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breast pathology Flashcards

1
Q

what is an example of a population screening programme?

A

the breast screening programme

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2
Q

what is screening?

A

it is a process of identifying people who appear healthy but may be at an increased risk of disease or condition

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3
Q

what is the aim of the breast screening programme?

A

to reduce the mortality from breast cancer and to identify and invite eligible women of the age of 50-70 years or in some areas 47-73. they are invited at appropriate intervals roughly every three years and results are aimed to be returned in 2 weeks of attendance for 90% of cases

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4
Q

what comprises the breast triple examination?

A

clinical, radiological and pathological

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5
Q

what does B1-B5 represent and how are the scores given?

A

scores are given based on the suspicion of the lesion
B1 and 2 is benign
B3 is cannot decide
B4 and B5 have suspicions of being malignant

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6
Q

what is the clinical part of the triple assessment?

A

history and physical examination

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7
Q

what is the imaging part of the triple assessment?

A

ultrasound and mammography

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8
Q

what is the pathological part of the assessment?

A

core cut biopsy and FNAC

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9
Q

what does B5 (pathology section) get split into?

A

B5 a - in situ and B5b - broken into the basement membrane so is invasive and malignant

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10
Q

what is the classifications for clinical exam?

A 
P1 - normal 
2 - benign lesion 
3 - atypical 
4 - atypical prob malignant 
5 - malignant
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11
Q

what are the classifications for radiology?

A 
R1 - normal 
2 - benign lesion 
3 - atypical 
4- atypical probably malignant 
5 - malignant
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12
Q

what is the two view mammogram looking for?

A

calcification

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13
Q

what are the differences between core and mammotome biopsies?

A

mammotome biopsy needles take a large amount of tissue

core is examined at three levels and mammotome at four - divided into blocks so can establish the level of calcification

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14
Q

what is an MDT in this scenario?

A

it is a group of experts with a specialist role in diagnosis, treatment and management of patients with breast cancer

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15
Q

what is normal breast histology?

A

when there are lactiferous ducts that divide into terminal duct lobular units which are a collection of alveoli draining into a duct which drain into nipples and are surrounded by fatty tissue

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16
Q

what is the inner and outer layer of the duct?

A

inner is the ciliated epithelial cells and outer is the myoepithelial flattened cells

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17
Q

what is a preceding change?

A

when there is intraductal proliferation that has not broken through the myoepithelial boundary

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18
Q

what is a malignant invasive change?

A

when there is intraductal proliferation that has broken through the myoepithial boundary

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19
Q

what is a benign fibrocystic change that results in cysts?

A

when the normal acini are slightly dilated

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20
Q

what is glandular parenchyma?

A

it is 15-20 lobes that are drained by a lactiferous duct - all lobes converge towards the areola and near the areola the lactiferous duct dilates to form a lactiferous sinus

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21
Q

what is found with fibrocystic change?

A

there may not be anything to feel - there are small calcifications on biopsy - there may be benign breast tissue with apocrine metaplasia and some microcysts - all associated with micro calcifications

22
Q

what are examples of fibrocystic change?

A

fibrocystic disease, fibrous mastopathy, mammary dysplasia, schimmelbusch’s disease, chronic cystic mastitis

23
Q

what are the characteristics of fibrocystic change?

A

generally affects pre-menopausal women and is bilateral and multifocal. There is a risk of developing FCC and increased risk in women with hyperoestrogenism but no risk for further carcinoma development

24
Q

what is fibrocystic change?

A

it is a constellation of benign, hormonally mediated breast changes including cyst formation, stromal fibrosis, mild epithelial hyperplasia without atypia

25
Q

what is the characteristics of fibrocystic disease?

A

microcysts or larger cysts and there is atypia so always in the B3 category
in a histology the yellow part is fat and white is the biopsy
it is well defined and the ductules and stroma are typical for the lesion and benign

26
Q

what is fibroadenoma?

A

it is a mobile, painless well defined lump in the breast and found as a lump so classified as asymtpomatic. It is common in afro-carribean women and in the ages of 20-30 years. It is a benign breast tissue with a well defined benign lesion showing proliferation of both epithelial and stromal components.

27
Q

how are fibroadenomas identified?

A

with an US guided biopsy and USS

USS - well defined rounded lump

28
Q

although fibroadenomas rarely undergo infarction, if they do, what is the result?

A

pain - sudden lack of blood supply - therefore the epithelial and morphological details are not seen on infarcted tissue
surgical resection recommended
may recur

29
Q

what will radiology of a fibroadenoma show?

A

well defined, homogenous hypoechoic mass on USS

30
Q

what will a high grade DCIS show?

A

it will be a lumpy breast on examination and a mammogram will show lots of coarse calcification - high grade will have associated comdeonecrosis and calcification and no invasion is seen

31
Q

what else may you see with DCIS?

A

larger lesions with lots of calcification and roliferation in epithelial cells that may be a circular cribriform formation to show they are atypical - contained

32
Q

what is done in a surgical excision?

A

this is done on a B5a and a wire is needed to feel the calcification around which the region will be removed - the wire is inserted into the centre of calcification

33
Q

what is DCIS?

A

it is malignant clonal proliferation of cells within breast parenchymal structures but no evidence of invasion - it is a precursor. It is most commonly identified as microcalcifications on screening and cannot alone produce metastasis but has the potential to progress to invasive if left. Look for signs of malignancy in the axillary lymph nodde

34
Q

what are the three markers used for invasive malignancies in the breast?

A

ER, PR and HER2

35
Q

what will be seen on a B5b histology?

A

cannot see the ductules - can see malignancy appearances of cells trying to invade the desmoplastic looking stroma, high grade tumour cells, and breast cored extensively infiltrated by ductal carcinoma

36
Q

what are invasive cancers graded on?

A

3 categories- tubule formation, pleomorphism score and mitotic score - out of three and divided into categories 1,2 and 3

37
Q

what is breast cancer?

A

it is invasive breast carcinoma that is estimated that 1/9 women get in their life time and is linked to oestrogen

38
Q

what are the other risk factors for breast carcinoma?

A

early menarche, late menopause, obesity in postmenopausal women, OCP and hormonal therapy for menopause and alcohol

39
Q

what is the histological grade of breast cancer done on?

A

the nottingham grading system

40
Q

what are the three grades of the nottingham grading system?

A

grade 1 - well differentiated tumour that demonstrated high homology to the normal breast terminal duct lobular unit, tubular formation of over 75% and a mild degree of pleomorphism with a lot mitotic count
grade 2 - moderately differentiated tumour
grade 3 - poorly differentiated tumour with a marked degree of cellular pleomorphism and frequent mitoses and no tubule formation of less than 10%

41
Q

what is ER and PR?

A

they are nucleus based receptors where the nucleus takes up the stain and it is based on the intensity of staining out of 3 - added to the proportion of nuclei that take up the stain

42
Q

what is Her2?

A

it is a membranous stain where herceptin positive are the darker membranes due to staining - a minimum of 10% of cancers look like this
if smaller than 10mm then localise with a wire and do excision, if invasive check sentinel node and also check other nodes and clear as if one is marked then others may also be

43
Q

what is reported in the pathology for malignancy?

A

insitu or invasive, grade and type

size, vascular invasion, relationship to borders, marker status, nodal status

44
Q

what are the main recognised types of breast carcinoma in order of their commonness?

A 
75% are ductal
lobular 
others 
tubular or cribriform or medullar 
mucoid 
metaplastic
45
Q

what are the main prognostic factors for breast carcinoma?

A

tumour grade - higher more likely to recur
size
node involvement
the nottingham prognostic index

46
Q

what is doen in the nottingham prognostic index?

A

the grade + the nodal status (score up to 4), then + 0.2xtumour size

47
Q

what are the categories and their implications int he nottingham prognostic index?

A
  1. 4 and lower is good - 80% 16 year survival
  2. 4-5.4 - moderate - 45% survival
  3. 4 plus is poor - 10%
48
Q

what will vascular invasion show?

A

colleciton of cells sitting in space linked by endothelial cells - the endothelial markers to tie together - CD31 and 34 are commonly used

49
Q

what is meant by margins?

A

measure the distance of the vascular invasion to the margin and if it is less than 1mm then surgical excision

50
Q

what are the approaches the treatment of breast carcinoma?

A

there are hormonally targetted treatments which are tamoxifen, aromatase inhibitors and bisphosphonates and HER2 targetted approaches which are trastuzumab

CP (38 decks)

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