Breast Pathology Flashcards
First off list 5 benign breast conditions
1) Fibrocystic change
2) Fibroadenoma
3) Intraductal papilloma
4) Fat necrosis
5) Duct Ectasia
What is a fibroadenoma and who gets it?
Proliferation of the epithelial and stromal elements leads to a circumscribed mobile, non-painful nodule.
Occurs in women of reproductive age, peaking at 3rd decade
May regress with age if left untreated
When would we suspect fat necrosis?
If it looks clinically and on mammogram like a carcinoma
PLUS they have a h/o trauma or surgery
What benign conditions commonly cause nipple discharge?
Intraduct Papillomas & Duct Ectasia
Name a breast condition that can be benign and malignant?
Phyllodes tumour
What is a Phyllodes tumour?
- A fibroepithelial fleshy tumour
- leaf like pattern
- cysts on its cut surface
How many women get and die from breast carcinoma?
1 in 8 women (22% of all female cancers)
1 in 3 affected women die of it
How does a carcinoma of the breast look clinically?
A hard fixed mass that tethers to the skin
With “orange peel” skin dimpling
Where does breast carcinoma spread to?
1) Locally to skin & pecs
2) Lymphatically to axillary & internal mammary nodes
3) By blood to bones, lungs, liver and brain
What tests can we do to identify a breast carcinoma?
Exam Mammogram US MRI FNA or Core Biopsy Wide Local Excision
We histologically classify breast carcinoma into Non-invasive (in situ) and Invasive. What are the subtypes of carcinoma in-situ?
Ductal Carcinoma in-situ (DCIS)
Lobular Carcinoma in-situ (LCIS)
Carcinoma in-situ is pre-invasive so non-palpable and can’t be detected clinically, how do we find it then?
On breast cancer screening
How do we determine the risk a non-invasive carcinoma will become invasive?
By its grade, which requires biopsy.
Low grade DCIS - 30% in 15yrs
High Grade DCIS - 50% in 8yrs
LCIS - 19% in 25yrs
What are the subtypes of invasive carcinoma of breast and which is the most common?
- Invasive Ductal Carcinoma 85%
- Invasive Lobular Carcinoma 10%
- Special 5% (tubular, mucinous and medullary)
What do we use to estimate prognosis for breast carcinoma, and what factors is it based on?
the Nottingham Prognostic Index (NRI)
Uses size, grade and nodal status
Whats the 5yr survival for breast cancer?
64% mean 5yr survival
How do we determine if a breast carcinoma will respond to hormonal therapies?
Check if its Oestrogen receptor or Progesterone receptor +VE (ER/PR)
What are the risk factors for breast carcinoma?
1) Gender
2) Age
3) Early Menarche
4) Older age of first pregnancy
5) F/h & H/o
6) Radiation
7) Hormonal treatment
8) Obesity
9) Alcohol
10) Genetic Factors
What are the major genetic risk factors for breast carcinoma?
BRCA1 or BRCA2
What options do we have for managing breast cancer?
Surgery - Radical mastectomy or breast conserving surgery +/- lymph node removal
RT and Chemo
Hormonal therapy e.g. tamoxifen
What is Paget’s disease of the nipple?
An Intraepithelial spread of intraductal carcinoma
It leads to large pale-staining cells in the epidermis of the nipple
How does Paget’s disease of nipple present?
Pain & itching
Scaling
Redness
It’s easily mistaken for eczema
You may see ulcers, crusting and serous or bloody discharge
What are the major male pathologies of the breast?
Carcinoma (very rare)
Gynaecosmastia (actually quite common)
What can cause gynaecomastia?
- Hyperthyroidism
- Cirrhosis
- Chronic renal or pulm disease
- Hypogonadism
- Certain medications e.g. hormone therapies, spironolactone, Tricyclic Antidepressants and the dank erb
