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Breast Pathology Flashcards

1
Q

What is the vertical anatomical location of the breast

A

2nd-6th rib

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2
Q

What is the transverse anatomical location of the breast

A

Sternal edge to midaxillary line

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3
Q

Which muscles are the breasts associated with

A

Pectoralis major
Serratus anterior
External oblique

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4
Q

What is the nipple

A

Prominence of the breast

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5
Q

What is the areola

A

Pigmented area around the nipple

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6
Q

What is the position of the nipple

A

Variable

Or 4th intercostal space

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7
Q

Dermatome lying over the nipple

A

T4

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8
Q

How many lobules does each breast have?

A

15-20

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9
Q

What is each lobule drained by?

A

Lactiferous duct

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10
Q

What are the 4 quadrants of the breast

A

Supero medial
Supero lateral
Inferior medial
Inferior lateral

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11
Q

Which quadrant of the breast has the axillary tail

A

Upper later

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12
Q

What is gynecomastia

A

Postnatal development of rudimentary lactirferous ducts in male

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13
Q

What is polymastia

A

An extra breast

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14
Q

What is polythelia

A

An extra nipple

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15
Q

What is amanita

A

Absence of a breast

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16
Q

What is aphelia

A

Absence of a nipple

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17
Q

What is the arterial supply to the breast

A

Lateral thoracic artery
Thorco acromial artery
Internal mammary artery

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18
Q

What is a fibroadenoma

A

A benign breast tumour

Among the most common

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19
Q

Clinical features of a fibroadenoma

A 
Well circumscribed
Freely mobile 
Non-painful
Highly mobile 
Vary in size
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20
Q

Who does fibroadenomas affect

A

Women of reproductive age

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21
Q

outcomes of fibroadenomas

A

1/3 regress
1/3 stay the same
1/3 get bigger

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22
Q

Rx for fibroadenomas

A

Observation and reassurance

Surgical excision if large

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23
Q

Ix for fibroadenoma

A

Examination
USS
Mammogram
FNA or core biopsy

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24
Q

What is an intraduct papilloma

A

Benign tumour that forms in milk ducts

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25
Q

Who is intraduct papilloma most common in

A

Middle aged

>40yrs

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26
Q

Symptoms of intraduct papilloma

A

Small lump

Discharge from nipple

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27
Q

Ix for intra-duct papilloma

A

Triple assessment

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28
Q

What can intra-duct papillomas show histologically

A

Atypia

Which can slightly increase risk of breast cancer

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29
Q

Rx for intra-duct papillomas

A

Often removed by surgery

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30
Q

What can fat necrosis simulate clinically and mammographically

A

Breast carcinoma

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31
Q

Potential breast history in fat necrosis

A

Breast reduction
Breast surgery
Antecedent trauma
Lipomodelling

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32
Q

Is fat necrosis benign or malignant

A

Benign

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33
Q

Pathology of fat necrosis

A

Fibrosis and calcification of breast tissue after injury

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34
Q

Clinical features of fat necrosis

A

Firm
Round
Lump/s
Usually painless

Skin around can be:
Red
Bruised
Dimpled

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35
Q

Ix for fat necrosis

A

Examination
USS/Mammogram
FNA/Core biopsy

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36
Q

Rx for fat necrosis

A

Nothing

Tend to avoid surgery to avoid further injury to the breast

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37
Q

Why can fat necrosis be difficult to diagnose

A

Due to its resemblance of carcinoma on mammograms

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38
Q

Is duct extasia a benign or malignant condition?

A

Benign

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39
Q

What is duct ectasia

A

Condition where the ducts beneath the nipples dilate
Duct walls thicken and fill with fluid
becoming

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40
Q

Risk factors for duct eurasia

A

Peri-menopausal

Post menopausal

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41
Q

What does duct ectasia have a strong association with?

A

Smoking

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42
Q

Ix for duct ectasia

A

Examination
USS/mammogram
FNA/Core biopsy
Nipple discharge testing

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43
Q

Rx for duct ectasia

A

Analgesia
Antibiotics if infected
Stop smoking

Sugery

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44
Q

Complication of duct ectasia

A

Infection

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45
Q

What is Phyllodes tumour

A

Fleshy benign tumour

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46
Q

What kind of histological pattern does Phyllodes tumour have

A

Leaf life pattern

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47
Q

3 categories of Phyllodes tumour

A

Benign
Borderline
Malignant

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48
Q

Who are Phyllodes tumours most common in

A

40-50yrs F

49
Q

Where are metastases in Malignant Phyllodes tumours

A

Haematogenous

50
Q

Ix for Phyllodes tumours

A

Triple assessment
Examination
USS/Mammogram
FNA/Core biopsy

51
Q

Rx for Phyllodes tumour

A

Always with surgery

Aim to remove entries tumour with a margin of normal breast tissue

52
Q

How common is breast cancer

A

Affect 1 in 8 women

53
Q

Does breast cancer more commonly affect F or M

A

1 in 8

54
Q

What is the commonest cause of female cancer death

A

Great cancer

55
Q

Risk factors for breast cancer

A 
F>M
Increasing age 
Early monarche 
Delayed menopause 
Radiation 
FH 
Personal history 
HRT 
BRCA1 
BRCA2 
Obesity 
Alcohol
56
Q

Signs of breast cancer

A 
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
Q

What is the difference between non-invasive and invasive breast cancer

A

Non-invasive: within basement membrane
Picked up on screening as not detected clinically

Invasive: Passes through the basement membrane
Often detected clinically

58
Q

2 types of non-invasive breast cancer

A

Ductal Carcinoma in Situ (DCIS)

Lobular Carcinoma in Situe

59
Q

What is the most common type of breast cancer

A

Invasive Ductal Carcinoma

60
Q

Describe ductal carcinoma in situ

A

Pre-malignant condition

61
Q

Ix for breast cancer Dx

A

Triple assessment
Clinical examination
USS/Mammogram
FNA/Core biopsy

62
Q

Staging Ix for breast cancer

A

CXR
Isotope bone scan
CT head/chest/abdo
Liver USS

63
Q

Are there any tumour markers for breast cancer?

A

No

64
Q

Who is eligible for breast screening

A

Females 50-70yrs

65
Q

How often are women breasts screened

A

3yr

66
Q

What does breast screening involve

A

Mammogram

67
Q

Local spread from breast cancer

A

Skin

Pectoral muscles

68
Q

Lymphatic spread from breast cancer

A

Axillary LN

Internal mammary LN

69
Q

Blood spread from breast cancer

A

Bone
Liver
Lung
Brain

70
Q

Describe ductal carcinoma in situ

A

Pre-invasive/Pre-malignant stage

Contained in the cells lining the breast ducts

71
Q

Difference between high risk DCIS and low risk DCIS

A

High grade - higher risk of invasive cancer (50% in 8yrs)

Low grade - lower risk of invasive cancer (30% in 15yrs)

72
Q

How is DCIS diagnosed?

A

Through screening

Not usually detected clinically

73
Q

Is lobular carcinoma in situe more or less common that DCIS

A

LCIS is rarer than DCIS

74
Q

Describe lobular carcinoma in situ (LCIS)

A

Pre-malignant/Pre-invasive stage
Non-metastatic disease
Begins in the breast lobules

75
Q

What is the 2nd most common type of breast cancer

A

Invasive lobular carcinoma

76
Q

Where does invasive ductal carcinoma begin

A

In the breast ducts

77
Q

Where does invasive lobular carcinoma begin

A

In the breast lobules

78
Q

What is Paget’s Disease

A

Cancer of the nipple

79
Q

Where does Paget’s Disease most usually arise from

A

Intraductal carcinomas

With intraepithelial spread to the nipple

80
Q

Describe inflammatory breast cancer

A

Rare

Yet very aggressive form of breast cancer

81
Q

Name 4 subtypes of Invasive ductal carcinomas

A

Medullary
Mucinous
Tubular
Papillary

82
Q

Describe medullary carcinoma

A 
Rare subtype of ICD 
Most common in BRCA1 mutation 
Tends to affect younger patients
High graded appearance 
Low graded behaviour
83
Q

Where are in situ carcinomas limited to

A

the basement membrane They do not metastasise

84
Q

Describe mucinous carcinomas

A

Rare subtype of ICD

Tends to affect post-menopausal women

85
Q

What can the presence or absence of oestrogen and progesterone receptor tell us about a breast cancer

A

Predictors of response to hormonal therapy

-ve will not response

86
Q

If a breast cancer expresses HER-2 what can this tell us

A

Associated with more aggressive disease

Associated with a poorer prognosis

87
Q

Who receives USS in triple assessment

A

<35yrs

88
Q

Who receives mammogram in triple assessment

A

> 35yrs

89
Q

Surgery options for breast cancer

A

Breast conservation:
Wide local excision
Quadranectomy
Segmentectomy

Mastectomy:
Removal or whole breast

90
Q

Who is suitable for breast conservation surgery

A 
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
Q

what is the clinical significant of the sentinel LN

A

It is the 1st LN to receive lymphatic drainage from the breast

92
Q

Which lymph nodes do you biopsy to ascertain LN spread of breast cancer

A

Sentinel LN

93
Q

If the sentinel LN is -ve what can be assumed

A

That the rest of the LN are -ve

94
Q

Do skip metastases odf LN occur?

A

NO

95
Q

If SLN is +ve what is required

A

Axillary clearance
or
Radiotherapy of axillary LN

96
Q

Hormone therapy RX of breast cancer in pre-menopausal women

A

Tamoxifen for 5yrs

97
Q

Action of tamoxifen

A

Oestrogen receptor blocker

98
Q

Hormone therapy Rx of breast cancer in post-menopausal women

A

Tamoxifen for 5yrs if good prognosis

Aromatase inhibitor for 5yrs if bad prognosis

99
Q

Who is suitable for chemotherapy in breast cancer RX

A

+ve nodes

Grade 3 cancers

100
Q

General Rxs of breast cancer

A 
Surgery 
Chemotherapy 
Radiotherapy
Hormonal therapy 
Axillary LN surgery
101
Q

What regimes of chemotherapy are given in breast cancer Rx

A

Toxanes

Anthracyclines

102
Q

What can Her-2 receptor predict in relation to treatment

A

Response to Trastuzumab (Herceptin)

103
Q

Who is Trastuzumab given to?

A

Those expressing Her-2 receptors

104
Q

Follow up Rx of breast cancer patients

A

Clinical examinait 6 monthly for 5 years
Yearly after that
Mammogram of breast at yearly intervals for 10 years

105
Q

N1 meaning in breast cancer staging

A

Mobile axillary nodes

106
Q

N2 meaning in breast cancer staging

A

Fixed/matted axillary LN

107
Q

N3 meaning in breast cancer staging

A

Infraclavicular/supraclavicular or internal mammary

108
Q

N0 Meaning in breast cancer staging

A

No nodal involvement

109
Q

M0 meaning in breast cancer staging

A

No metastases

110
Q

M1 meaning in breast cancer staging

A

Distant metastases

111
Q

Tis meaning in breast cancer staging

A

Tumour in situ

112
Q

T1 meaning breast cancer staging

A

<2cm

113
Q

T2 meaning breast cancer staging

A

2-5cm

114
Q

T3 meaning breast cancer staging

A

> 5cm

115
Q

T4 meaning breast cancer staging

A

Invasion to chest wall/skin

116
Q

Complications of axillary LN clearance

A 
Lymphoedema 
Decreased ROM of shoulder 
Nerve 
damage
Sensory disturbance 
Radiation induced sarcoma
117
Q

Main risk fo mammogram

A

High dose radiation

118
Q

What is the aim of breast cancer screening?

A

To detect cancers at a pre-invasive/in-situ stage

119
Q

Which nerves supply the breast

A

Anterior and lateral branches of 4th-6th intercostal nerves

Reproduction (14 decks)

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