Breast Pathology Flashcards
How does breast pathology usually present?
- Painful breast
- Palpable mass
- Nipple discharge
How can one classify different breast pathologies?
- Inflammatory conditions
- Benign proliferative conditions
- Benign neoplastic conditions
- Malignant neoplastic conditions
Name some inflammatory pathologies of the breast
- Mammary duct ectasia
- Acute mastitis
- Fat necrosis
What is mammary duct ectasia? What is the epidemiology? Symptoms? Cytology?
It is granulomatous inflammation and dilatation of the breast ducts.
It usually affects women ages 40-60.
It presents with a periareolar mass, and thick white nipple secretions.
On cytology, there are large dilated ducts, with proteinaceous material and inflammatory cells.
What is acute mastitis? What is the epidemiology? Symptoms? Cytology? How is it treated? Are there any other variations?
This is an acute infection of the breast.
It most commonly occurs during lactation or breastfeeding, as a result of staphylococcus infection through cracks in the nipple.
It presents as a painful, tender red breast and fever.
On cytology, the breast tissue is necrotic, and infiltrated with neutrophils.
It is treated with antibiotics and drainage.
There is also periductal mastitis, associated with smoking (not lactation) that shows keratinising squamous epithelium extending deep into nipple duct orifices.
What is fat necrosis? What is the epidemiology? Symptoms? Cytology?
This is an inflammatory reaction to damaged adipose tissue.
It is usually caused by trauma, radiotherapy or surgery.
It presents as a painless breast mass.
Name some benign proliferative conditions of the breast
- Fibrocystic disease/fibroadenosis
- Phyllodes tumour
- Gynaecomastia
- Epithelial hyperplasia
- Flat epithelial hyperplasia
- In situ lobular neoplasia
How does one investigate any breast pathology?
- Clinical history and examination
- Imaging (mammogram, US or MRI)
- Cytology/histopathology (fine needle aspirate or core biopsy)
What is the gold standard in diagnosing malignancy in the breast?
Histopathology
How is cytological evaluation of breast tissue divided to summarise the suspicion of malignancy?
C1-5
- C1 = inadequate sample
- C2 = benign
- C3 = atypical but benign
- C4 = suspicion of malignancy
- C5 = malignant
What is fibrocystic disease? What is the epidemiology? Symptoms? Cytology?
What is fibroadenosis
This is fibrous and cystic tissue changes within the breast, caused by an exaggerated normal response to hormones.
This is very common.
It presents as a ‘lumpy breast’.
On cytology, one can see small cysts which contain fluid, and inflammation and fibrosis secondary to cyst rupture.
Fibroadenosis involved fibrous changes with an increased number of acini per lobule.
What is phyllodes tumour? What is the epidemiology? Symptoms? Cytology?
This is a leaf-like tumour arising from the interlobular stroma. They are mostly benign, but can be aggressive and malignant.
They usually affect those above the age of 50.
They usually present as a palpable mass.
What is gynaecomastia? What is the epidemiology? Symptoms? Histology?
This is unilateral/bilateral enlargement of the male breast, usually caused by a hyperoestrogenic state (alcohol, liver damage, testicular tumour).
It most commonly affects prepubertal boys and men over the age of 50.
It presents as enlargement of the breast tissue.
On histology, there is epithelial hyperplasia and finger like projection into ducts.
Name some benign neoplastic conditions of the breast
- Fibroadenoma
- Duct papilloma
- Radial scar
What is a fibroadenoma? What is the epidemiology? Symptoms? Cytology?
What is the treatment?
This is a benign tumour from the stroma.
It can occur at any age, but most commonly affects those in reproductive age. They can increase in size during pregnancy, and calcify after menopause.
They usually present as a painless, mobile hard lump.
On cytology, there is an overgrowth of collagenous mesenchyme.
Treat by surgical removal.
What is a duct papilloma? Symptoms? Cytology?
This is a benign papillary tumour arising anywhere within the ductal system of the breast.
It usually presents with bloody discharge and no lump.
On cytology, some duct dilation is seen with a central papillary growth.
What is a radial scar? Cytology?
This is a benign sclerosing lesion.
On cytology, there is a central scarring with surrounding proliferating glandular tissue in a stellate pattern.
Name some malignant neoplastic conditions of the breast
- Carcinoma in situ
- Invasive carcinoma
What is the epidemiology surrounding breast cancer?
It is the most common cancer in women, affecting 1 in 8.
It usually affects those aged over 75 (younger in afro-Caribbean’s)
There is a ethnic predilection to Caucasian women.
What are the risk factors associated with breast cancer?
Genetic:
- BRCA1 or 2 mutations
- Also susceptible to other gynaecological cancers
- Up to 85% of women with a BRCA mutation will develop cancer
Hormonal:
- Oestrogen exposure
- Early menarche/late menopause
- Nulliparity
- Obesity/alcohol
- COCP
History:
- Age
- Family history
- Ethnicity
What is carcinoma in situ? What types exist?
This is a neoplastic proliferation of cells that is limited to the ducts or lobules by a basement membrane.
They can be ductal or lobular.
Ductal:
- Higher incidence since screening programme
- Increased risk of progression to invasive cancer
- Surgical removal is curative
Lobular:
- Always incidental as no calcification
What is invasive carcinoma? What types exist?
This is neoplastic proliferation of cells that has infiltrated within the breast, with the capacity to spread to distal sites.
They can be ductal, lobular, tubular, mucinous or basal-like.
Ductal:
- Cannot be classified into another group
- Most common
Lobular:
- Cells aligned in chains/strands
Tubular:
- Cells arranged into tubules
- Rarely palpable as very small
Mucinous:
- Abundant quantities of mucin
Basal-like:
- Sheets of atypical cells with lymphocytic infiltrate
- Positive for CK 5, 6 and 14
- Negative for ER/PR/HER2 receptors
How are neoplastic conditions graded?
They are given a score out of 3 for their:
- Nuclear polymorphism
- Tubule formation
- Mitotic activity
Scores 3-5: Grade 1
Scores 6-7: Grade 2
Scores 8-9: Grade 3
What is the significance of hormone receptor activity with neoplastic conditions?
What treatments are available to these?
They are all assessed for their oestrogen, progesterone and HER2 receptor status.
Oestrogen/Progesterone receptor positive: good prognosis
HER2 receptor positive: poor prognosis
Treatments:
- ER/PR +ve: tamoxifen [mixed agonist/antagonist of oestrogen at receptor]
- HER2 +ve: Herceptin/trastuzumab [monoclonal Ig to HER2] (cardiotoxic, monitor LVEF)
What is the current screening programme for breast cancer in the UK?
Women aged 47-73 invited for mammogram every 3 years
What is the triple assessment?
- Examination
- Imaging (mammogram, US or MRI)
- Cytology (fine-needle aspirate or biopsy)
Describe the epidemiology surrounding male breast cancer. How does it present? Cytology?
This is a very rare cancer, accounting for 0.2% of all cancers. It usually affects males above the age of 65.
It presents as a palpable mass.
On cytology, it can show the same types of breast carcinoma as in females.
