Breast Pathology Flashcards by Lauren Horsburgh

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

True

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

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

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

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

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What syndromes are associated with breast hypoplasia?

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

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

False - congenital nipple inversion is benign

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

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

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

When breastfeeding

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What are the symptoms of acute mastitis?

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

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

True

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Why is acute mastitis more common during breastfeeding?

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

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

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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What is the cause of periductal mastitis?

The central ducts become inflamed, blocked and dilated

Associated with chronic inflammation and scarring

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

Smoking

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What are the symptoms of periductal mastitis?

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

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

True

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What causes fat necrosis of the breast?

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

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

Necrotic fat
Chronic inflammation
Presence fo multinucleate cells

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

It can be mistaken for cancer

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

True

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

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

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

Fibrocystic change

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What is the cause of fibrocystic change in the breast?

Aberrant response of normal breast tissue to fluctuations in cyclical hormones

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

Multiple lumps and bumps in the breast tissue

Often worse before menstruation

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

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

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

Micro-calcification

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

Adenosis

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

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

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

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

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

True

What is the median age for a breast cancer diagnosis?

mid 60s

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

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

What are the possible signs and symptoms of breast cancer?

``` 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 ```

At what age are women invited for breast cancer screening?

50 - 70

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

Every 3 years

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

Ultrasound

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

Mammography (x-ray)

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

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

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

Wide local excision | Mastectomy

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

Size and stage of tumour Size of breast Location of tumour

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

Radiotherapy

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

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

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

When tumours are large, multiple or extensive

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

True

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?

Poor arm function | Gross arm oedema following surgery

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

Sentinel node biopsy

What is the sentinel node?

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

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

No further treatment required

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

Further treatment via surgery or axillary radiotherapy

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

Oestrogen, progesterone, HER2

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

Tamoxifen

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?

Aromatase inhibitors such as letrozole

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

Triple negative breast carcinomas

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

This predicts a poorer prognosis

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

Nottingham prognostic index

What are the two types of dysplastic breast tumours?

Ductal carcinoma in situ | Lobular carcinoma in situ

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

Terminal duct lobular unit

What features are exhibited by dysplastic breast lesions?

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

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

Ductal carcinoma in situ

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?

True

How is ductal carcinoma in situ treated?

Surgery but without axillary surgery

What is the most common type of breast cancer?

Ductal carcinoma

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

True

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

False

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

Lobular carcinoma

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

True

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

E-cadherin

Give examples of 'special types' of invasive malignancy in the breast.

Papillary / micropapillary Tubular Medullary Mucinous

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

True

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

True

What is the most common benign neoplasm in the breast?

Fibroadenoma

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

True

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

Giant lobule | Expanded and distorted tissue

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

False - these are more common in older patients

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

True

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

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

Phyllodes tumours are always benign. T/F?

False - they are usually, but not always, benign

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

Intra-duct neoplasm

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

True

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

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