <50% of the lobule LCIS involves >50% of the lobule
56
What are Atypical lobular hyperplasia and lobular carcinoma in situ types of?
Different types of lobular in situ neoplasia
57
Define Lobular in situ neoplasia
Intra-lobular proliferation of characteristic cells
58
Lobular in situ neoplasia is ER positive/negative?
ER positive
59
Lobular in situ neoplasia is E-cadherin positive or negative?
E-cadherin negative
60
What gene is affected in lobular in situ neoplasia?
CDH1 gene is deleted/mutated | found on Chromosome 16
61
In lobular in situ neoplasia incidence _______ after menopause
Decreases
62
List some features of lobular in situ carcinoma
Non palpable Frequently multi focal and bilateral May calcify
63
Lobular in situ neoplasia is usually an incidental finding. True/False?
true
64
What is the clinical significance of finding lobular in situ neoplasia?
It is a marker of increased risk of breast cancer | A true precursor lesion
65
What is the standard management for lobular in situ neoplasia?
If discovered on core biopsy: - vacuum or excision Follow up and exclude higher grade lesion/malignancy
66
How much does the risk of invasive carcinoma increase for the following findings? - Epithelial hyperplasia - Atypical ductal hyperplasia - DCIS (low grade)
Epithelial hyperplasia - 2x risk Atypical ductal hyperplasia - 4x risk DCIS 10x risk
67
Is Ductal carcinoma in situ typically focal or multifocal?
Focal | Easier to remove surgically
68
Where does Ductal carcinoma in situ occur?
Terminal ductal lobular unit
69
Does ductal carcinoma in situ typically affect one or multiple duct systems
Single
70
What is the name given when high grade DCIS involves the nipple epidermis?
Paget's Disease
71
Ductal Carcinoma in situ has cytologically _____ ______ cells
Malignant Epithelial
72
What type of classification is used for predicting outcome in DCIS?
Cytological grading only
73
What % of DCIS can progress to invasion (following incisional biopsy only)
up to 75%
74
What is the management plan for DCIS
Surgical removal Adjuvant radiotherapy Chemoprevention (trial period atm)
75
Why is adjuvant radiotherapy given for DCIS
It reduces the risk of recurrence
76
What follow up is required post DCIS surgical removal?
Mammogram follow up
77
Define micro invasive carcinoma
A rare form of high grade DCIS involving early stage invasion less than 1mm.
78
Define invasive breast carcinoma
Malignant (breast) epithelial cells have breached the basement membrane and infiltrated normal tissue There is a high risk of metastasis and death
79
List some risk factors for breast carcinoma
``` Increased age Early menarche Late menopause Nulliparous Hormone Replacement Therapy Hormones - (exo/endo) OCP Geography Previous breast disease ```
80
Give some protective measures for breast carcinomas
``` Breast feeding multiple pregnancies Giving birth to first child when younger Physical Activities (mild correlation between NSAID use and lower risk) ```
81
Why Is early menarche/late menopause considered a risk factor?
The more menstrual cycles you go through the higher your risk. More exposure to high levels of oestrogen
82
Having a BMI >30 increases the risk of breast carcinoma by __ %?
30%
83
Why does an increased BMI increase the risk of breast carcinoma?
Increased levels of oestrogen
84
What two genes are know for having strong correlation with breast cancer?
BRCA 1 BRCA 2 45-64% lifetime risk
85
BRCA 1 and 2 are associated with what % of all breast cancers?
2%
86
How many women will develop breast cancer?
1 in 8
87
What areas do breast carcinomas commonly metastasize to?
``` Bone Liver Brain Lungs Abdominal viscera Female genital tract ```
88
What risk is there when removing lymph nodes during breast surgery
Lymphoedema Therefore we try not to remove all unless necessary
89
What is significant about the lymph drainage of the breast?
Some of it shares a lymph drainage with the upper limb
90
What three headings must you consider when classifying invasive breast cancer?
Morphology Gene expression profiling Hormone receptor expression
91
What is the most common form of breast carcinoma?
Ductal = 70% Then lobular (10%)
92
What are the 3 hormone receptors involved in breast carcinomas?
``` ER = oestrogen PgR = progesterone HER2 = human epidermal growth factor receptor 2 ```
93
What does ER expression predict?
Response to anti-oestrogen therapy ie higher expression = better response to therapy
94
What class of anti cancer medication is effective in HER2 positive disease?
Humanised mouse monoclonal Antibodies | e.g. Trastuzamab

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