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Breast Pathology Flashcards

1
Q

what does “triple assessment” entail when assessing patient with breast disease?

A

clinical - history and exam

imaging - mammography, US, MRI

pathology - cytopathology, histopathology

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2
Q

how can breast cytopathology be carried out?

A

fine needle aspiration (FNA)
fluid
nipple discharge
nipple scrape

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3
Q

how is breast FNA cytology classified?

A 
C1 - unsatisfactory 
C2 - benign 
C3 - atypica, probably benign 
C4 - suspicious of malignancy 
C5 - malignant
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4
Q

what are diagnostic methods of breast histopathology?

A

needle core biopsy
vacuum assisted biopsy (large mass)
skin biopsy
incisional biopsy or mass

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5
Q

what are therapeutic methods of breast histopathology?

A

vacuum assisted excision
excisional biopsy of mass
resection of cancer - wide local excision, mastectomy

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6
Q

how can breast needle core biopsy be classified?

A 
B1 - unsatisfactory / normal 
B2 - benign 
B3 - atypia, probably benign 
B4 - suspicious of malignancy 
B5 - malignant (B5a = carcinoma in situ, B5b = invasive carcinoma)
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7
Q

what are developmental anomalies which are benign breast disease?

A

hypoplasia
juvenile hypertrophy
accessory breast tissue
accessory nipple

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8
Q

what are the non-neoplastic benign breast diseases?

A 
gynaecomastia 
fibrocystic change 
hamartoma
fibroadenoma 
sclerosing lesions (sclerosing adenosis, radial scar / complex sclerosing lesions)
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9
Q

what are inflammatory causes of benign breast disease?

A

fat necrosis
duct ectasia
acute mastitis / abscess

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10
Q

what are the benign tumours within the breast?

A

phyllodes tumour

intraduct papilloma

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11
Q

what is gynaecomastia?

A

breast development in the male

ductal growth without lobular development

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12
Q

what are the causes of gynaecomastia?

A

exogenous / endogenous hormones
cannabis
prescription drugs
liver disease

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13
Q

who does fibrocystic change normally occur in?

A

women aged 20-50

*majority 40-50

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14
Q

fibrocystic change is very common - true or false?

A

true - 19-34% in autopsy studies

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15
Q

what are the different causes of fibrocystic

A

menstrual abnormalities (particularly anovulatory cycles)
early menarche
late menopause
often resolve or diminish after menopause

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16
Q

how does fibrocystic change present?

A 
smooth discrete lumps 
sudden pain 
cyclical pain 
lumpiness 
incidental finding 
screening
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17
Q

what does fibrocystic change look like on gross pathology?

A

cysts

  • 1mm - several cm
  • blue domed with pale fluid
  • usually multiple
  • assoc with other benign changes

intervening fibrosis

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18
Q

what does fibrocystic change look like on microscopic pathology?

A

cysts

  • thin walled but may have fibrotic wall
  • lined by apocrine epithelium

intervening fibrosis

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19
Q

what is the definition of metaplasia?

A

the change from one fully differentiated cell type to another fully differentiated cell type

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20
Q

what is the management of fibrocystic change?

A

exclude malignancy
reassure
excise if necessary

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21
Q

what is a hamartoma?

A

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

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22
Q

who is fibroadenomas more common in?

A

african women

*these are common and usually solitary

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23
Q

what are the clinical features of a fibroadenoma?

A 
peak incidence in 3rd decade 
picked up on screening 
painless, firm, discrete, mobile mass
"breast mouse" - move about
solid on US
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24
Q

what does a fibroadenoma look like?

A

circumscribed
rubbery
grey-white colour
biphasic tumour / lesion (epithelium, stroma)

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25
how are fibroadenomas treated?
diagnose reassure excise
26
what are sclerosing lesions?
benign, disorderly proliferation of acini and stroma can cause a mass or calcification may mimic carcinoma
27
how does sclerosing adenosis usually present?
pain, tenderness or lumpiness / thickening asymptomatic age 20-70 *these are benign, no further treatment necessary
28
what does radial scar look like pathologically?
stellate architecture central puckering radiating fibrosis
29
what does radial scar look like histologically?
fibroelastotic core radiating fibrosis containing distorted ductules fibrocystic change epithelial proliferation
30
in situ or invasive carcinoma may occur with radial scar lesions - true or false?
true they often show epithelial proliferation and mimic carcinoma radiologically
31
what is the treatment of radial scar?
excise or sample extensively by vacuum biopsy
32
what can cause fat necrosis of breast?
local trauma - seat belt injury, frequently no history warfarin therapy
33
what does fat necrosis look like?
damage and disruption of adipocytes infiltration by acute inflammatory cells "foamy" macrophages subsequent fibrosis and scarring
34
what is the treatment of fat necrosis?
confirm diagnosis | exclude malignancy
35
what are the clinical features of duct ectasia?
``` affects sub-areolar ducts pain acute episodic inflammatory changes blood and/or purulent D/C fistulation nipple retraction and distortion ```
36
what lifestyle habit is duct ectasia associated with?
smoking
37
what is the management of duct ectasia?
treat acute infections exclude malignancy stop smoking excise ducts
38
what are the 2 main causes of acute mastitis / abscess?
duct extasia - mixed organisms, anaerobes lactation - staph aureus, strep pyogenes
39
what is the management of acute mastitis / abscess?
antibiotics percutaneous drainage incision and drainage treat underlying cause
40
what are the clinical features of a phyllodes tumour?
40-50 | slow growing unilateral breast mass
41
what are the characteristics of a phyllodes tumour?
biphasic tumour stromal overgrowth *behaviour depends on benign, borderline or malignant (sarcomatous)
42
phyllodes tumours are not prone to local recurrence - true or false?
false - prone to local recurrence if not adequately excised
43
do phyllodes tumours often metastasise?
no
44
what are the clinical features of intraduct papilloma?
age 35-60 nipple discharge +/- blood asymptomatic at screening (nodules, calcification)
45
what does intraduct papilloma look like?
sub-areolar ducts 2-20mm diameter papillary fronds containing a fibrovascular core covered by myoepithelium and epithelium epithelium may show proliferative activity
46
what determines the severity / what we call intraduct papilloma?
the epithelial proliferation - none - usual type hyperplasia - atypical ductal hyperplasia - ductal carcinoma in situ
47
malignant phyllodes tumours occur due to overgrowth of what component?
stroma * this is why it is called sarcomatous * they appear slightly like a fibroadenoma
48
when do angiosarcomas usually occur in the breast?
after radiation
49
what other malignant tumours can occur in the breast?
malignant phyllodes angiosarcinoma lymphoma (breast / lymph nodes) mets from other cancers
50
what other cancers can potentially metastasise to the breast?
carcinomas - bronchial, ovarian serous, clear cell kidney melanoma uterine leiomyosarcoma
51
what makes a breast cancer a "carcinoma"
tumour of glandular epithelium in the TDLU ductal / acinar epithelial cells are affected
52
what various precursor lesions may be identified prior to development of a ductal cancer?
usual type epithelial hyperplasia columnar cell change atypical ductal hyperplasia ductal carcinoma in situ (DCIS)
53
what various precursor lesions may be identified prior to development of a lobular cancer?
lobular in situ neoplasia (LISN) atypical lobular hyperplasia lobular carcinoma in situ (LCIS)
54
what makes a cancer of the breast "in situ"?
confined within basement membrane cytologically malignant but non-invasive
55
describe how lobular in situ neoplasia would be identified?
often ER positive - stimulated by oestrogen so often incidence decreases after menopause multiple and bilateral not palpable or grossly visible may calcify - seen on mammography usually incidental finding
56
many causes of lobular in situ neoplasia are identified on core biopsy yet higher grade lesions are found on open biopsy - true or false?
true
57
lobular in situ neoplasia can put patients at risk of invasive carcinoma and other lesions - true or false?
true
58
if lobular in situ neoplasia is found on core biopsy, what is the next step to exclude other lesions?
excision or vacuum biopsy to exclude higher grade lesion if LISN is discovered on larger biopsy then follow up and clinical trials
59
what is meant by atypical duct hyperplasia?
duct formation within other ducts
60
describe the appearance of high grade DCIS?
necrosis in centre of duct as not receiving nutrients from out in stroma large atypical cells large nuclei mitotic figures
61
how many duct systems are usually involved in DCIS?
one - singular duct system
62
how can DCIS spread locally?
may involve lobules (cancerisation) may involve nipple skin (Pagets - still in situ)
63
how is ductal carcinoma in situ (DCIS) treated?
surgery mammographic follow up if low risk adjuvant radiotherapy chemoprevention endocrine therapy
64
what is microinvasive DCIS defined as?
DCIS (high grade) with invasion of <1mm
65
is the incidence of breast cancers increasing or decreasing?
increasing
66
what age does breast screening normally take place and why?
50-70 most people diagnosed at this age so screening most cost effective
67
what are the main risk factors for carcinoma of breast?
``` age more oestrogen exposure previous breast disease geography (western world) life-style genetics ```
68
what can increase a patients oestrogen exposure and put them at higher risk of breast cancer?
age at menarche / menopause later age at first birth decreased parity lack of breast feeding hormones (OCP, HRT)
69
what lifestyle factors can increase a patients risk of breast cancer?
``` bodyweight alcohol consumption diet NSAIDs (lowers the risk) smoking ```
70
where do breast cancers locally spread to?
stroma of breast skin muscles of chest wall
71
what lymph nodes do breast cancers normally infiltrate?
sentinel nodes drain tumour first - if not affected no need for axillary clearance most cancers will drain from sentinel to axillary some medial cancers will drain to internal mammary node
72
where do breast cancers normally metastasise to?
``` bone liver brain lungs abdominal viscera female genital tract ```
73
what is the difference between grade and stage of tumour?
grade = how differentiated lesion is stage = how far it has spread in body
74
what treatments can be aimed at tumours with oestrogen receptor expression?
oophrectomy tamoxifen aromatase inhibitors (letrozole) GnRH antagonists (zoladex inj)
75
what treatments can be aimed at tumours expressing the HER2 receptor?
trastuzaman (herceptin)

Breast (6 decks)

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