breast pathology Flashcards
for which age groups would US/Mammogram/MRI be used to look at breasts?
Ultrasound – youngest girls – dense breast
MRI - more detailed images
Mammogram - is a low dose X-ray. older girls/women
when is cytopathology indicated in breast disease?
positives and cavaets?
- Used in the investigation of nipple discharge and palpable lumps
- Good cellular detail and quick to prepare but does NOT show the tissue architecture
list the meaning of the different coding of breast aspirate on cytology
C1 = inadequate C2 = benign C3 = atypia, probably benign C4 = suspicious of malignancy C5 = malignant
how is breast histopathology conducted?
positives and cavaets?
Intact tissue removed, fixed in formalin, embedded in paraffin wax, thinly sliced, stained with H&E.
neg: Takes 24 hours to process.
pos: Architectural & cellular detail.
what is the gold standard for the diagnosis of breast cancer ?
histopathology
which cells must be present on cytology in normal breast tiissue?
their function?
Myoepithelial cells
help to pump breast milk
which condition presents with
nipple discharge - often blood stained or green
Sometimes causes breast pain,
breast mass - subareolar
nipple retraction
what is this condition?
duct ectasia
when milk/mammary duct beneath the nipple widens, the duct walls thicken and the duct fills with fluid. affects peri-postmenopausal women
what are the signs of duct ectasia on mammogram? and cytology?
Mammogram: Microcalcification
Cytology: proteinaceous material and inflammatory cells only inside the DUCT.
Foamy histiocytes/ Macrophages present
prognosis of duct ectasia?
what does this mimic?
Benign condition with no increased risk of malignancy.
can mimic invasive carcinoma
which condition presents with
breast: painful (tender), red, hot
breast lump/ hard area - wedge shape
nipple discharge; white
fever, fatigue, chills
acute mastitis
what is the aetiology and treatment of acute mastitis?
Seen in lactating women due to cracked skin (BREASTFEEDING!) and stasis of milk ->
bacteria invasion -> can cause pus/abscess formation
Staphylococci the usual organism.
Drainage & antibiotics usually curative.
- continue breast feeding
what is the prognosis of acute mastitis?
risk of chronic mastitis
risk of duct ectasia at same time
what inflammatory cells would cytology show on acute mastitis?
lots of neutrophils
what inflammatory cells would cytology show on fat necrosis?
Histiocytes/ macrophages
which condition presents with
firm, round lump (or lumps) and is usually painless
The skin around the lump may look red, bruised or occasionally dimpled - tethering
inverted nipple sometimes
fat necrosis
which condition presents with
benign (noncancerous) condition in which the breasts feel lumpy - firm, ropy or rubbery
cobblestone texture in breast
breast ache, itching
Fibrocystic disease
develop fluid-filled cysts along with areas of fibrosis in one or both breasts
what is the prognosis for Fibrocystic disease
No increased risk for subsequent breast carcinoma.
The following signs are common on cytology in which condition?
Branching networks irregular - v peculiar
Biphasic – stromal and fibrous/glandular cells
Fibroadenoma
In the fibroepithelial neoplasms, name:
Benign
Malignant
Benign; fibroadenoma
Potentially Malignant: Phyllodes (most are benign)
A typically large, fast-growing mass that in women aged over 50 should prompt which diagnosis ?
phyllodes
origin of phyllodes tumours?
form from the periductal stromal cells of the breast.
how is breast cell malignancy determined?
Based on the cellularity- number of cells and their clustering
take the stromal cells for example:
(high cellularity + stromal overgrowth –> malignant)
how does intraductal papilloma present?
Central papillomas present with nipple discharge.
Peripheral papillomas may remain clinically silent if small.
what is the origin of intraductal papilloma?
central papillomas - larger lactiferous ducts
peripheral papilloma - small terminal ductules
BENIGN
What present as stellate/stellar masses on screening mammograms which may closely a carcinoma?
radial scar
what is being described:
central fibroelastotic core
with radiating spokes of ducts and lobules - can show unusual changes such as cysts and epithelial hyperplasia
radial scar
what is the risk of developing cancer with:
Usual epithelial hyperplasia
if any, what type of cancer?
1.5-2.0x risk for subsequent
invasive carcinoma.
what is the risk of developing cancer with:
Flat epithelial atypia
if any, what type of cancer?
4 times relative risk of developing
low grade ductal carcinoma in situ.
what is the risk of developing cancer with:
In situ lobular neoplasia
if any, what type of cancer?
subsequent invasive breast carcinoma
7-12x risk
list the prolefrative. breast diseases.
characteriisitics?
are they malignant?
Usual epithelial hyperplasia
Flat epithelial atypia
In situ lobular neoplasia
character: Microscopic lesions which usually produce no symptoms
all present an increased risk of invasive breast carcinoma.
list the malignant breast diseases
Ductal carcinoma in situ (DCIS)
Basal-like carcinoma
-> high chance of malignancy (invasive breast carcinomas) BUT not an INEVITABLE progression
which is the most COMMON breast tumour?
characteriisitics?
Invasive breast carcinomas
epithelial origin
how does DCIS present?
85% are detected on MAMMOGRAM as areas of microcalcification.
10% produce clinical findings such as a lump, nipple discharge, or eczematous change of the nipple (Paget’s disease of the nipple).
what is the treatment for DCIS?
Treatment is surgical excision -> of the tumour.
Complete excision with clear margins is curative
if it is very large or in multiple areas of breast THEN mastectomy
cribriform DCIS is seen in which grade?
low grade DCIS
BRCA mutations put you at risk of which breast cancer?
% risk?
which mutation most common?
Invasive breast carcinomas
85% lifetime risk
BRCA 2
what are the risk factors for breast cancers, especially Invasive breast carcinomas
?
High lifetime oestrogens:
Early menarche, late menopause, increased weight, high alcohol consumption, oral contraceptive use, and a positive family history are all associated with increased risk.
BRCA mutations
what are the genetic origins of low and high grade Invasive breast carcinomas?
“Low grade” breast carcinomas:
- from low grade DCIS or in situ lobular neoplasia
- 16q loss.
“High grade” breast carcinomas
- high grade DCIS
- much more complex genetics
describe the histology of the following:
Invasive ductal carcinoma
Invasive lobular Carcinoma
Invasive TUBULAR Carcinoma
Invasive MUCINOUS Carcinoma
Invasive ductal carcinoma:
- large, pleomorphic, nucleates cells. have large nuclei
Invasive lobular Carcinoma
- Trabecular pattern of growth
- linear arrangement of cells: Indian File pattern
- monomorphic; look like each other
Invasive TUBULAR Carcinoma
- Low grade, low likelihood of mets
- elongated tubules of cancer cells
Invasive MUCINOUS Carcinoma
- contain a lot of mucin
what would ivx for Basal-like Carcinoma show?
Histopath:
Sheets of markedly atypical cells with a prominent lymphocytic infiltrate
Immunohistochem:
basal cytokeratins (CK5/6 and CK14)
○ Associated with BRCA mutations
what are the parameters for breast tumour grading?
1) tubule formation 2) nuclear pleomorphism,, and 3)mitotic activity.
what is the receptor status for the following tumours:
low grade
high grade
basal-like carcinoma
LG: ER/PR + and Her2-
HG: ER/PR- and Her2+
BLC: ER/PR- and Her2- (triple negative)
*estrogen receptor, progesterone receptor
most important prognosstc indicator in breast cancere?
status of the axillary lymph nodes
what is the purpose and characterisitcs of the NHS Breast Screening Programme?
to pick up DCIS or early invasive carcinomas.
Women aged 47-73
Screening every 3 years
Mammogram: looks for abnormal areas of calcification or a mass within the breast.
Which core biopsy scores are representative of:
DCIS
Invasive carcinoma
B5a: DCIS
B5b: Invasive carcinoma
woman attends NHS Breast Screening Programme and has an abnormal mammogram.
what are the next steps?
further ivx: another mammogram or Ultrasound
+ core biopsy - > for B grade
male gynaecomastia of histology is similar to ___ ?
§ Similar to fibroadenoma
