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Y3 OBS AND GYNAE > Breast Pathology > Flashcards

Breast Pathology Flashcards

1
Q

List the three steps to assessment of a patient with breast pathology

A

Clinical - history, exam
Imaging - mammography, US, MRI
Pathology - cytopathology, histopathology

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2
Q

List the different methods of obtaining breast cytopathology specimens

A

Fine needle aspiration
Fluid
Nipple discharge
Nipple scrape

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3
Q

Outline the grading method used for FNA

A 
C1: Unsatisfactory
C2: Benign
C3: Atypia
C4: Suspicious 
C5: Malignant
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4
Q

List the different methods of obtaining breast histopathology specimens

A

Needle core biopsy
Vacuum-assisted biopsy
Skin biopsy
Incisional biopsy of mass

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5
Q

Outline the grading method used for needle core biopsy

A 
B1: Unsatisfactory
B2: Benign
B3: Atypia
B4: Suspicious 
B5: Malignant
a. CISU
b. Invasive
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6
Q

What types of therapeutic excision can be done for breast pathology?

A

Excisional biopsy of mass
Wide local excision of cancer
Mastectomy

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7
Q

List the main categories of benign breast disease

A

Developmental anomalies
Non-neoplastic
Inflammatory
Tumours

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8
Q

List aetiology of developmental anomaly causing benign breast disease

A

Hypoplasia
Juvenile hypetrophy
Accessory breast tissue
Accessory nipple

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9
Q

List non-neoplastic causes of benign breast disease

A 
Gynaecomastia
Fibrocystic change
Hamartoma
Fibroadenoma
Sclerosing lesions
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10
Q

List inflammatory causes of benign breast disease

A

Fat necrosis
Duct ectasia
Acute mastitis/ abscess

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11
Q

List benign tumours causing breast disease

A

Phyllodes tumour

Intraduct papilloma

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12
Q

What is gynaecomastia?

A

Breast development in the male with ductal growth without lobular development

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13
Q

List some causes of gynaecomastia

A

Exogenous/endogenous hormones
Cannabis
Drugs (furosemide)
Liver disease

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14
Q

Fibrocystic change is non-neoplastic and typically affects women of what ages?

A

Aged 20-50, majority are 40-50

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15
Q

List the clinical features of fibrocystic change of the breasts

A

Menstrual disturbance
Smooth, discrete lump
Sudden/cyclical pain

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16
Q

Fibrocystic change of the breasts is associated with late menarche and late menopause. True/False?

A

False

Early menarche, late menopause

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17
Q

Describe the pathological appearance of fibrocystic change of the breasts

A

Blue-domed cysts with pale fluid

Thin-walled but may be fibrous

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18
Q

How is fibrocystic change managed?

A

Reassurance

Excision if necessary/symptomatic

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19
Q

What is a hamartoma?

A

Circumscribed lesion consisting of normal breast tissue but present in abnormal proportion or distribution

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20
Q

A fibroadenoma is a common benign lesion of the breasts - list some clinical features

A

Painless
Discrete, mobile mass
Peak incidence in 30’s

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21
Q

Describe the pathological appearance of fibroadenoma of the breasts

A

Circumscribed, solid
Rubbery
Grey-white colour
Biphasic - consists of epithelium and stroma

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22
Q

How is fibroadenoma of the breasts managed?

A

Reassurance

Excision if necessary

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23
Q

What is sclerosing adenosis?

A

Benign, disordered proliferation of acini and stroma that can cause a mass (lumpiness, thickening) or calcification

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24
Q

Describe the pathological appearance of a radial scar

A

Stellate architecture
Central puckering
Radiating fibrosis
Distorted ductiles

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25
Q

Sclerosing adenosis and radial scars may mimic carcinoma. True/False?

A

True

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26
Q

How is radial scar of the breast managed?

A

Excise

Sample excessively using vacuum biopsy

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27
Q

List some common causes of fat necrosis of the breasts

A 
Local trauma (seatbelt injury)
Warfarin tehrapy
28
Q

What is the characteristic pathological sign of fat necrosis?

A

Foamy macrophages

29
Q

What is duct ectasia of the breast?

A

Lactiferous duct becomes blocked/clogged

30
Q

List clinical features of duct ectasia

A

Pain
Bloody/purulent discharge
Fistulation
Nipple retraction/distortion

31
Q

How is duct ectasia managed?

A

Treat acute infection
Exclude malignancy
Stop smoking
Excise ducts

32
Q

What are the 2 main aetiologies that cause acute mastitis?

A 
Duct ectasia
Lactatory infection (Staph aureus, Step pyogenes)
33
Q

How is acute mastitis managed?

A

Antibiotics
Percutaneous drainage
Incision and drainage
Treat cause

34
Q

What is a Phyllodes tumour?

A

Slow-growing unilateral benign breast mass

35
Q

What is the characteristic pathological sign of Phyllodes tumour?

A

Stromal invasion

36
Q

List types of papillary lesions causing benign breast disease

A

Intraduct papilloma
Nipple adenoma
Encapsulated papillary carcinoma

37
Q

List clinical features of intraduct papilloma

A

Nipple discharge
Bleeding
Asymptomatic/ detected at screening

38
Q

Which malignant breast cancer typically occurs following radiation for a previous breast cancer?

A

Angiosarcoma

39
Q

List the main metastatic tumours to the breast

A 
Bronchial carcinoma
Ovarian serous carcinoma
Clear cell carcinoma of kidney
Malignant melanoma
Leiomyosarcoma
40
Q

Where does breast carcinoma arise?

A

Glandular epithelium of terminal duct lobular unit (TDLU)

41
Q

What type of carcinoma is breast carcinoma?

A

Adenocarcinoma

42
Q

List the precursor lesions that can give rise to breast carcinoma

A 
Epithelial hyperplasia
Columnar cell hyperplasia
Atypical ductal hyperplasia
Ductal carcinoma in situ
Lobular in situ neoplasia
43
Q

How is in situ carcinoma of the breast defined?

A

Confined to basement membrane of acini and ducts, i.e. non/pre -invasive

44
Q

What are the 2 subtypes of lobular in situ neoplasia and how are they defined?

A

Atypical lobular hyperplasia (less than 50% of lobule affected)
Lobular carcinoma in situ (more than 50% of lobule affected)

45
Q

List pathological features of lobular in situ neoplasia

A

Small-intermediate sized nuclei
Solid proliferation
Intracytoplasmic vacuoles

46
Q

How is lobular in situ neoplasia managed?

A

Core biopsy of lymph nodes

Excision/vacuum biopsy to exclude high grade lesion

47
Q

Lobular in situ neoplasia is palpable. True/False?

A

False

Not palpable or grossly visible

48
Q

Which precursor lesion equates to 15-20% of all breast malignancies?

A

Ductal carcinoma in situ

49
Q

State the characteristic feature of ductal carcinoma in situ

A

Unicentric (single duct system)

50
Q

Which disease is essentially high-grade ductal carcinoma in situ involving the nipple skin?

A

Paget’s disease

51
Q

How is ductal carcinoma in situ managed?

A

Surgery
Adjuvant radiotherapy
Chemoprevention

52
Q

How is invasive carcinoma of the breast defined?

A

Malignant epithelial cells which have breached the basement membrane

53
Q

What is the peak age range of incidence of breast carcinoma?

A

50-70’s

54
Q

List risk factors for breast carcinoma

A

Age
Abnormal reproductive history (age at menarche/first birth/menopause, parity, breast feeding)
Hormone therapy (OCP, HRT)
Previous breast disease
Poor lifestyle (weight, alcohol, diet, smoking)
Genetics

55
Q

NSAIDs lower the risk of breast carcinoma. True/False?

A

True

56
Q

What aspect of lifestyle is a protective factor against breast carcinoma?

A

Physical activity

57
Q

An affected first-degree relative increases the risk of breast cancer by how much?

A

Doubles the risk

58
Q

What two cancer syndrome equates to a 45-64% lifetime risk of developing breast cancer?

A

BRCA1

BRCA 2

59
Q

TNM is the staging method used for breast carcinoma. What are the common sites of local invasion (T)?

A

Stroma of breast
Skin
Muscles of chest wall

60
Q

TNM is the staging method used for breast carcinoma. What are the common sites of lymphatic spread (N)?

A

Internal mammary nodes
Intramammary nodes
Sentinel nodes

61
Q

TNM is the staging method used for breast carcinoma. What are the common sites of blood-borne spread (M)?

A 
Bone
Liver
Brain
Lungs
Abdominal viscera
Femal genital tract
62
Q

State the two main classifications of breast carcinoma and give their prevalence

A

Ductal (70%)

Lobular (10%)

63
Q

List the pathological features that are assessed when grading a breast carcinoma

A

Tubular differentiation
Nuclear pleomorphism
Mitotic activity

64
Q

What 2 factors/receptors help predict and offer prognosis for breast carcinoma?

A

HER2
Oestrogen receptor (ER)
(Progesterone receptor)

65
Q

If a patient shows overexpression of the ER harmone receptor, how does this affect their management?

A

Indicates a response to anti-oestrogen therapy

66
Q

List examples of anti-oestrogen therapies used in breast cancer management

A 
INVASIVE
Oophrectomy
NON-INVASIVE
SERMs (Tamoxifen
Aromatase inhibitors (letrozole)
GNRH antagonists
67
Q

List tumour markers that can be used to monitor the response of breast cancer to treatment

A

CEA
CA15-3
CA125

Y3 OBS AND GYNAE (44 decks)

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