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Reproduction and sexual health > Breast pathology > Flashcards

Breast pathology Flashcards

1
Q

benign breast disease is very common/rare

A

common

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2
Q

what is the difference between cytopathology and histopathology

A

cytopathology - cells are obtained from fluid by FNA

histopathology - pieces of tissue are examined from biopsy

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3
Q

techniques for obtaining cells for cytopathology

A

FNA
fluid from cyst
nipple discharge
nipple scrape

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4
Q

How is breast FNA cytology categorised

A 
C1 - unsatisfactory 
C2 - benign  
C3 - atypia, probably benign 
C4 - suspicious of malignancy 
C5 - malignant
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5
Q

can FNA cytology differentiate between CIS and invasive carcinoma

A

no, which is why it is not used as much anymore

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6
Q

methods of obtaining breast histopathology samples

A

needle core biopsy
vacuum assisted biopsy
skin biopsy
incisional biopsy of a mass

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7
Q

how is needle core biopsy categorised

A 
B1 - unsatisfactory/normal
B2 - benign 
B3 - atypia, probably benign 
B4 - suspicious of malignancy 
B5 - malignant 
B5a CIS
B5b invasive carcinoma
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8
Q

what is a wide local excision also known as

A

breast conservation therapy

removes tumour with clear margin

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9
Q

what groups of benign breast disease are there

A

developmental anomalies
non-neoplastic
inflammatory
tumours

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10
Q

what is breast hypoplasia

A

condition where 1 or both breasts don’t fully mature or develop

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11
Q

what is breast juvenile hypertrophy

A

rapid growth of 1 or both breasts

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12
Q

list the benign breast developmental anomalies

A

hypoplasia
juvenile hypertrophy
accessory breast tissue
accessory nipple

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13
Q

what is accessory breast tissue

A

mass anywhere along the embryological mammary streak

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14
Q

what is an accessory nipple

A

minor malformation of mammary tissue resulting in an extra nipple

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15
Q

what non-neoplastic changes can occur in the breast

A 
gynaecomastia 
fibrocystic change 
hamartoma 
fibroadenoma 
sclerosing lesions
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16
Q

what inflammatory conditions of the breast are there

A

fat necrosis
duct ectasia
acute mastitis
abscess

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17
Q

what are the benign tumours of the breast

A

Phyllodes tumour

intraduct papilloma

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18
Q

what is gynaecomastia

A

breast development in males

ductal growth without lobular development

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19
Q

what are the causes of gynaecomastia

A

hormones - exogenous/endogenous
drugs - spironolactone, furosemide
cannabis
liver disease

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20
Q

who does fibrocystic change affect

A

women ages 20-50 (usually 40-50)

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21
Q

what is fibrocystic change associated with

A

menstrual abnormalities
early menarche
late menopause

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22
Q

fibrocystic change resolves after menopause, true or false

A

true

from reduced oestrogen

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23
Q

how does fibrocystic change present

A 
smooth discrete lumps
sudden pain (rupture or bleeding of cysts)
cyclical pain 
lumpiness
incidental / screening
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24
Q

what is the pathology of fibrocystic change

A

cysts

intervening fibrosis

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25
Q

what is a red flag in gross pathology

A

blood staining

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26
Q

define metaplasia

A

change of one fully differentiated cell type to another fully differentiated cell type

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27
Q

is metaplasia neoplastic/precursor lesion

A

no

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28
Q

management of fibrocystic change

A

exclude malignancy
reassure
only excise if it is a problem

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29
Q

define hamartoma

A

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

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30
Q

in which group of women is fibroadenoma common

A

African women

3rd decade of life

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31
Q

presentation of fibroadenoma

A

painless
firm
discrete
mobile mass “breast mouse” as it moves away from your finger as you try to examine it

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32
Q

pathological features of a fibroadenoma

A

localised hyperplasia

proliferation of intralobular stroma

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33
Q

is fibroadenoma a biphasic tumour, what does this mean

A

yes

there is overgrowth of 2 components: epithelium and stroma

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34
Q

features of a fibroadenoma

A

circumsribed
rubbery
grey white colour

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35
Q

management of fibroadenoma

A

diagnose
reassure
excise

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36
Q

what are the subtypes of sclerosing lesions of the breast

A

sclerosing adenosis
radial scar
complex sclerosing lesion

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37
Q

what are sclerosing lesions

A

benign, disorderly proliferation of acini and stroma

can cause a mass or calcification

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38
Q

sclerosing lesions may/may not mimic carcinoma radiologically

A

may mimic carcinoma

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39
Q

characteristics of sclerosing adenosis

A

pain/tenderness
lumpiness/thickening
asymptomatic
20-70 yo

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40
Q

characteristics of radial scar

A

wide age range

incidental findings

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41
Q

what is a radial scar called if:
1-9mm
>10mm

A 
1-9mm = radial scar 
>10mm = complex sclerosing lesion
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42
Q

histology of a radial scar

A

fibroelastic core
distorted ductules
fibrocystic change
epithelial proliferation

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43
Q

can CIS or invasive carcinoma occur within radial scars

A

yes

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44
Q

treatment of radial scars

A

excise or sample extensively by vaccum biopsy

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45
Q

causes of fat necrosis

A

local trauma

warfarin therapy

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46
Q

what is fat necrosis

A

damage to adipocytes
infiltration by acute inflammatory cells
foamy macrophages
subsequent fibrosis and scarring eg nipple indrawing

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47
Q

management of fat necrosis

A

confirm diagnosis

rule out malignancy

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48
Q

clinical features of duct ectasia

A 
pain 
acute episodic inflammatory changes 
bloody/purulent discharge 
fistulation 
periductal inflammation and fibrosis 
nipple retraction and distortion
49
Q

what does duct ectasia affect

A

sub areolar ducts

50
Q

what is duct ectasia associated with

A

smoking

51
Q

management of duct ectasia

A

treat acute infections
exclude malignancy
stop smoking
excise ducts

52
Q

what are the 2 main causes of mastitis and which organisms are responsible

A

duct ectasia - mixed organisms, anaerobes

lactation - staph A, strep pyogenes

53
Q

management of mastitis

A

antibiotics
percutaneous drainage
incision and drainage
treat underlying cause

54
Q

clinical features of Phyllodes tumour

A

40-50s
slow growing unilateral breast mass
biphasic tumour
stromal overgrowth > epithelium

55
Q

what is Phyllodes tumour also known as

A

Cytosarcoma phyllodes

56
Q

what are the categories of Phyllodes tumour

A

benign
borderline
malignant sarcomatous

57
Q

Are phyllodes tumours prone to recurrence if not adequately excised

A

yes

58
Q

list papillary lesions of the breast

A

intraduct papilloma
nipple adenoma
ecapsulated papillary carcinoma

59
Q

which age group os affected by intraduct papilloma

A

35-60

60
Q

clinical features of intraduct papilloma

A 
nipple discharge +- blood 
nodules 
calcification 
sub areolar ducts 
covered by MEp
61
Q

what kinds of epithelial proliferation can you get in an intraduct papilloma

A

none
usual type hyperplasia
atypical ductal hyperplasia
ductal carcinoma in situ

62
Q

what kind of malignant breast tumours can you get

A 
breast carcinoma 
non-epithelial breast malignancies 
metastases
malignant Phyllodes tumour
angiosarcoma
lymphoma
63
Q

risk factor for angiosarcoma of the breast

A

history of previous radiotherapy

64
Q

what is a malignant Phyllodes tumour treated as

A

sarcoma

65
Q

which tumours metastasise to the breast

A 
bronchial carcinoma
Ovarian serous carcinoma
clear cell carcinoma of the kidney 
malignant melanoma 
leiomyosarcoma
66
Q

define breast carcinoma and what is its technical name

A

malignant tumour of breast epithelial cells (ductal/acinar cells)
breast adenocarcinoma

67
Q

where does breast carcinoma arise from

A

glandular epithelium of the Terminal duct Lobular Unit TDLU

68
Q

where can precursor lesions arise in the breast

A

ductal

lobular

69
Q

list ductal precursor lesions of breast carcinoma

A

epithelial hyperplasia of usual type
columnar cell change +- atypia
atypical ductal hyperplasia
ductal carcinoma in situ

70
Q

list lobular precursor lesions of breast carcinoma

A

atypical lobular hyperplasia

lobular carcinoma in situ

71
Q

define carcinoma in situ CIS

A

cytologically malignant cells confined within basement membrane of acini and ducts

72
Q

what types of CIS are there

A

ductal

lobular

73
Q

what kinds of lobular in situ neoplasia are there

A

atypical lobular hyperplasia

lobular CIS

74
Q

what % of the lobule is involved in atypical lobular hyperplasia

A

<50%

75
Q

what % of the lobule is involved in lobular CIS

A

> 50%

76
Q

pathological characteristics of lobular in situ neoplasia

A

small nuclei
solid
ER positive
E-cadherin negative

77
Q

clinical features of lobular in situ neoplasia

A 
multifocal and bilateral 
reduced incidence after menopause (because ER+)
not palpable 
may calcify 
usually incidental
78
Q

what is the significance of lobular in situ neoplasia

A

marker of subsequent risk

true precursor lesion

79
Q

management of lobular in situ neoplasia

A

excision/vacuum biopsy
follow up
clinical trials

80
Q

where does ductal CIS arise

A

TDLU

81
Q

Pathological features of DCIS (ductal carcinoma in situ)

A

cytologically malignant epithelial cells
confined in basement membrane of duct
may involve lobules (cancerisation)
may involve nipple skin (Paget’s disease of the breast)

82
Q

how does Paget’s disease of the breast arise and is it invasive

A

high grade DCIS moves along the duct to nipple epidermis

Paget’s is still in situ as basement membrane is in tact

83
Q

how can you classify DCIS

A

cytological grade
histological type
presence of necrosis

84
Q

what is the significance of DCIS

A

RF for developing invasive carcinoma

true precursor lesion for invasive carcinoma

85
Q

management of DCIS

A

diagnose
surgery
adjuvant radiotherapy
chemoprevention

86
Q

what is microinvasive carcinoma

A

rare condition where high grade DCIS has gone through the basement membrane but invasion is <1mm

87
Q

how is microinvasive carcinoma treated

A

same as high grade DCIS

88
Q

what are the pathways of breast carcinogenesis

A

low, intermediate and high grade

89
Q

what does high grade DCIS turn into

A

G3 ductal carcinoma

90
Q

define invasive breast carcinoma

A

malignant epithelial cells which have breached the basement membrane
infiltration of normal tissue

91
Q

which age group is screened for breast cancer

A

50-70 year olds

92
Q

what are risk factors for breast carcinoma

A 
age 
reproductive history
OCP, HRT
previous breast disease
western countries
lifestyle 
alcohol
genetics
93
Q

which age group is screened for breast cancer

A

50-70 year olds

94
Q

what are risk factors for breast carcinoma

A 
age 
reproductive history: early menarche, late menopause, parity, breastfeeding (more oestrogen stimulation, increases risk)
OCP, HRT
previous breast disease
western countries
lifestyle - high BMI
alcohol
genetics
95
Q

what aspects of reproductive history increases the risk of breast cancer

A

early menarche
late menopause
nulliparity

96
Q

what lifestyle factors increase risk of breast cancer

A

high BMI
alcohol
less exercise

97
Q

what procedure could you consider in those with BRCA mutations

A

prophylactic mastectomies

98
Q

how is invasive breast carcinoma staged

A

T0-4, N1-3, M0-1
local invasion of breast stroma, skin, muscle
lymphatic involvement of axillae, internal mammary chain
blood spread to bone, liver, brain, lungs, female genital tract

99
Q

what procedure could you consider in those with BRCA mutations

A

prophylactic mastectomies

100
Q

how is invasive breast carcinoma staged

A

TNM
local invasion of breast stroma, skin, muscle
lymphatic involvement of axillae, internal mammary chain
blood spread to bone, liver, brain, lungs, female genital tract

101
Q

which group of lymph nodes do the majority of breast cancer spread to

A

axilla

102
Q

what are sentinel nodes

A

first nodes that drain the tumour

103
Q

how can invasive breast carcinoma be classified

A

morphologically
gene expression profiling
hormone receptor expression

104
Q

what does ER + mean

A

oestrogen receptor positive tumour

105
Q

what does PR + mean

A

progesterone receptor positive tumour

106
Q

what is the most common type of breast carcinoma

give examples of others too

A

ductal

lobular
mucinous
NST - no special type

107
Q

what does tumour grade mean

A

how well differentiated the tumour is

ie how similar it is to the parent tissue

108
Q

a well differentiated tumour is similar/not similar to its parent tissue

A

similar

109
Q

how can you assess the grade of breast carcinoma

A

tubular differentiation
nuclear pleomorphism
mitotic activity

110
Q

if a tumour is grade 1, what did it score

A

3, 4 or 5

111
Q

if a tumour is grade 2, what did it score

A

6 or 7

112
Q

if a tumour is grade 3, what did it score

A

8 or 9

113
Q

which hormone receptor is most commonly positive in tumours

A

ER +

114
Q

How do you manage ER+ tumours

A 
anti-oestrogen therapy 
oophorectomy 
tamoxifen 
aromatase inhibitors
GnRH agonists
115
Q

what does HER2 stand for

A

Human Epidermal growth factor Receptor 2

in abnormal cells there are many multiple copies

116
Q

what kind of drug is goserilin

A

GnRH agonist

117
Q

what treatment is available for HER2 + tumours

A

herceptin (trastuzamab)

118
Q

which cancer type (hormone receptor) has the best survival outcome

A

ER+
PR+
HER2 -

119
Q

list protective factors for breast cancer

A

NSAIDs
having children
breast feeding
maintaining healthy weight and exercise

Reproduction and sexual health (46 decks)

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