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Year 3 - Repro and Sexual Health > Breast Pathology > Flashcards

Breast Pathology Flashcards

1
Q

What imaging modalities are used for the breasts?

A

Mammogram
Ultrasound
MRI

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2
Q

What are the 5 classifications from fine needle aspiration?

A 
C1 - unsatisfactory 
C2 - benign 
C3 - atypia 
C4 - suspicious 
C5 - malignant
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3
Q

Describe how fine needle aspiration is carried out

A

Orange or blue needle syringe put into the area of interest and aspirated

(Epithelial cells come out easier than stromal cells)

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4
Q

What samples from the breast can be sent for cytopathology?

A

Fluid from cysts
Nipple discharge
Nipple scrape

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5
Q

What histopathological techniques can be used for investigation of breast lumps?

A

Needle core biopsy
Vacuum assisted biopsy
Skin biopsy
Incisional biopsy

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6
Q

What are the classifications given from needle core biopsy?

A 
B1 - Unsatisfactory 
B2 - Benign 
B3 - atypia 
B4 - suspicious 
B5 - malignant 
B5a - carcinoma in situ 
B5b - invasive carcinoma
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7
Q

Which muscle does the blood supply to the breast pass through?

A

Pec major

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8
Q

Give examples of developmental abnormalities of the breast

A

Hypoplasia
Juvenile hypertrophy
Accessory tissue/nipples

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9
Q

Give examples of non-neoplastic benign breast disease

A 
Gynaecomastia
Fibrocystic change
Hamartoma 
Fibroadenoma
Sclerosing lesions - sclerosing adenosis, radial scar, complex sclerosing lesions
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10
Q

What is gynaecomastia?

A

Breast development in the male

Duct growth without lobular development

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11
Q

What can cause gynaecomastia?

A

Hormones
Cannabis
Prescription drugs
Liver disease

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12
Q

Who gets fibrocystic changes in the breast?

A

Women 20-50

But mostly 40-50

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13
Q

What menstrual features are associated with fibrocystic change?

A

Early menarche
Late menopause
Menstrual abnormality

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14
Q

How does fibrocystic change in the breast present?

A

Smooth discrete lumps
Sudden pain due to bleeding or rupture
Cyclical pain
Lumpiness

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15
Q

Describe the cysts found in fibrocystic change in the breasts

A 
1mm - several cm 
Blue domed with pale fluid 
Multiple 
Thin walled
Lined with apocrine epithelium
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16
Q

How is fibrocystic change in the breast managed?

A

Exclude malignancy
Reassure
Can excise if necessary

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17
Q

What is a hamartoma?

A

Well circumscribed lesion composed of cell types normal to breast but present in abnormal proportion or distribution

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18
Q

Who commonly gets fibroadenomas?

A

African women

20s

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19
Q

How does a fibroadenoma present?

A 
Solitary 
Painless
Firm
Mobile
Grey-white colour 
Local hyperplasia 
"Breast mouse"
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20
Q

How does a fibroadenoma appear on ultrasound?

A

Solid

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21
Q

How is a fibroadenoma managed?

A

Reassure

Excise

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22
Q

What is the difference between a radial scar and a complex sclerosing lesion?

A

Size
Radial scar 1-9mm
CSL 10+mm

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23
Q

What is sclerosing adenosis?

A

Proliferative lesion which has become hardened, damaged or distorted

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24
Q

How does a radial scar appear?

A

With central puckering

Translucent, oval lesions in the middle

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25
Q

How does a radial scar/CSL appear histologically?

A

Fibro-elastic core
Radiating fibrosis
Fibrocystic change
Epithelial proliferation

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26
Q

Give examples of inflammatory breast disease

A

Fat necrosis
Duct ectasia
Acute mastitis
Abscess

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27
Q

What causes fat necrosis?

A

Local trauma eg surgery, seatbelt injury

Warfarin therapy

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28
Q

Describe the pathophysiology of fat necrosis

A

Trauma causing damage and disruption of adipocytes
Infiltration by acute inflammatory cells
Foamy macrophages enter
Subsequent fibrosis and scarring

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29
Q

How is fat necrosis managed?

A

Exclude malignancy

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30
Q

What is duct ectasia?

A

Blockage or clogging or one lactiferous duct

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31
Q

How does duct ectasia present?

A 
Inflammation, pain, hot
Fibrosis and scarring
Distortion
Discharge
Nipple retraction/distortion
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32
Q

How is duct ectasia managed?

A

Treat acute infection
Exclude malignancy
Stop smoking
Excise ducts

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33
Q

What is a Phyllode’s tumour?

A

Biphasic, slow-growing, unilateral tumour with stromal overgrowth

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34
Q

What age group most commonly get Phyllode’s tumour?

A

40-50

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35
Q

How may intraduct papilloma present?

A

Nipple discharge and blood

Can be asymptomatic

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36
Q

What age group commonly get intraduct papilloma?

A

35-60

37
Q

Which cell type covers intraduct papilloma?

A

Myoepithelium

38
Q

Describe the core of an intraduct papilloma

A

Fibrous

39
Q

What is the malignant component of a Phyllode’s tumour?

A

Sacromatous stromal component

40
Q

When do women tend to get angiosarcoma of the breast?

A

Post radiotherapy

41
Q

Which malignant tumours can spread to breast?

A 
Bronchial carcinoma
Ovarian serous carcinoma 
Clear cell carcinoma of the kidney 
Malignant melanoma 
Leiomyosarcoma
42
Q

Where does a breast carcinoma arise?

A

Glandular epithelium of the terminal duct unit

43
Q

Give examples of precursor lesions to malignant breast tumour

A 
Ductal -
Epithelial hyperplasia of usual type
Columnar cell change 
Atypical ductal hyperplasia 
Ductal carcinoma in situ

Lobular -
Atypical hyperplasia
Lobular carcinoma in situ

44
Q

Where is an in situ breast carcinoma confined to?

A

Basement membrane of acini and ducts

45
Q

Describe a lobular in situ neoplasia

A

Small - int sized nuclei
Intracytoplasmic lumen and vacuoles
Bilateral and multifocal

46
Q

Which hormonal receptors does a lobular neoplasia in situ have?

A

Oestrogen

47
Q

Which gene is affected in lobular neoplasia in situ and how?

A

Deletion and mutation of CDHI gene on chromosome 16q22.1

48
Q

What is the risk of invasive carcinoma increased by with ductal carcinoma in situ?

A

10x

49
Q

What is the most common breast malignancy?

A

DCIS

50
Q

How is DCIS managed?

A

Excised
Adjuvant radiotherapy
Anti-oestogen

51
Q

What is Paget’s disease of the nipple?

A

High grade DCIS which extends along the ducts to the epidermis of the nipple

52
Q

What is a micro-invasive carcinoma?

A

DCIS of a high grade with invasion of less than 1mm

53
Q

What are protective factors for invasive carcinoma?

A

First child early
Breastfeeding
Exercise

54
Q

Which genes are associated with breast and ovarian cancer?

A

BRCA1 and 2

55
Q

Which gene is associated with Li Fraumeni syndrome?

A

TP53

56
Q

Which tumours are associated with Li Fraumeni syndrome?

A 
Childhood sarcoma 
Brain
Leukaemia 
Adrenocortical carcinoma
Early-onset breast
57
Q

Which tumours are associated with BRCA 1?

A

Breast
Ovarian
Bowel
Prostate

58
Q

Which tumours are associated with BRCA2 gene?

A

Breast (incl male)
Ovarian
Prostate
Pancreatic

59
Q

Which gene is associated with Cowden’s syndrome?

A

PTEN

60
Q

Which tumours are associated with Cowden’s syndrome?

A

Breast
GI
Thyroid

61
Q

Which genes are associated with Peutz-Jeghers syndrome?

A

STK11

LBK1

62
Q

Which tumours are associated with Puetz-Jegher’s syndrome?

A

Breast
GI
Pancreatic
Ovarian

63
Q

Which gene is associated with ataxia telangiectasia?

A

ATM

64
Q

Which tumours are associated with ataxia telangiectasia?

A

Non-Hodgkin lymphoma
Ovarian
Breast

65
Q

What hormone receptors may invasive carcinoma have?

A

Oestrogen
Progesteron
HER2

66
Q

In assessment of an invasive carcinoma, which score makes it Grade 1?

A

3-5

67
Q

In assessment of an invasive carcinoma, which score makes it Grade 2?

A

6-7

68
Q

In assessment of an invasive carcinoma, which score makes it Grade 3?

A

8-9

69
Q

What factors are used in the assessment of an invasive carcinoma?

A

Tubular differentiation
Nuclear pleomorphism
Mitotic activity

70
Q

How can oestrogen receptor positive cancers be manged?

A

Tamoxifen
Aromatase inhibitors (letrozole)
GnRH inhibitors (Goserilin, zoladex)
Oophorectomy

71
Q

What is the role of aromatase in the female?

A

Convert androgen to oestrogen

72
Q

What does HER2 stand for?

A

Human epidermal growth factor receptor 2

73
Q

What prognostic tools are used for breast malignancy?

A

Nottingham Prognostic Index
Adjuvant! Onine
PREDCIT

74
Q

What factors does the Nottingham Prognostic Index take into account?

A

0.2x tumour diameter
Tumour grade
Lymph node status

75
Q

What factors does Adjuvant! Online take into account?

A

Histopathology
ER pos/neg
Clinical factors

76
Q

What factors does PREDICT take into account?

A 
Histopathology
Clinical factors
HER2
ER pos/neg
Mode of detection
77
Q

How does sclerosing adenosis present?

A

Can be painful or symptomatic

78
Q

Which age group commonly gets sclerosing adenosis?

A

20-70

79
Q

How is a radial scar treated?

A

Excise

80
Q

How does duct ectasia change breast structure?

A

Dilates subareolar ducts

81
Q

Describe the discharge found in duct ectasia

A

Purulent

Bloody

82
Q

Phyllode’s tumour commonly metastasises to axillary nodes

True/false

A

False

Recurrence common but mets rare

83
Q

What is the difference between atypical lobular hyperplasia and lobular carcinoma in situ?

A

Atypical lobular hyperplasia <50% lobule involved

Lobular CIS >50% lobule involved

84
Q

What is the next step if lobular neoplasia found on core biopsy?

A

Excisional or vacuum biopsy to exclude higher grade malignancy

85
Q

How is a micro-invasive carcinoma managed?

A

Same as DCIS

86
Q

What is an invasive breast carcinoma?

A

Malignant epithelial cells which have breached the basement membrane

87
Q

Why is high BMI associated with higher rates of breast cancer?

A

Increased oestrogen production

88
Q

Which chemo drug are HER2 positive cancers sensitive to?

A

Trastuzumab (Herceptin)

Year 3 - Repro and Sexual Health (23 decks)

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