Breast Pathology Flashcards
1
Q
What is the vertical anatomical location of the breast
A
2nd-6th rib
2
Q
What is the transverse anatomical location of the breast
A
Sternal edge to midaxillary line
3
Q
Which muscles are the breasts associated with
A
Pectoralis major
Serratus anterior
External oblique
4
Q
What is the nipple
A
Prominence of the breast
5
Q
What is the areola
A
Pigmented area around the nipple
6
Q
What is the position of the nipple
A
Variable
Or 4th intercostal space
7
Q
Dermatome lying over the nipple
A
T4
8
Q
How many lobules does each breast have?
A
15-20
9
Q
What is each lobule drained by?
A
Lactiferous duct
10
Q
What are the 4 quadrants of the breast
A
Supero medial
Supero lateral
Inferior medial
Inferior lateral
11
Q
Which quadrant of the breast has the axillary tail
A
Upper later
12
Q
What is gynecomastia
A
Postnatal development of rudimentary lactirferous ducts in male
13
Q
What is polymastia
A
An extra breast
14
Q
What is polythelia
A
An extra nipple
15
Q
What is amanita
A
Absence of a breast
16
Q
What is aphelia
A
Absence of a nipple
17
Q
What is the arterial supply to the breast
A
Lateral thoracic artery
Thorco acromial artery
Internal mammary artery
18
Q
What is a fibroadenoma
A
A benign breast tumour
Among the most common
19
Q
Clinical features of a fibroadenoma
A
Well circumscribed Freely mobile Non-painful Highly mobile Vary in size
20
Q
Who does fibroadenomas affect
A
Women of reproductive age
21
Q
outcomes of fibroadenomas
A
1/3 regress
1/3 stay the same
1/3 get bigger
22
Q
Rx for fibroadenomas
A
Observation and reassurance
Surgical excision if large
23
Q
Ix for fibroadenoma
A
Examination
USS
Mammogram
FNA or core biopsy
24
Q
What is an intraduct papilloma
A
Benign tumour that forms in milk ducts
25
Who is intraduct papilloma most common in
Middle aged
| >40yrs
26
Symptoms of intraduct papilloma
Small lump
| Discharge from nipple
27
Ix for intra-duct papilloma
Triple assessment
28
What can intra-duct papillomas show histologically
Atypia
| Which can slightly increase risk of breast cancer
29
Rx for intra-duct papillomas
Often removed by surgery
30
What can fat necrosis simulate clinically and mammographically
Breast carcinoma
31
Potential breast history in fat necrosis
Breast reduction
Breast surgery
Antecedent trauma
Lipomodelling
32
Is fat necrosis benign or malignant
Benign
33
Pathology of fat necrosis
Fibrosis and calcification of breast tissue after injury
34
Clinical features of fat necrosis
Firm
Round
Lump/s
Usually painless
Skin around can be:
Red
Bruised
Dimpled
35
Ix for fat necrosis
Examination
USS/Mammogram
FNA/Core biopsy
36
Rx for fat necrosis
Nothing
| Tend to avoid surgery to avoid further injury to the breast
37
Why can fat necrosis be difficult to diagnose
Due to its resemblance of carcinoma on mammograms
38
Is duct extasia a benign or malignant condition?
Benign
39
What is duct ectasia
Condition where the ducts beneath the nipples dilate
Duct walls thicken and fill with fluid
becoming
40
Risk factors for duct eurasia
Peri-menopausal
| Post menopausal
41
What does duct ectasia have a strong association with?
Smoking
42
Ix for duct ectasia
Examination
USS/mammogram
FNA/Core biopsy
Nipple discharge testing
43
Rx for duct ectasia
Analgesia
Antibiotics if infected
Stop smoking
Sugery
44
Complication of duct ectasia
Infection
45
What is Phyllodes tumour
Fleshy benign tumour
46
What kind of histological pattern does Phyllodes tumour have
Leaf life pattern
47
3 categories of Phyllodes tumour
Benign
Borderline
Malignant
48
Who are Phyllodes tumours most common in
40-50yrs F
49
Where are metastases in Malignant Phyllodes tumours
Haematogenous
50
Ix for Phyllodes tumours
Triple assessment
Examination
USS/Mammogram
FNA/Core biopsy
51
Rx for Phyllodes tumour
Always with surgery
| Aim to remove entries tumour with a margin of normal breast tissue
52
How common is breast cancer
Affect 1 in 8 women
53
Does breast cancer more commonly affect F or M
1 in 8
54
What is the commonest cause of female cancer death
Great cancer
55
Risk factors for breast cancer
```
F>M
Increasing age
Early monarche
Delayed menopause
Radiation
FH
Personal history
HRT
BRCA1
BRCA2
Obesity
Alcohol
```
56
Signs of breast cancer
```
Hard lump/thickening in breast or armpit
Often painless
Discharge or bleeding from nipple
Fixed mass
Tethering to skin
Peau d-orange
Dimpling of skin
Inverted nipple
```
57
What is the difference between non-invasive and invasive breast cancer
Non-invasive: within basement membrane
Picked up on screening as not detected clinically
Invasive: Passes through the basement membrane
Often detected clinically
58
2 types of non-invasive breast cancer
Ductal Carcinoma in Situ (DCIS)
| Lobular Carcinoma in Situe
59
What is the most common type of breast cancer
Invasive Ductal Carcinoma
60
Describe ductal carcinoma in situ
Pre-malignant condition
61
Ix for breast cancer Dx
Triple assessment
Clinical examination
USS/Mammogram
FNA/Core biopsy
62
Staging Ix for breast cancer
CXR
Isotope bone scan
CT head/chest/abdo
Liver USS
63
Are there any tumour markers for breast cancer?
No
64
Who is eligible for breast screening
Females 50-70yrs
65
How often are women breasts screened
3yr
66
What does breast screening involve
Mammogram
67
Local spread from breast cancer
Skin
| Pectoral muscles
68
Lymphatic spread from breast cancer
Axillary LN
| Internal mammary LN
69
Blood spread from breast cancer
Bone
Liver
Lung
Brain
70
Describe ductal carcinoma in situ
Pre-invasive/Pre-malignant stage
| Contained in the cells lining the breast ducts
71
Difference between high risk DCIS and low risk DCIS
High grade - higher risk of invasive cancer (50% in 8yrs)
| Low grade - lower risk of invasive cancer (30% in 15yrs)
72
How is DCIS diagnosed?
Through screening
| Not usually detected clinically
73
Is lobular carcinoma in situe more or less common that DCIS
LCIS is rarer than DCIS
74
Describe lobular carcinoma in situ (LCIS)
Pre-malignant/Pre-invasive stage
Non-metastatic disease
Begins in the breast lobules
75
What is the 2nd most common type of breast cancer
Invasive lobular carcinoma
76
Where does invasive ductal carcinoma begin
In the breast ducts
77
Where does invasive lobular carcinoma begin
In the breast lobules
78
What is Paget's Disease
Cancer of the nipple
79
Where does Paget's Disease most usually arise from
Intraductal carcinomas
| With intraepithelial spread to the nipple
80
Describe inflammatory breast cancer
Rare
| Yet very aggressive form of breast cancer
81
Name 4 subtypes of Invasive ductal carcinomas
Medullary
Mucinous
Tubular
Papillary
82
Describe medullary carcinoma
```
Rare subtype of ICD
Most common in BRCA1 mutation
Tends to affect younger patients
High graded appearance
Low graded behaviour
```
83
Where are in situ carcinomas limited to
the basement membrane They do not metastasise
84
Describe mucinous carcinomas
Rare subtype of ICD
| Tends to affect post-menopausal women
85
What can the presence or absence of oestrogen and progesterone receptor tell us about a breast cancer
Predictors of response to hormonal therapy
| -ve will not response
86
If a breast cancer expresses HER-2 what can this tell us
Associated with more aggressive disease
| Associated with a poorer prognosis
87
Who receives USS in triple assessment
<35yrs
88
Who receives mammogram in triple assessment
>35yrs
89
Surgery options for breast cancer
Breast conservation:
Wide local excision
Quadranectomy
Segmentectomy
Mastectomy:
Removal or whole breast
90
Who is suitable for breast conservation surgery
```
Tumour size <4cm
Breast/Tumour size ratio
Suitable for radiotherapy
Single not multiple tumours
Minimal in situ cancer component present
Patients wish – most important!
```
91
what is the clinical significant of the sentinel LN
It is the 1st LN to receive lymphatic drainage from the breast
92
Which lymph nodes do you biopsy to ascertain LN spread of breast cancer
Sentinel LN
93
If the sentinel LN is -ve what can be assumed
That the rest of the LN are -ve
94
Do skip metastases odf LN occur?
NO
95
If SLN is +ve what is required
Axillary clearance
or
Radiotherapy of axillary LN
96
Hormone therapy RX of breast cancer in pre-menopausal women
Tamoxifen for 5yrs
97
Action of tamoxifen
Oestrogen receptor blocker
98
Hormone therapy Rx of breast cancer in post-menopausal women
Tamoxifen for 5yrs if good prognosis
| Aromatase inhibitor for 5yrs if bad prognosis
99
Who is suitable for chemotherapy in breast cancer RX
+ve nodes
| Grade 3 cancers
100
General Rxs of breast cancer
```
Surgery
Chemotherapy
Radiotherapy
Hormonal therapy
Axillary LN surgery
```
101
What regimes of chemotherapy are given in breast cancer Rx
Toxanes
| Anthracyclines
102
What can Her-2 receptor predict in relation to treatment
Response to Trastuzumab (Herceptin)
103
Who is Trastuzumab given to?
Those expressing Her-2 receptors
104
Follow up Rx of breast cancer patients
Clinical examinait 6 monthly for 5 years
Yearly after that
Mammogram of breast at yearly intervals for 10 years
105
N1 meaning in breast cancer staging
Mobile axillary nodes
106
N2 meaning in breast cancer staging
Fixed/matted axillary LN
107
N3 meaning in breast cancer staging
Infraclavicular/supraclavicular or internal mammary
108
N0 Meaning in breast cancer staging
No nodal involvement
109
M0 meaning in breast cancer staging
No metastases
110
M1 meaning in breast cancer staging
Distant metastases
111
Tis meaning in breast cancer staging
Tumour in situ
112
T1 meaning breast cancer staging
<2cm
113
T2 meaning breast cancer staging
2-5cm
114
T3 meaning breast cancer staging
>5cm
115
T4 meaning breast cancer staging
Invasion to chest wall/skin
116
Complications of axillary LN clearance
```
Lymphoedema
Decreased ROM of shoulder
Nerve
damage
Sensory disturbance
Radiation induced sarcoma
```
117
Main risk fo mammogram
High dose radiation
118
What is the aim of breast cancer screening?
To detect cancers at a pre-invasive/in-situ stage
119
Which nerves supply the breast
Anterior and lateral branches of 4th-6th intercostal nerves
