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3 REPRO > breast pathology > Flashcards

breast pathology Flashcards

1
Q

how is fine needle aspiration performed

A

needle inserted into mass
material drawn into needle
needle is moved around mass to sample different areas
material expelled from needle
small amount of material in needle when withdrawn

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2
Q

what are the classifications of FNA (C1-C5)

A 
C1 - unsatisfactory sample 
C2 - benign 
C3 - atypia, probably benign
C4 - suspicious of malignancy 
C5 - malignant
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3
Q

apart from FNA, what other materials can be used for cytopathology investigation

A

fluid
nipple discharge
nipple scrape

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4
Q

how is needle core biopsy performed

A

needle covered with sheath inserted
sheath withdrawn and released again
sheath cuts small sample that is removed in the needle

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5
Q

core needle biopsy classification (B1-B5)

A 
B1 - unsatisfactory 
B2 - benign 
B3 - atypia, probably benign 
B4 - suspicious of malignancy 
B5 - malignant 
B5a - CIS
B5b: invasive
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6
Q

what are developmental anomalies in the breast

A

hypoplasia
juvenile hypertrophy
accessory breast tissue
accessory nipple

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7
Q

what is gynaecomastia

A

breast development in the male

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8
Q

how does gynaecomastic breast tissue differ from female breast tissue

A

ductal growth without lobular development

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9
Q

what causes gynaecomastia

A

exogenous/endogenous hormones (oestrogen)
cannabis
prescription drugs
liver disease

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10
Q

in what ages group does fibrocystic change present

A

20-50

mostly 40-50

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11
Q

fibrocystic change is associated with which other gynaecologist signs

A

early menarche
late menopause
menstrual abnormalities

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12
Q

how does fibrocystic change present

A

smooth discrete lumps
sudden/cyclical pain
incidental finding

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13
Q

gross pathology of fibrocystic change

A

blue domed with pale fluid
usually multiple
intervening fibrosis

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14
Q

what causes the fibrosis in fibrocystic change

A

rupture of cysts and subsequent scarring

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15
Q

microscopic pathology of fibrocystic change

A

thin walled cysts that may have fibrotic wall

lined by apocrine epithelium

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16
Q

management of fibrocystic change

A

exclude malignancy
reassure
excise if necessary

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17
Q

what is a hamartoma

A

circumscribed lesion composed of cell types normal to the breast but present in an abnormal proportion of distribution

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18
Q

presentation of fibroadenoma

A

painless, firm, discrete, mobile mass

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19
Q

clinical features of fibroadenoma

A

localised hyperplasia
proliferation of interlobular storm
circumscribed, rubbery, grey-white lesions

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20
Q

management of fibroadenoma

A

exclude malignancy
reassure
excise

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21
Q

what are sclerosing lesions

A

benign, disorderly proliferation of acini and stroma

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22
Q

features of sclerosing adenosis

A

pain, tenderness or lumpiness/thickening

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23
Q

what is the difference between radial scar and complex sclerosing lesion

A

radial scar = 1-9 mm

CSL = >10 mm

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24
Q

appearance of radial scar on mammogram

A

stellate architecture
central puckering
radiating fibrosis

25
Q

histological appearance of radial scar

A

fibroelastic core
radiating fibrosis containing distorted ductules
fibrocystic change
epithelial proliferation

26
Q

why is radial scar/CSL clinically relevant

A

mimics cancer radiologically

most likely benign but may contain CIS or invasive carcinoma

27
Q

treatment of sclerosing lesions

A

excise or sample extensively by vacuum biopsy

28
Q

cause of fat necrosis

A

trauma
often seat belt trauma
often no memorable history of trauma

29
Q

what cause fat necrosis

A

damage and disruption of adipocytes
infiltration of acute inflammatory cells
foamy macrophages (full of fat droplets)
subsequent fibrosis and scarring

30
Q

clinical features of duct ectasia

A 
affects sub-areolar ducts 
pain
acute episodic inflammatory changes 
bloody and/or purulent discharge (green/yellow colour)
fistulation
nipple retraction and distortion
31
Q

what is commonly associated with duct ectasia

A

smoking

32
Q

management of duct ectasia

A

treat acute infections
exclude malignancy
stop smoking
excise ducts

33
Q

common causes of acute mastitis/abscess

A

duct ectasia

lactation

34
Q

which organisms are associated with mastitis caused by duct ectasia

A

mixed organisms

anaerobes

35
Q

which organisms are associated with mastitis caused lactation

A

staph aureus

strep pyogenes

36
Q

management of mastitis/abscess

A

antibiotics
percutaneous drainage
incision and drainage
treat underlying cause

37
Q

which type of mostly benign breast tumour is prone to recurrence if not properly excised

A

phyllodes tumour

38
Q

clinical features of phyllodes tumour

A

slow growing unilateral breast mass

39
Q

presentation of introduction papilloma

A

nipple discharge +/-blood

40
Q

how are intraductal papilloma picked up at screening

A

nodules and calcification

41
Q

how to intraductal papilloma appear histologically

A

papillary fronds containing a fibrovascular core

42
Q

how is intraductal papilloma classified

A

benign IDP
IDP with atypical ductal hyperplasia (ADH)
IDP with ductal carcinoma in situ (DCIS)

43
Q

which type of tumour has a sarcomatous stromal component

A

malignant phyllodes tumour

44
Q

which breast tumour is associated with radiotherapy

A

angiosarcoma

45
Q

which cancer metastasise to the breast

A 
bronchial carcinoma 
ovarian serous carcinoma 
clear cell carcinoma of the kidney 
malignant melanoma 
soft tissue tumours
46
Q

what is the difference between atypical lobular hyperplasia and lobular CIS

A

atypical lobular hyperplasia <50% of lobule affected

lobular CIS >50% of lobular affected

47
Q

features of lobular CIS

A 
small-intermediate sized nuclei 
solid proliferation 
intra-cytoplasmic lumens/vacuoles
ER positive 
e-cadherin negative
48
Q

where does ductal CIS arise

A

in terminal duct lobular unit

49
Q

what is Paget’s disease of the nipple

A

high grade DCIS extending along ducts to reach the epidermis of the nipple

still in situ as hasn’t breached basement membrane

50
Q

what is the progression from normal cells to DCIS

A 
normal cells 
epithelial hyperplasia of usually type 
columnar cell change 
atypical ductal hyperplasia 
DCIS
51
Q

risk factors for breast Ca

A 
age 
reproductive hx
hormones (OCP/HRT)
previous breast disease 
Western Europe high
weight 
smoking/alcohol 
genetics
52
Q

breast Ca will invade which local tissues

A

stroma of breast
skin
muscles of chest wall

53
Q

blood borne mets spread where?

A 
bone
liver
brain
lungs 
abdominal viscera 
genital tract
54
Q

what is the most common type of breast ca

A

ductal

55
Q

how is breast ca graded

A

tubular differentiation 1-3
nuclear pleomorphism 1-3
mitotic activity 1-3

score 3-5 = grade 1
score 6-7 = grade 2
score 8-9 = grade 3

56
Q

the majority of breast ca is ER +ve; true or false

A

true

57
Q

which drugs can be used if ER +ve

A

tamoxifen
aromatase inhibitors
GnRH antagonists

58
Q

HER2 +ve means that which drug can be used

A

trastuzamab (Herceptin)

59
Q

what can be used to predict prognosis

A

Nottingham prognostic index
adjuvant! online
PREDICT (NHS)

3 REPRO (40 decks)

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