Breast- Pathology Flashcards
identify the 5 benign breast conditions
- fibrocystic change
- fibroadenoma
- intraductal papilloma
- fat necrosis
- duct ectasia
what is fibrocystic change?
hyperplastic overgrowth of all of the components of the mammary gland unit
what is fibrocystic change caused by?
abnormal response of breast to ovarian hormones
features of fibrocystic change?
- fibrosis
- adenosis
- cysts
- ductal epithelial hyperplasia
- apocrine metaplasia
what is the epidemiology of fibroadenoma?
most common breast tumour of adolescents / young women
key features of fibroadenoma?
- circumsized, mobile, non-tender nodule
- may regress with time if left untreated
- proliferation of stromal and epithelial elements
in who does intraductal papilloma usually occur in and how does it present?
- middle aged women
- nipple discharge
what is the aetiology of fat necrosis?
- previous trauma
- past surgery
what are features of fat necrosis (clinically and radiologically)?
- can simulate carcinoma both clinically and radiologically
- clinically a hard, irregular breast lump
what are features of fat necrosis on histology?
histiocytes with foamy cytoplasm
how does duct ectasia present?
nipple discharge
what is Phyllodes tumour?
- a fleshy tumour with a leaf-like pattern and cysts on cut surface
- circumscribed with epithelial and stromal elements
- may be benign/ borderline /malignant
- <1% of breast tumours
Breast carcinoma
- Epidemiology?
- most common cause of female cancer death
- 1/8 women will get it
Symptoms / signs of Breast carcinoma?
- Hard lump/mass in breast
- tethering to skin / dimpling of skin
- discharge / bleeding
- change in size /shape of breast
- change in colour of areola
- redness over breast skin
risk factors of Breast carcinoma?
- Increased age
- FH
- BRCA1/2
increased exposoure to oestrogen:
- age at menstruation and menarche
- age at 1st pregnancy
- hormonal therapies ie HRT /OCP
lifestyle:
- obesity
- alcohol
radiation
histological classification of Breast carcinoma ?
Non-Invasive
- Ductal Carcinoma In Situ
- Lobular Carcinoma In Situ
Invasive
- Invasive Ductal Carcinoma (85%)
- Invasive Lobular Carcinoma
- other types:
- mucinous carcinoma
- tubular carcinoma
- medullary carcinoma
what are the features of in-situ carcinoma?
- pre-invasive
- no metastatic spread
- not detected clincially
- apart from DCIS on X-Ray
- risk of invasion depending on grade
- multicentricity and bilaterality in LCIS
what is Paget’s Disease of the Nipple and where does it affect?
result of intraepithelial spread of intraductal carcinoma
- affects nipple or areola
what are symptoms of Paget’s disease?
pain/ itching / discharge / ulceration/ crusting / scaling and redness
what are diagnostic procedures for Breast carcinoma and outline their sensitivities
- clinical examination 88%
- Mammography 93%
- US 88%
- MRI
- Fine Needle Aspiration cytology 94%
- Needle Core Biopsy
- wide local excision with adequate margins
outline the breast screening process
mammogram every 3 years for women aged 50-70
what are the 2 most important mammographic indicators of breast cancer?
- mass
- microcalcifications
- tiny specks of calcium in the soft tissue of the breast
- in majority of cases, this is normal
- however in a few cases it can be cancerous / pre-cancerous tissue
outline the spread of breast cancer?
- Local
- skin / pectoral muscles
- Lymphatic
- axillary lymph nodes / internal mammary
- Blood
- bone, lung, liver, brain
what are the factors that influence someone’s prognosis regarding Breast carcinoma?
- LYMPH SPREAD–> best prognostic indicator
- age
- presence of ER/PR/HER-2
- type / size and grade of cancer
what does the presence of the HER-2 receptor predict?
response to Trastuzumab (Herceptin)
