Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Reproduction & Sexual Health > Breast pathology > Flashcards

Breast pathology Flashcards

1
Q

Features of a typical benign aspirate?

A

apocrine cells (ductile epithelial cells in honeycomb sheet)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Features of a malignant breast aspirate?

A

enlarged cells, some are very dark and falling apart, degenerate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the significance of C5 cytological sample by FNA?

A

C5 normally means malignant but in breast tissue it doesn’t indicate if the cells are invasive or just within the duct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the gold standard diagnostic test for breast cancer? Why is it used more now?

A

needle core biopsy

can give categories B5a (carcinoma in situ) and B5b (invasive carcinoma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the difference in prognosis with B5a and B5b breast cancer?

A

carcinoma in situ (5a) is localised to one segment since lobules supply one lobe of breast each; whereas invasive carcinoma (5b) is not confined to one segment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Where is the milk line? What can appear anywhere on this line?

A

from nipple down anterior abdominal wall - accessory breast tissue can develop anywhere down this line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Patient in a minor RTA but was wearing seatbelt so no t much damage. She presents soon after the accident to GP complaining of a sore, red, hot left breast.
Diagnosis?

A

fat necrosis - common after trauma, seatbelt is clue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What type of growth is seen in gynaecomastia?

A

ductal growth WITHOUT lobular development

hyper plastic epithelium, almost always benign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

List some causes of gynaecomastia.

A

exogenous/endogenous hormones
cannabis
prescription drugs (spironolactone, digoxin)
liver disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Why would anovulatory menstrual cycles be linked with fibrocystic (non-neoplastic) change?

A

prolonged oestrogen stimulation (no ovum released - no corpus luteum to switch off oestrogen production)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

45 y/o woman presents with cyclical pain, lumps which are smooth and discrete. She noticed them after checking her breasts in the shower, she says both breasts feel lumpy.

A

fibrocystic change - smooth discrete lumps are cysts, benign

exclude malignancy, reassure, excise if necessary (most resolve or diminish after menopause)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

cytology of breast tissue shows thin-walled structures which are blue domed and have pale fluid in centre. There appears to be intervening fibroids and they are lined by apocrine sweat glands.
Pathology?

A

Fibrocystic change - cysts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is metaplasia?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Hamartoma definition.

A

Circumscribed lesion composed of cell types normal to the breast but present in an abnormal (architectural) proportion or distribution.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Most common lump in young women?

A

Fibroadenoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

African lady presents aged 40 asking for her breasts to be checked. She thought she felt a firm, painless lump in her right breast but isn’t sure. You examine her and feel a firm, discrete mass which seems to move with your palpation.
Diagnosis?

A

Fibroadenoma
“breast mouse” - moves away from finger as examined

diagnose, reassure, excise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Why is a fibroadenoma described as a biphasic tumour/lesion?

A

epithelium - localised hyperplasia

stroma - proliferation of interlobular stroma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

benign, disorderly proliferation of acini and stroma

A

sclerosing adenosis / complex sclerosis lesion (radial scar)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

50 y/o woman presents for breast screening - she has no symptoms.
Mammography is done and a central area of low density with long spiculated bands running concentrically are seen. The mass is calculated as being 8mm in size.
Diagnosis and treatment?

A

radial scar since 1-9mm
complex sclerosis lesion = >10mm

probably not malignant but in situ or invasive carcinoma may occur within these lesions

treatment - excise or sample extensively by vacuum biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

sclerosing adenosis

A

benign proliferative condition of the terminal duct lobular units characterised by an increased number of acini and their glands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

50 y/o woman presents with cyclical breast pain and complaints of tender and “thickened” breast tissue. Multiple small firm nodules felt.
Diagnosis and treatment?

A

sclerosis adenosis - small lumps are calcifications

negligible risk of subsequent carcinoma - no further treatment necessary.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Screening mammogram showed central puckering, stellate architecture and radiating fibrosis. What would you expect histology to show?

A

fibroelastic core
radiating fibrosis containing distorted ductules
fibrocystic change
epithelial proliferation

radial scar/complex sclerosing lesion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

causes of fat necrosis

A

local trauma - seat belt injury, dogs jumping up on women

initiation of warfarin therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Which ducts are affected in duct ectasia?

A

sub-areolar ducts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
55 y/o female smoker presents with a Hx of mild breast pain over past months but has now noticed a green coloured discharge from her nipple area. The pain has increased since noticing this discharge and her nipple is also retracted. Diagnosis and management?
duct ectasia which has become infected | treat acute infection, exclude malignancy, stop smoking, excise ducts to stop recurrence.
26
Likely organisms for non-lactating mastitis? treatment?
mixed organisms, anaerobes flucloxacillin 1g qds + 400mg metronidazole tds OR co-trimoxazole 960mg bd + metronidazole 400mg tds 7 days
27
Likely organisms for lactating mastitis? treatment?
staph aureus & strep pyogenes NSAIDs + warm compresses at first and if no improvement by 12-24hrs move to antibiotics. flucloxacillin 1g qds or clindamycin 450mg tds for 7-10days
28
50 y/o patient presented with a slow growing unilateral breast mass. You palpate the mass and think it is around 5cm in size. Histology shows variation in stromal overgrowth from benign to borderline. Diagnosis and management?
Phyllodes tumour Prone to local recurrence if not excised adequately; rarely metastasise. Wide local excision (1cm).
29
List some possible papillary lesions. Age range of patients and some common features?
Intra-duct papilloma Nipple adenoma Encapsulated papillary carcinoma Age 35-60 Nipple discharge ± blood Asymptomatic at screening - calcification / nodules.
30
Pathology of intraduct papilloma?
originate from walls of milk (sub-areolar) ducts, typically grow within the duct and cause local obstruction. Covered by myoepithelium and epithelium; fibrovascular core with papillary frond, forming a small, smooth well-circumscribed nodules.
31
What size are papillomas?
2-10mm
32
Epithelium covering papillomas may show proliferative activity. Which type of proliferation might be seen in benign introduction papilloma (IDP)?
none or usual type hyperplasia (UTH) --> benign IDP
33
Apart from benign IDP, what other type of epithelial proliferation might be seen?
IDP with atypical ductal hyperplasia (ADH) | IDP with ductal carcinoma in situ (DCIS) / Papillary DCIS
34
What type of nipple discharge would not worry you?
clear, yellow and watery discharge - can be elicited from the nipples of women of reproductive age.
35
What type of nipple discharge would worry you?
bloody discharge especially from a single duct
36
Commonest cause of spontaneous nipple discharge?
intraductal papilloma - benign lesions
37
When might nipple discharge be a sign of malignancy?
when there is an associated palpable mass
38
What investigations are done for pathological nipple discharge?
mammography, ultrasound, surgical excision of the discharging ducts (to establish cause and relieve the discharge)
39
50 y/o woman present with nipple discharge. The left nipple is indurated with some superficial erosion. She reports it being previously dry and eczematous lesion around the areola. But it is now red and weeping. Investigation and diagnosis?
incisional or punch biopsy for histology | high grade DCIS extending along ducts to reach epidermis of nipple = Paget's disease of nipple
40
Which tumours are likely to metastasise to the breast?
bronchial carcinoma, ovarian serous carcinoma, clear cell carcinoma of kidney malignant melanoma leiomyosarcoma (uterine)
41
Describe breast carcinoma.
malignant tumour of breast epithelial cells - ductal or acinar epithelial cells. Arise in the glandular epithelium of the terminal duct lobular unit (TDLU). technically an adenocarcinoma since arise from glandular epithelium
42
describe atypical ductal hyperplasia (ADH)
(incomplete) ducts forming within established ducts
43
Where is carcinoma in-situ found and what does cytology show?
confined within basement membrane of acini and ducts | cytologically malignant but non-invasive
44
There are 2 types of lobular in situ neoplasia, what are they?
Atypical lobular hyperplasia (ALH): <50% of lobule involved. | Lobular carcinoma in situ (LCIS): >50% of lobule involved
45
Describe the characteristic cells fo intra-lobular proliferation.
``` small-intermediate sized nuclei solid proliferation intra-cytoplasmic lumens/vacuoles ER positive E-cadherin negative ```
46
What is the significance of E-cadherin molecule in breast carcinoma diagnosis?
e-cadherin is a cell adhesion molecule; deletion & mutation of CDH1 gene on chromosome 16 is useful for diagnosis of ALH/LCIS (E-cadherin negative)
47
Incidence of lobular in situ neoplasia (LCIS/ALH) increases after menopause. T/F?
FALSE incidence decreases after menopause since the cells are oestrogen receptor (ER) positive which means they require oestrogen to grow (levels drop after menopause)
48
List some features of LCIS/ALH.
frequently multifocal & bilateral not palpable, not visible grossly may calcify - mammography usually an incidental finding
49
Lobular neoplasia is discovered on core biopsy. What do you do?
Excision or vacuum biopsy to exclude higher-grade lesion
50
Lobular neoplasia discovered on vacuum or excision biopsy. What do you do?
Follow up (annual mammography for 5 years); clinical trials
51
Describe a typical ductal carcinoma in situ (DCIS).
10-20% of breast malignancies are DCIS Arise in TDLU Characteristically unicentric (single duct system) Duct dilated and filled with cells Necrosis within centre of ducts (if high grade) which can calcify due to regular cell death
52
What is the significance of DCIS being confined to the basement membrane of a duct?
It can move either forward to nipple or backwards to lobules within the duct
53
If DCIS involves the nipple skin what is this condition? Describe it.
Paget's disease of the nipple - high grade DCIS extending along the reach the epidermis of the nipple; still in situ carcinoma (i.e. non-invasive)
54
What is the criteria for micro-invasive carcinoma?
DCIS (high grade) with invasion of <1mm | treat as high grade DCIS
55
Peak incidence for invasive breast carcinoma?
50-70
56
List some risk factors for invasive breast carcinoma.
``` Age (50-70) Age at menarche Age at first birth (>35) Parity Breastfeeding Age at menopause Endogenous / exogenous hormones (OCP, HRT) Previous breast disease Geography (western world disease) Body weight (BMI>30) Physical inactivity (exercise is protective) Alcohol consumption (higher level of oestrogen in alcohol consumers) Diet (high fat - small increase risk) Smoking ```
57
Effect of reproductive history on risk of breast carcinoma?
Related to oestrogen exposure - things that decrease oestrogen exposure will reduced risk of breast cancer. E.g. early menarche increases risk but multiparty and breastfeeding all your kids decreases risk since less exposure to oestrogen during pregnancy and breastfeeding
58
Impact of having a 1st degree relative affected by breast cancer?
doubles risk
59
Difference between prophylactic management for BRCA1 & BRCA2 mutations?
prophylactic bilateral mammectomy in BRCA1; prophylactic surgery in BRCA2
60
Breast carcinoma grading.
Assessing tubular differentiation (1-3), nuclear pleomorphism (1-3) and mitotic activity (1-3) score 3-5 = grade 1 score 6 or 7 = grade 2 score 8 or 9 = grade 3
61
ER+ breast cancer sub-types will respond to anti-oestrogen therapy. What are some options for anti-oestrogen therapies?
oophrectomy tamoxifen aromatase inhibitors (letrozole) GnRH antagonists (Goserilin)
62
Better survival outcomes seen in ER+ sub-types vs. ER- subtypes. T/F?
TRUE
63
Better survival probability if progesterone receptor positive (PR+) vs. PR- T/F?
TRUE
64
What is HER2?
human epidermal growth factor receptor 2
65
Significance of over expression and amplification of HER2?
predicts response to Trastuzamab (herceptin) | - monoclonal antibody that is very active in HER2+ disease
66
HER2- sub-types have worse survival outcomes vs. HER2+ | T/F?
FALSE | HER2- has better survival outcomes vs. HER2+
67
What test can be done to detect HER2 amplification?
FISH - membrane staining - lots of red signals since lots of gene amplification
68
HER2 breast cancer sub-type receptors?
ER-, HER2+
69
Basal-like breast cancer sub-type receptors?
ER-, HER2-, basal cytokeratins (CK)+
70
Luminal A, B and C breast cancer sub-type receptors?
Luminal A: ER+, low proliferation | Luminal B & C: ER+, high proliferation
71
Combination of of ER, PR and HER2 receptors for best outcomes?
ER+, PR+, HER2-
72
Combination of ER, PR and HER2 receptors for worst outcomes?
ER-, PR-, HER2- (triple negative) OR HER2+
73
How would you assess the response to neoadjuvant breast cancer chemotherapy?
mammography, ultrasound, MRI
74
What are the neoadjuvant treatment options for breast conservation?
Chemotherapy (standard FEC100 + taxane) ± Herceptin Endocrine: aromatase inhibitors > tamoxifen so reserved for post-menopausal women Both methods reduce mastectomy rates
75
What is considered equivalent disease free in breast conservation treatment?
clear margins >= 1mm PLUS breast radiotherapy
76
What is "oncoplastic" surgery?
safe oncological (cancer) surgery while avoiding tissue deformity
77
Large breast / large tumour + reshaping --> ?
therapeutic mammoplasty
78
Small breasts --> ?
volume replacement techniques
79
What are the main problems with implant reconstruction?
``` loss of implants (infection) capsular contracture implant rippling implant migration 40% require revision surgery ``` older implants have <1:25,000 risk of Anaplastic Large Cell lymphoma
80
Describe the current 2 stage implant reconstruction.
1st stage: mastectomy and creation of sub muscular pocket w/ expander insertion Clinical visits for expansion 2 weekly. 2nd stage: exchange of expander for permanent implant
81
What are the advantages of Acellular Dermal Matrix (ADM) /implants?
"one stage" implant reconstruction by providing lower pole coverage. Better lower pole expansion Reduced post-op pain improved aesthetic outcome permanent implant can be used at 1st operation also useful for revision surgery
82
TRAM/DIEP flaps?
Transverse rectus abdominus flap Deep inferior epigastric artery perforator flap (have to take both sides as an ellipse but only use half of it - large portion of tummy)
83
IGAP flap?
Inferior gluteal artery perforator flap - top of buttock (slight asymmetry of bums)
84
What comprises pre-operative axillary staging?
USS axilla ± core biopsy
85
What can be used for contralateral symmetrising?
liposuction: syringe from stomach, spin it out and separate it into blood, fat & excess oil, inject fat only into breast
86
what is first line therapy for metastatic breast cancer?
Bevacizumab - a recombinant humanised monoclonal antibody against vascular endothelial growth factor (VEG-F)

Reproduction & Sexual Health (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions