Breast pathology Flashcards
Green-white (+bloody) nipple discharge
Duct ectasia (Duct clogs and fills with secretions that can discharge from nipple - ducts dilate + can rupture leading to blood in discharge)
Blood-stained discharge
Ductal papilloma
Mobile lump
Artichoke like appearance
Phylloides tumour (stroma proliferates + pushes up on ducts to produce artichoke like protrusions)
Triple assessment
- History + breast exam
- Imaging (<35 USS, >35 mammogram)
- Solid lump = core biopsy + histology; fluctuant lump = FNA + cytology
Histology/cytology grading
B1-B5 (histology - tissue) C1-C5 (cytology - cells) 1 - Normal breast tissue 2 - Benign 3 - Atypical 4 - ? Malignancy 5 - Malignancy (for B - a = DCIS, b = carcinoma)
Breast-feeding
Acute inflammation, abscess
Express milk, flucloxacillin
Acute mastitis
Cracked nipples from breast feeding allow S aureus to enter and cause acute inflammation
Post-trauma adipose necrosis
Firm painless lump w/ skin thickening
Obese
Fat necrosis
Adipocytes degenerate following trauma
Lumpy breasts
Multiple bilateral masses
Fibrocystic disease (formation of multiple small cysts that burst to cause fibrosis)
Breast mouse
Well circumscribed mobile lump
Commonest benign tumour of breast - shelling out is curative
Hormone responsive (pregnancy, menopause)
Fibroadenoma (benign proliferation of stroma)
Red roughened ulcerated nipple
Paget’s disease (like eczema of the nipple)
Painless breast lump
Dilatation of duct
Breast feeding
Galactocele (during breast feeding milk blocks duct but no infection)
Bloody discharge without lump (hidden in duct)
3D papillary clusters
Duct papilloma (benign proliferation of duct cells - tumour concealed within duct)
Incidental finding
Stellate
Radial scar (central core containing benign ducts)
Multi-focal + bilateral
Pre-menopausal
Histology: no calcificiation, no necrosis, normal nuclei
Better prognosis
Lobular carcinoma in situ
No invasion into BM
Carcinoma in situ
Single+ unilateral
Post-menopausal
Histology: calcification, central necrosis, pleiomorphic nuclei
Worse prognosis
Ductal carcinoma in situ
Is ductal or lobular carcinoma in situ best?
Ductal - less likely to progress to carcinoma
Hard fixed lump
Paget’s disease
Peau d’orange
Nipple retraction
Invasive carcinoma`
Most common carcinoma
80% ductal
15% lobular
5% tubular
Carcinoma RF
Increased unopposed oestrogen
BRCA (85% lifetime risk)
ER/PR +
Low grade
Tamoxifen response
HER2+
High grade
Herceptin response
4 determinants of prognosis
Axillary LN spread (best predictor)
Receptor status (indicates grade + chemo response)
Sub-type (ductal, lobular, tubular)
Grade (tubule formation + nuclear polymorphism + mitotic activity each scored /3 to produce score /9 - indicates how well differentiated)
Carcinoma grading
Nottingham modification of Blue-Richardson criteria
Tubule formation + nuclear polymorphism + mitotic activity
Each scored /3 to produce score /9 - indicates how well differentiated + therefore prognosis
Breast screening programme
Every 5y
47-73y
Mammogram
Sheets of atypical cells w/ lymphocyte infiltrate
CK5/6/14+
Basal-like carcinoma
