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Breast: Pathology Flashcards

1
Q

What is tissues are present in the breast?

A
  • Epithelial ducts and lobules (glandular tissue)

- Mesnchymal fat and fibrous tissue

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2
Q

What doe physiological changes of breast occur with?

A

Age and pregnancy

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3
Q

What is breast structure dependent on?

A

Hormones: oestrogen and progesterone

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4
Q

What is the structure of the breast?

A
  • Each breast has 8 to 10 sections (lobes) arranged like the petals of a daisy
  • Inside each lobe are many smaller structures called lobules 
  • At the end of each lobule are tiny sacs (bulbs) that can produce milk
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5
Q

How do breasts develop during puberty?

A
  • Before puberty breasts in both sexes contain ducts
  • There is variable degrees of branching but lack of lobules
  • 15-25 lactiferous ducts
  • Branching starts at the nipple and extends to the terminal ductal lobular unit
  • Hormonally responsive
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6
Q

What do the lymph ducts of the breasts do?

A

Drain fluid that carries white blood cells from the breast tissues into lymph nodes in the axilla and behind the sternum

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7
Q

What do the lymph nodes of the breast do?

A

Filter harmful bacteria and play a key role in fighting off infection

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8
Q

Give examples of benign breast conditions.

A
  • Fibrocystic change
  • Fibroadenoma
  • Intraduct papilloma
  • Fat necrosis
  • Duct ectasia
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9
Q

What is fibrocystic change?

A
  • Fibrosis
  • Adenosis
  • Cysts
  • Apocrine metaplasia
  • Ductal epithelial hyperplasia (usual type, atypical)
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10
Q

What is a fibroadenoma?

A

Circumscribed mobile nodule in reproductive age

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11
Q

How does duct ectasia present?

A

Nipple discharge

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12
Q

How does fat necrosis occur?

A

Trauma

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13
Q

How does intraduct papilloma present?

A
  • Lactiferous ducts

- Nipple discharge

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14
Q

What is the most common breast tumour in adolescent and young adult women?

A

Fibroadenoma (peak age= 3rd decade)

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15
Q

What can happen to firboadenomas if left untreated?

A

Can regress with age

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16
Q

How do fibroadenomas present?

A
  • Well-circumscribed
  • Freely mobile
  • Nonpainful mass
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17
Q

What is the pathology behind fibroadenomas?

A

Proliferation of epithelial and stromal elements

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18
Q

What are the 2 types of growth pattern of fibroadenomas?

A

Intracanalicular pattern

  • Ducts distorted elongated
  • Slit-like structures

Pericanalicular pattern
-Ducts not compressed

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19
Q

How do tubular adenomas present?

A
  • Less common than fibroadenomas
  • Young women
  • Discrete, freely movable mass
  • Uniform sized ducts
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20
Q

How do lactating adenomas present?

A
  • Enlarging mass during lactation or pregnancy

- Prominent secretory change

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21
Q

Who is usually affected by intraduct papillomas?

A

Middle aged women

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22
Q

What histological features may be present in intraduct papillomas?

A

Epithelial hyperplasia (may be atypical)

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23
Q

How do intraduct papillomas present?

A

Nipple discharge

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24
Q

What may there be history of with fat necrosis?

A

Antecedent trauma or prior surgical intervention

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25
Q

What can be seen on mammography of fat necrosis?

A

Fibrosis, calcifications and egg shell

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26
Q

What can fat necrosis simulate clinically and mammographically?

A

Carcinoma

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27
Q

What can be see on histology of fat necrosis?

A
  • Histiocytes with foamy cytoplasm

- Lipid-filled cysts

28
Q

What percentage of breast tumours are made up by phyllodes tumours?

A

<1%

29
Q

What are phyllodes tumours?

A
  • Fleshy tumours with leaf like pattern and cysts on cut surface
  • They are circumscribed, connective tissue and epithelial ranged from 1-15cm
  • Most benign, small proportion malignant
30
Q

What type of metastasis is associated with phyllodes tumours?

A

Haematogenous

31
Q

What is the epidemiology of breast carcinoma?

A
  • Affects one in 8 females
  • 22% of all female cancers 
  • 1 in 870 men
  • Commonest cause of female cancer death (1/3 of affected women will die from disease)
  • 350 males yearly in the UK
  • 470,000 deaths worlwide
32
Q

How do breast carcinomas present on mammography?

A

Soft tissue opacity with calcification

33
Q

What is the macroscopic presentation of breast carcinomas?

A
  • Hard lump
  • Fixed mass
  • Tethering to the skin
  • Peau d’orange dimpling of skin
34
Q

What are the risk factors for breast carcinoma?

A
  • Gender 
  • Age 
  • Menstrual history
  • Age at first pregnancy
  • Radiation 
  • Family history
  • Personal history
  • Hormonal treatment
  • Genetic factors
  • Other factors: obesity, lack of physical activity, alcohol
35
Q

Give examples of breast lesions and their relative risk of cancer.

A

Epithelial proliferation without atypia
RR 1.5-2x

Epithelial proliferation with atypia ductal or lobular
RR 4-5x

Lobular carcinoma in situ
RR 8-10x

Ductal carcinoma in situ
RR 8-10x

36
Q

What percentage of breast cancer is attributable to inherited factors?

A

5-10%

37
Q

What genes confer susceptibility to breast cancer?

A
  • BRCA1 (20-40%)
  • BRCA2 (10-30%)
  • TP53 (<1%)
  • PTEN (<1%)
  • Other genes (30-70%)
38
Q

How can breast cancers be classified histologically?

A

Non invasive

  • DCIS
  • LCIS

Invasive

  • Invasive ductal carcinoma NST (~75%)
  • Invasive lobular carcinoma and its variants (5-15%)
  • Special types (all the rest)
39
Q

What are the features of an in situ carcinoma?

A
  • Preinvasive, does not form a palpable tumour
  • Not detected clinically, only x-ray in DCIS screening
  • Multicentricity and bilaterality (LCIS)
  • No metastatic spread
  • Risk of invasion depending on grade
40
Q

What is the risk of progression with in situ cancer?

A
  • Low grade DCIS: 30% in 15 years
  • High grade DCIS: 50% in 8 years
  • LCIS : 19% in 25 years and bilaterality
41
Q

Give examples of breast cancer of special types

A
  • Tubular carcinoma
  • Mucinous carcinoma
  • Carcinoma with medullary features
  • Metaplastic carcinoma
  • Other
42
Q

What investigations are carried out for breast cancer?

A
  • Clinical examination
  • Radiology (Mammogram, ultrasound, MRI)
  • Fine needle aspiration cytology FNA
  • Needle core biopsy
  • Wide local excision with adequate margin
43
Q

What is the breast screening programme?

A
  • Women aged 50-70 years are invited for mammogram every 3 years
  • Lead to 30% reduction in mortality
44
Q

What are microcalcifications?

A
  • Tiny deposits of calcium which can appear anywhere in the breast and often show up on mammogram?
  • Majority are harmless
  • Some may be precancerous or cancerous
45
Q

Who has microcalcifications?

A

Most women have 1 or more of various size

46
Q

What are the 2 most important mammographic indicators of breast cancer?

A
  • Masses

- Microcalcifications

47
Q

What is included in the histology report of a breast tumour?

A
  • Invasive vs. Non-invasive
  • Histological Type-Ductal (85%) vs. Lobular
  • Grade (estimate of the aggressiveness under microscope) .
  • Size .
  • Margins . 
  • Lymph Nodes .
  • Oestrogen/ Progesterone Receptor (2/3 positive) . 
  • HER-2/ neu
48
Q

Where can breast cancer spread locally?

A
  • Skin

- Pectoral muscles

49
Q

Where can breast cancer spread lymphatically?

A

Axillary and internal mammary nodes

50
Q

Where can breast cancer spread haematogenously?

A
  • Bone
  • Lungs
  • Liver
  • Brain
51
Q

What is prognosis of breast cancer dependent on?

A
  • Node status (best prognostic indicator)
  • Tumour size ( < 2cm )
  • Type 
  • Grade (1,2,3 ) 
  • Age
  • Lymphovascular space invasion
  • Hormone receptors
  • HER2 status
  • Proliferative rate
  • Gene expression profile
52
Q

What is the Nottingham prognostic index based on?

A
  • Tumour size
  • Grade
  • Nodal status
53
Q

What molecular markers are looked at in breast cancer for targeting treatments?

A
  • ER /PR strong predictors of response to hormonal therapies
  • ER/PR negative tumours do not respond
  • HER-2 : about 20-30% positive- predicts response to trastuzumab ( Herceptin
54
Q

What are the 5 molecular subtypes of breast cancer?

A
  • Basal like
  • Her 2+
  • Normal
  • Luminal A
  • Luminal B
55
Q

What are the features of luminal A breast cancer?

A
  • ER-positive
  • HER2-negative
  • Low Ki67
56
Q

What are the features of luminal B breast cancer?

A
  • ER-positive

- HER2-positive (or HER2-negative with high Ki67)

57
Q

What are the features of basal-like breast cancer?

A
  • ER negative
  • PR negative
  • HER2 negative
58
Q

What are the features of HER2 type breast cancer?

A
  • ER negative
  • PR negative
  • HER2 positive
59
Q

How is breast cancer managed?

A
  • Staging 
  • Surgery (mastectomy, breast conserving surgery – WLE) + lymph nodes
  • Radiotherapy 
  • Antihormonal therapy (Tamoxifen) 
  • Chemotherapy
60
Q

What is Paget’s disease of the nipple a result of?

A

Intrepithelial spread of intraductal carcinoma

61
Q

How does Paget’s appear on histology

A
  • Large pale-staining cells within the epidermis of the nipple 
  • Limited to the nipple or extend to the areol
62
Q

How does Paget’s disease present?

A
  • Pain or itching
  • Scaling and redness mistaken for eczema
  • Ulceration, crusting and serous or bloody discharge
63
Q

How common is carcinoma of the male breast?

A

<1% of all breast cancers

64
Q

What is gynaecomastia?

A
  • The most common clinical and pathologic abnormality of the male breast
  • Increase in subareolar tissue
  • 30-40% are bilateral
65
Q

What is gynaecomastia associated with?

A
  • Hyperthyroidism
  • Cirrhosis of the liver
  • Chronic renal failure
  • Chronic pulmonary disease
  • Hypogonadism
  • Hormone use
  • Digitalis, cimetidine, spironolactone, marihuana, tricyclic antidepressants

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