Breast Pathology Flashcards
List the three steps to assessment of a patient with breast pathology
Clinical - history, exam
Imaging - mammography, US, MRI
Pathology - cytopathology, histopathology
List the different methods of obtaining breast cytopathology specimens
Fine needle aspiration
Fluid
Nipple discharge
Nipple scrape
Outline the grading method used for FNA
C1: Unsatisfactory C2: Benign C3: Atypia C4: Suspicious C5: Malignant
List the different methods of obtaining breast histopathology specimens
Needle core biopsy
Vacuum-assisted biopsy
Skin biopsy
Incisional biopsy of mass
Outline the grading method used for needle core biopsy
B1: Unsatisfactory B2: Benign B3: Atypia B4: Suspicious B5: Malignant a. CISU b. Invasive
What types of therapeutic excision can be done for breast pathology?
Excisional biopsy of mass
Wide local excision of cancer
Mastectomy
List the main categories of benign breast disease
Developmental anomalies
Non-neoplastic
Inflammatory
Tumours
List aetiology of developmental anomaly causing benign breast disease
Hypoplasia
Juvenile hypetrophy
Accessory breast tissue
Accessory nipple
List non-neoplastic causes of benign breast disease
Gynaecomastia Fibrocystic change Hamartoma Fibroadenoma Sclerosing lesions
List inflammatory causes of benign breast disease
Fat necrosis
Duct ectasia
Acute mastitis/ abscess
List benign tumours causing breast disease
Phyllodes tumour
Intraduct papilloma
What is gynaecomastia?
Breast development in the male with ductal growth without lobular development
List some causes of gynaecomastia
Exogenous/endogenous hormones
Cannabis
Drugs (furosemide)
Liver disease
Fibrocystic change is non-neoplastic and typically affects women of what ages?
Aged 20-50, majority are 40-50
List the clinical features of fibrocystic change of the breasts
Menstrual disturbance
Smooth, discrete lump
Sudden/cyclical pain
Fibrocystic change of the breasts is associated with late menarche and late menopause. True/False?
False
Early menarche, late menopause
Describe the pathological appearance of fibrocystic change of the breasts
Blue-domed cysts with pale fluid
Thin-walled but may be fibrous
How is fibrocystic change managed?
Reassurance
Excision if necessary/symptomatic
What is a hamartoma?
Circumscribed lesion consisting of normal breast tissue but present in abnormal proportion or distribution
A fibroadenoma is a common benign lesion of the breasts - list some clinical features
Painless
Discrete, mobile mass
Peak incidence in 30’s
Describe the pathological appearance of fibroadenoma of the breasts
Circumscribed, solid
Rubbery
Grey-white colour
Biphasic - consists of epithelium and stroma
How is fibroadenoma of the breasts managed?
Reassurance
Excision if necessary
What is sclerosing adenosis?
Benign, disordered proliferation of acini and stroma that can cause a mass (lumpiness, thickening) or calcification
Describe the pathological appearance of a radial scar
Stellate architecture
Central puckering
Radiating fibrosis
Distorted ductiles
Sclerosing adenosis and radial scars may mimic carcinoma. True/False?
True
How is radial scar of the breast managed?
Excise
Sample excessively using vacuum biopsy
List some common causes of fat necrosis of the breasts
Local trauma (seatbelt injury) Warfarin tehrapy
What is the characteristic pathological sign of fat necrosis?
Foamy macrophages
What is duct ectasia of the breast?
Lactiferous duct becomes blocked/clogged
List clinical features of duct ectasia
Pain
Bloody/purulent discharge
Fistulation
Nipple retraction/distortion
How is duct ectasia managed?
Treat acute infection
Exclude malignancy
Stop smoking
Excise ducts
What are the 2 main aetiologies that cause acute mastitis?
Duct ectasia Lactatory infection (Staph aureus, Step pyogenes)
How is acute mastitis managed?
Antibiotics
Percutaneous drainage
Incision and drainage
Treat cause
What is a Phyllodes tumour?
Slow-growing unilateral benign breast mass
What is the characteristic pathological sign of Phyllodes tumour?
Stromal invasion
List types of papillary lesions causing benign breast disease
Intraduct papilloma
Nipple adenoma
Encapsulated papillary carcinoma
List clinical features of intraduct papilloma
Nipple discharge
Bleeding
Asymptomatic/ detected at screening
Which malignant breast cancer typically occurs following radiation for a previous breast cancer?
Angiosarcoma
List the main metastatic tumours to the breast
Bronchial carcinoma Ovarian serous carcinoma Clear cell carcinoma of kidney Malignant melanoma Leiomyosarcoma
Where does breast carcinoma arise?
Glandular epithelium of terminal duct lobular unit (TDLU)
What type of carcinoma is breast carcinoma?
Adenocarcinoma
List the precursor lesions that can give rise to breast carcinoma
Epithelial hyperplasia Columnar cell hyperplasia Atypical ductal hyperplasia Ductal carcinoma in situ Lobular in situ neoplasia
How is in situ carcinoma of the breast defined?
Confined to basement membrane of acini and ducts, i.e. non/pre -invasive
What are the 2 subtypes of lobular in situ neoplasia and how are they defined?
Atypical lobular hyperplasia (less than 50% of lobule affected)
Lobular carcinoma in situ (more than 50% of lobule affected)
List pathological features of lobular in situ neoplasia
Small-intermediate sized nuclei
Solid proliferation
Intracytoplasmic vacuoles
How is lobular in situ neoplasia managed?
Core biopsy of lymph nodes
Excision/vacuum biopsy to exclude high grade lesion
Lobular in situ neoplasia is palpable. True/False?
False
Not palpable or grossly visible
Which precursor lesion equates to 15-20% of all breast malignancies?
Ductal carcinoma in situ
State the characteristic feature of ductal carcinoma in situ
Unicentric (single duct system)
Which disease is essentially high-grade ductal carcinoma in situ involving the nipple skin?
Paget’s disease
How is ductal carcinoma in situ managed?
Surgery
Adjuvant radiotherapy
Chemoprevention
How is invasive carcinoma of the breast defined?
Malignant epithelial cells which have breached the basement membrane
What is the peak age range of incidence of breast carcinoma?
50-70’s
List risk factors for breast carcinoma
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
NSAIDs lower the risk of breast carcinoma. True/False?
True
What aspect of lifestyle is a protective factor against breast carcinoma?
Physical activity
An affected first-degree relative increases the risk of breast cancer by how much?
Doubles the risk
What two cancer syndrome equates to a 45-64% lifetime risk of developing breast cancer?
BRCA1
BRCA 2
TNM is the staging method used for breast carcinoma. What are the common sites of local invasion (T)?
Stroma of breast
Skin
Muscles of chest wall
TNM is the staging method used for breast carcinoma. What are the common sites of lymphatic spread (N)?
Internal mammary nodes
Intramammary nodes
Sentinel nodes
TNM is the staging method used for breast carcinoma. What are the common sites of blood-borne spread (M)?
Bone Liver Brain Lungs Abdominal viscera Femal genital tract
State the two main classifications of breast carcinoma and give their prevalence
Ductal (70%)
Lobular (10%)
List the pathological features that are assessed when grading a breast carcinoma
Tubular differentiation
Nuclear pleomorphism
Mitotic activity
What 2 factors/receptors help predict and offer prognosis for breast carcinoma?
HER2
Oestrogen receptor (ER)
(Progesterone receptor)
If a patient shows overexpression of the ER harmone receptor, how does this affect their management?
Indicates a response to anti-oestrogen therapy
List examples of anti-oestrogen therapies used in breast cancer management
INVASIVE Oophrectomy NON-INVASIVE SERMs (Tamoxifen Aromatase inhibitors (letrozole) GNRH antagonists
List tumour markers that can be used to monitor the response of breast cancer to treatment
CEA
CA15-3
CA125
