Breast Pathology

Question 1

What is more commonly used in breast pathology - cytology or histopathology?

Answer 1

Histopathology

Question 2

What method is used for breast cytology?

Answer 2

Fine needle aspiration

Question 3

Give some methods that can be used in breast histopathology

Answer 3

Needle core biopsy
Vacuum-assisted biopsy
Skin biopsy
Incisional biopsy

Question 4

What is the main difference between needle core biopsy and FNA biopsy staging?

Answer 4

Can tell if cancer is in-situ or invasive in needle core biopsy

Question 5

How may fibrocystic breast disease present?

Answer 5

Smooth discrete lumps

Pain

Question 6

What pathology occurs in fibrocystic breast disease?

Answer 6

Multiple cysts (lined by apocrine epithelium) form with intervening fibrosis

Question 7

What is a hamartoma?

Answer 7

A lesion of the breast composed of normal cell types present in an abnormal proportion/distribution

Question 8

How do fibroadenomas present?

Answer 8

Painless firm discrete mobile mass

Question 9

What is the best imaging modality for fibroadenomas?

Answer 9

USS

Question 10

What pathology occurs in fibroadenoma?

Answer 10

Hyperplasia of glandular epithelium with proliferation of the intralobular stroma

Question 11

What is the most common age group for fibroadenomas?

Answer 11

20-30

Question 12

What pathology occurs in sclerosing lesions of the breast?

Answer 12

Benign disorderly proliferation of acini and stroma

Question 13

What are the main sclerosing lesions of the breast?

Answer 13

Sclerosing adenosis

Radial scar

Question 14

How are radial scars treated?

Answer 14

Excision or vacuum biopsy sample

Question 15

What are the main causes of breast fat necrosis?

Answer 15

Local trauma (seat belt injury)
Warfarin therapy

Question 16

What occurs in fat necrosis?

Answer 16

Damage and disruption of adipocytes causing infiltration by inflammatory cells

Question 17

How does duct ectasia present?

Answer 17

Pain
Bloody/purulent discharge
Fistulation

Question 18

Duct ectasia is associated with which group of women?

Answer 18

Smokers

Question 19

What occurs in duct ectasia?

Answer 19

Lactiferous duct becomes blocked leading to periductal inflammation and fibrosis

Question 20

What are the two main causes of acute mastitis?

Answer 20

Duct ectasia

Lactation

Question 21

How is acute mastitis managed?

Answer 21

Antibiotics

Percutaneous drainage

Question 22

What pathology occurs in Phyllodes tumour?

Answer 22

There is overgrowth of the periductal stromal cells

Question 23

What are the main benign papillary lesions?

Answer 23

Intraductal papilloma

Nipple adenoma

Question 24

How does intraductal papilloma commonly present?

Answer 24

Nipple discharge +/- blood

Question 25

How are intraductal papillary lesions graded?

Answer 25

Level of epithelial proliferation

Question 26

Breast carcinoma arises where?

Answer 26

Glandular epithelium of TDLU

Question 27

What are the two main precursor lesions of breast cancer?

Answer 27

Ductal | Lobular

Question 28

An in-situ breast carcinoma is confined within what?

Answer 28

Basement membrane of acini and ducts

Question 29

What is neoplasm of <50% of the lobule called?

Answer 29

Atypical lobular hyperplasia

Question 30

What is neoplasm of >50% of the lobule called?

Answer 30

Lobular carcinoma in-situ

Question 31

Why is lobular in-situ neoplasia significant?

Answer 31

As it increases relative risk of invasive carcinoma eightfold

Question 32

What types of intraductal proliferation can occur?

Answer 32

Columnar cell change Atypical ductal hyperplasia Ductal carcinoma in-situ

Question 33

What occurs in ductal carcinoma in-situ?

Answer 33

Cytologically malignant epithelial cells are confined within the basement membrane of the duct

Question 34

What occurs in Paget's disease of the nipple?

Answer 34

A high grade DCIS extends along ducts to reach the epidermis of the nipple

Question 35

What occurs in microinvasive carcinoma?

Answer 35

DCIS with invasion of <1mm

Question 36

What occurs in invasive breast carcinoma?

Answer 36

Malignant epithelial cells have breached the basement membrane

Question 37

Give some gene mutations that can predispose to breast cancer

Answer 37

BRCA1/2 TP53 PTEN

Question 38

Breast carcinomas are graded under which three parameters?

Answer 38

Tubular differentiation Nuclear pleomorphism Mitotic activity

Question 39

Invasive breast cancer can express which hormone receptors?

Answer 39

Oestrogen receptors Progesterone receptors HER2

Question 40

What is the clinical significance of oestrogen receptor expression?

Answer 40

As it predicts response to anti-oestrogen therapy

Question 41

What is the clinical significance of HER2 expression?

Answer 41

Predicts repsonse to trastuzamab (herceptin)

Question 42

How is breast cancer staged?

Answer 42

T - invasion of adjacent tissues N - lymphatic spread M - blood-borne spread