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Female GU / Breast > Breast Pathology > Flashcards

Breast Pathology Flashcards

1
Q

Ectopic breast tissue is capable of exhibiting all of the pathologies which might be found in normal breast tissue. T/F?

A

True

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2
Q

Where in the body would ectopic breast tissue commonly be found?

A

In the ‘milk line’ between the axilla and the groin.

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3
Q

Ectopic breast tissue is only every composed of glandular material. T/F?

A

False - it may be fully formed and might include a nipple

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4
Q

What syndromes are associated with breast hypoplasia?

A

Ulnar-mammary syndrome
Poland syndrome
Turner’s syndrome
Congenital adrenal hyperplasia

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5
Q

Nipple inversion present from birth is a sign of breast malignancy. T/F?

A

False - congenital nipple inversion is benign

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6
Q

New nipple inversion is always a sign of breast malignancy. T/F?

A

False - this may be a sign of breast malignancy but this is not always the case

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7
Q

When would a woman be most likely to experience acute mastitis?

A

When breastfeeding

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8
Q

What are the symptoms of acute mastitis?

A 
Flu like symptoms
Fever
Breast pain
Decreased milk outflow
Breast warmth, firmness, erythema, swelling and tenderness
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9
Q

It is possible to have abscess formation with acute mastitis. T/F?

A

True

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10
Q

Why is acute mastitis more common during breastfeeding?

A

Breastfeeding can cause fissuring of the skin which allows the entry of organisms and stagnant milk allows the growth of these organisms

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11
Q

What are the possible causes of granulomatous inflammation of the breast?

A

Systemic granulomatous diseases such as tuberculosis and sarcoidosis
Idiopathic granulomatous mastitis (when infection has been clinically excluded)
Reactions to ruptured implants

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12
Q

Why is it important that infection is clinically excluded before diagnosing idiopathic granulomatous mastitis?

A

The treatment for idiopathic granulomatous mastitis is with steroids which are immunosuppressants which would make an infectious cause of granulomatous breast disease worse

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13
Q

What is the cause of periductal mastitis?

A

The central ducts become inflamed, blocked and dilated

Associated with chronic inflammation and scarring

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14
Q

What lifestyle factor is related to the development of periductal mastitis?

A

Smoking

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15
Q

What are the symptoms of periductal mastitis?

A

Redness, swelling and tenderness around nipple
Mass beneath nipple
Nipple retraction
Nipple discharge

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16
Q

Periductal mastitis can cause a breast abscess. T/F?

A

True

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17
Q

What causes fat necrosis of the breast?

A

Trauma including external trauma, previous surgery or other inflammatory conditions which damages the breast fat.

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18
Q

What is the histological appearance of fat necrosis in the breast?

A

Necrotic fat
Chronic inflammation
Presence fo multinucleate cells

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19
Q

Fat necrosis can manifest as a lump, Why is this significant?

A

It can be mistaken for cancer

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20
Q

The boundary between hyper plastic and dysplastic change in breast tissue can be blurred. T/F?

A

True

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21
Q

What types of hyperplastic lesions in the breast can increase the risk of breast cancer or are related to dysplasia?

A

Some types of columnar cell change
Atypical forms of ductal hyperplasia
In-situ lobular neoplasia

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22
Q

What type of hyperplastic change in the breast is most common?

A

Fibrocystic change

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23
Q

What is the cause of fibrocystic change in the breast?

A

Aberrant response of normal breast tissue to fluctuations in cyclical hormones

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24
Q

What is the clinical presentation of fibrocystic change in the breast?

A

Multiple lumps and bumps in the breast tissue

Often worse before menstruation

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25
Q

What microscopic abnormalities can be present in fibrocystic change in the breast?

A 
Small and large cysts
More glands or lobar tissue
More fibrous stroma
Epithelial hyperplasia
Apocrine metaplasia
Micro-calcification
Columnar cell changes
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26
Q

What microscopic abnormalitiy, which is sometimes seen in fibrocystic change of the breast, can be seen on mammography?

A

Micro-calcification

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27
Q

In fibrocystic change in the breast, there is often an increased the glandular and lobular tissue. What is the term for this?

A

Adenosis

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28
Q

In fibrocystic change in the breast, there can be apocrine metaplasia. What does this mean?

A

The epithelial cells of the cysts change to look like apocrine sweat glands

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29
Q

A radial scar is a hyperplastic change in the breast. What characteristic of radial scars differentiate it from breast cancer?

A

Fibrosis and elastic material at centre
Star shaped or flower head appearance
Trapped glands are only. ‘pseudo-infiltrative’
Myoepithelial cells present

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30
Q

Myoepithelial cells are not present in breast cancers. T/F?

A

True

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31
Q

What is the median age for a breast cancer diagnosis?

A

mid 60s

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32
Q

What are the risk factors for the development of breast cancer?

A

Early menarche, late menopause, late 1st pregnancy
HRT therapy, oral contraceptive use
Dense breast on mammography
Alcohol and smoking
Positive FHx
Rare genetic syndromes e.g. BRCA1+2, Li Fraumeni syndrome

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33
Q

What are the possible signs and symptoms of breast cancer?

A 
Lumps
Thinkings
Skin changes such as redness and pen d'orange
New nipple inversion
Rashes and redness of the nipple
Nipple discharge
Lump in the axilla
34
Q

At what age are women invited for breast cancer screening?

A

50 - 70

35
Q

How often are women invited for mammograms for breast cancer screening?

A

Every 3 years

36
Q

What imaging technique would be used to investigate possible breast cancer in young women?

A

Ultrasound

37
Q

What imaging technique would be used to investigate possible breast cancer in older women?

A

Mammography (x-ray)

38
Q

What techniques can be used to provide tissue samples for diagnosis of breast cancer?

A

Fine needle aspiration provides cytology samples
Core biopsy provides histology sample
Excision biopsy is both diagnostic and often therapeutic

39
Q

What are the two surgical options in the treatment of breast cancer?

A

Wide local excision

Mastectomy

40
Q

What factors influence the type of surgery used to treat breast cancer?

A

Size and stage of tumour
Size of breast
Location of tumour

41
Q

What other cancer treatment method is usually used alongside wide local excision in the treatment of breast cancer?

A

Radiotherapy

42
Q

Once wide local excision of a breast cancer has taken place, why is the sample coated in a black dye?

A

To mark the margin of the sample so that surgical margin can be assessed by the pathologists

43
Q

When would mastectomy rather than wide local excision be used in the treatment of breast cancers?

A

When tumours are large, multiple or extensive

44
Q

Chemotherapy can be used to shrink breast tumours to make wide local excision posissible. T/F?

A

True

45
Q

If breast cancer has spread to the axillary lymph nodes it may be necessary to excise all of these nodes. What are the long-term consequences of this?

A

Poor arm function

Gross arm oedema following surgery

46
Q

What is the modern alternative to excising all the axillary nodes in a patient with breast cancer?

A

Sentinel node biopsy

47
Q

What is the sentinel node?

A

The node in which cancer will likely spread to first before it involves any other axillary nodes

48
Q

If no tumour is found in a sentinel node biopsy in breast cancer treatment, what is the next step?

A

No further treatment required

49
Q

If a tumour is found in a sentinel node biopsy in breast cancer treatment, what is the next step?

A

Further treatment via surgery or axillary radiotherapy

50
Q

Breast cancers are tested for the presence of which hormone receptors?

A

Oestrogen, progesterone, HER2

51
Q

Give an example of a drug used in the hormonal treatment of breast cancers?

A

Tamoxifen

52
Q

In post-menopausal women there is no endogenous oestrogen from the ovaries but oestrogen can be produced in soft tissues such as the fat of the breast, What class of drug can be used to inhibit this process?

A

Aromatase inhibitors such as letrozole

53
Q

Chemotherapy following surgery is particularly useful in the treatment of what kinds of breast cancers?

A

Triple negative breast carcinomas

54
Q

If a breast cancer is positive for the HER2 receptor, how does this affect the prognosis?

A

This predicts a poorer prognosis

55
Q

What method can be used to combine the stage and grade of a breast tumour to determine prognosis?

A

Nottingham prognostic index

56
Q

What are the two types of dysplastic breast tumours?

A

Ductal carcinoma in situ

Lobular carcinoma in situ

57
Q

Both type of dysplastic breast tumour arise from which part of the breast tissue?

A

Terminal duct lobular unit

58
Q

What features are exhibited by dysplastic breast lesions?

A

Malignant looking proliferation of epithelial cells within basement membrane
No extension into breast stroma
No communication with blood vessels of lymphatics
No possibility of metastases

59
Q

Which type of dysplastic breast tumour is more likely to progress to breast cancer?

A

Ductal carcinoma in situ

60
Q

A significant percentage of patients with ductal carcinoma in situ will already have a breast carcinoma but this just hasn’t been picked up on in the biopsy. T/F?

A

True

61
Q

How is ductal carcinoma in situ treated?

A

Surgery but without axillary surgery

62
Q

What is the most common type of breast cancer?

A

Ductal carcinoma

63
Q

Ductal carcinoma of the breast exhibits the classic signs of malignancy. T/F?

A

True

64
Q

Lobular carcinoma of the breast exhibits the classic signs of malignancy. T/F?

A

False

65
Q

Other than ductal carcinoma of the breast, what is the most common type fo breast cancer?

A

Lobular carcinoma

66
Q

Lobular carcinoma is likely to be bilateral and/or multifocal. T/F?

A

True

67
Q

Which molecule is lost in lobular carcinoma cells in the breast?

A

E-cadherin

68
Q

Give examples of ‘special types’ of invasive malignancy in the breast.

A

Papillary / micropapillary
Tubular
Medullary
Mucinous

69
Q

Invasive breast neoplasms can, in rare cases, be sarcomas, lymphomas and malignant phyllodes. T/F?

A

True

70
Q

Benign neoplasms will form a mass which will continue to grow despite removal of the stimulus. T/F?

A

True

71
Q

What is the most common benign neoplasm in the breast?

A

Fibroadenoma

72
Q

Benign breast lumps are more likely to be mobile than tethered. T/F?

A

True

73
Q

What is the miscroscopic appearance of a fibroadenoma of the breast?

A

Giant lobule

Expanded and distorted tissue

74
Q

Phyllodes tumours are common in younger patients. T/F?

A

False - these are more common in older patients

75
Q

Fibroadenomas of the breast are common in younger patients. T/F?

A

True

76
Q

Microscopically, how does a phyllodes tumour differ from a fibroadenoma?

A

These are more cellular, more mitotic and more atypical than a fibroadenoma. They are also often larger tumours

77
Q

Phyllodes tumours are always benign. T/F?

A

False - they are usually, but not always, benign

78
Q

What type of benign neoplasm can occur just below the nipple?

A

Intra-duct neoplasm

79
Q

Patients with an intra-duct neoplasm often present with nipple discharge. T/F?

A

True

80
Q

How is papillomatosis different from intra-duct neoplasm of the breast?

A

Papillomatosis occurs in the small. ducts at the periphery of the breast
Intra-duct neoplasm occurs below the nipple

Female GU / Breast (7 decks)

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