Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Genital System > Breast Pathology > Flashcards

Breast Pathology Flashcards

1
Q

Clinical features

A

Physiologic changes must be distinguished from
pathologic changes

Many conditions present as a lump

Always note the characteristics of the lump and the
age of the patient

Discharge from the nipple

Associated skin involvement

Nipple retraction

Below the age of 35 breast cancer is rare but a
histologic diagnosis is mandatory in all breast masses
/ lesions

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

Diagnostic methods

A

Imaging – mammography and ultrasound

FNA – needle inserted into the lump, cells
aspirated and stained and examined by
pathologists

Core/trucut biopsy – tissue sample, more
reliable diagnosis, receptor studies can be
performed

Frozen section

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

Non-neoplastic Conditions

A

Throphic enlargement

Inflammatory Conditions

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

Non-neoplastic Conditions:

Throphic Enlargement

A
  • Juvenile hypertrophy
  • Gynaecomastia - men

Causes:

➢ Puberty
➢ Liver cirrhosis – increased oestrogen
➢ Drugs - Digitalis
➢ Oestrogen therapy - Rx of prostate ca
➢ Klinefelter syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Non-neoplastic Conditions:

Inflammatory Conditions

A

Acute mastitis: lactating women, staf aureaus,
cracked nipple

Chronic mastitis: isolated organ tuberculosis

Duct ectasia: nipple discharge with a retroareolar mass

Fat necrosis: can mimic carcinoma, trauma

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

Non-neoplastic Proliferative Conditions

A

Vaguely defined conditions representing a single entity with a wide spectrum of clinical and pathological characteristics.

Numerous terms have been used to describe it, including fibroadenosis, fibrocystic disease, fibrocystic change, cystic mastopathy ect.

Cystic change of the breast most likely the best accepted term at this stage

The term ANDI - Abberations of Normal Development and Involution also commonly used.

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

Cystic Change of the Breast/Fibrocystic disease of the breast

A

Very common

Causes symptoms and signs in 10% of women between 30 and 55 years.

Histological signs at post mortem in 50% of women in this age group

Clinically present with premenstrual swelling and discomfort, lumpiness and sometimes discrete masses(cysts) in the breasts

Signs and symptoms tend to decrease with onset of menstruation (hormonal relationship)

Etiology and pathogenesis unknown – most likely caused by hormonal factors, possibly oestrogen.

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

Fibrocystic change of the Breast:

Macroscopy

A

Solid, firm areas due to increased fibrosis

Fluid containing cysts up to 2cm in diameter
– ’blue domed cysts’ due to blue color

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

Fibrocystic change of the Breast:

Microscopy

A

A combination of the following is found:

Adenosis: enlargement of the lobules

Epithelial hyperplasia: proliferation of the epithelium in the ducts, acini and cysts which often leads to the formation of papillary structures (papillomatosis)

Cyst formation: due to dilatation of the acini and small
ducts

Apocrine metaplasia: pink cytoplasm (cells resemble
apocrine glands)

Fibrosis: increase in amount of fibrous connective tissue

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

Breast Tumours

A

■ Primary

Benign:

Fibroadenoma
Benign phyllodes tumour
Intraduct papilloma

Malignant:

Carcinoma
Malignant phyllodes tumour

■ Secondary:

Rare, occasionally bronchus or contralateral breast carcinoma

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

Fibroadenoma

A

Most common benign breast tumour

15 – 40 years (reproductive years)

Arises from the lobules of the breast

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

Fibroadenoma:

Macroscopy

A

Firm, well demarcated mass/es

Mobile, can be multiple

Usually 1 to 5cm in diameter

Sometimes referred to as ‘breast mice’

Lobulated and grey-white in colour

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

Fibroadenoma:

Microsscopy

A

Consist of a proliferation of fibrous
connective tissue in which numerous benign
glandular structures are present.

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

Benign Phyllodes Tumour

A

Rare

Any age but median of 45 years

Present as a discreet mass whuich may be large

Benign and malignant types

Note: don’t spread to lymph nodes but
hematogenous

Tend to recur / malignant can metastasize

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

Benign Phyllodes Tumour:

Macroscopy

A

Well circumscribed macroscopically

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

Benign Phyllodes Tumour:

Microscopy

A

Composed of epithelium and stroma

The stroma is more cellular than that of
fibroadenomas

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

Intraduct Papilloma

A

Middle aged women (40 to 60 years)

Less common

Causes nipple discharge (oftern bloody): differential diagnosis carcinoma

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

Intraduct Papilloma:

Macroscopy

A

Usually small (1cm in diameter)

Found in the larger ducts

Papillary appearance

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

Intraduct Papilloma:

Microscopy

A

Papillary (finger-like) structures consisting of
a fibrovascular core covered by epithelial
cells

20
Q

Screening

A 
In developed countries with a high incidence
screening programmes (mammogram) have been
introduced

Women whose cancers have been detected by
regular mammography have increased survival rate
because they are detected earlier with less risk of
metastasis

Suspicious mammography – microcalcification,
localised densities

RSA – medical aid patients – mammogram yearly
starting at the age of 40

21
Q

Breast Carcinoma

A

Most common malignant tumour in white females
in South Africa

Also common in black South African women(Cervix and esophageal cancer more common)

35 – 70 years

Only 0,5% of breast carcinomas occur in males

Present with a palpable mass in the breast. Initially
mobile, later fixed to the skin or underlying chest
wall.

Numerous other clinical signs including nipple
discharge, oedema of the skin and skin ulceration

22
Q

Risk Factors Ass. with Breast Carcinoma

A

Gender, female (increase with age)

Family history of breast cancer-Increases risk

Nulliparous women-Increases risk

First pregnancy after 30-Increaed risk

Early menarche and late menopause

Absence of breast feeding: controversial

Severe epithelial hyperplasia – atypical hyperplasia

Obesity

Radiation

23
Q

Breast Carcinoma:

Aetiology

A

Cause still uncertain

Hormones probably oestrogen

Genetic:

  • BRCA1 (Chr 17q) and BRCA2 (Chr13q) mutations
  • 5-8% breast cancer due to inherited gene mutations
  • Lifetime risk of 65% (BRCA1), 45% (BRCA2)
  • Also increased risk for development of ovarian and other cancers
24
Q

Classification of Breast Carcinoma

A

In-Situ Carcinoma-Limited to the basement membrane(Non-invasive)

Infiltrating/Invasive

25
Q

In-Situ Carcinoma:

Types

A

Intraduct/Ductal carcinoma in situ (DCIS)

Lobular neoplasia/carcinoma in-situ (LN)

26
Q

In-situ Carcinoma:

Macroscopy

A

Occasionally DCIS forms an irregular palpable mass but both LN and DCIS are usually not detectable on clinical examination

LN is never palpable

DCIS can be detected using mammography or an incidental finding

In South Africa DCIS and LN are usually incidental finding

27
Q

In-Situ Carcinoma:

Miccroscopy

A

DCIS: large ducts containing pleomorphic cells with mitotic activity

Specific growth patterns seen with DCIS, differ form benign epitheliosis (Comedo type, cribriform type and papillary type)

LN: Lobules are distended and filled with small uniform cells

28
Q

Prognosis of in situ carcinoma

A

■ Complete resection: excellent prognosis

■ Usually incidental finding

29
Q

Infiltrating/Invasive Carcinoma:

Types

A

Infiltrating duct carcinoma (75%)

Infiltrating lobular carcinoma (10%)

Medullary carcinoma

Mucinous carcinoma

Tubular carcinoma

Papillary carcinoma

30
Q

Infiltrating/Invasive Carcinoma:

Macroscopic

A

Slightly more common in the left breast

Most are small initially and measure 1,5 – 5cm in diameter

  • 50% in upper outer quadrant
  • 10% in each of the other quadrants
  • 20% retro-areolar

Poorly circumscribed, grey-white in colour

Firm and gritty on sectioning

Yellow stripes/chalky streaks on sectioning - elastosis

Medullary and mucinous carcinomas tend to be better circumscribed and soft, can measure up to 15cm in diameter.

Mucinous carcinoma contains jelly-like fluid

31
Q

Infiltrating/Invasive Carcinoma:

Microscopic

A

Infiltrating duct carcinoma

Infiltrating lobular carcinoma (10%)

Medullary carcinoma

Mucinous carcinoma

Tubular carcinoma

Papillary carcinoma

32
Q

Infiltrating duct carcinoma:

A

Cells are large and
pleomorphic and form glandular structures and
solid groups. Often mitotically active

33
Q

Infiltrating lobular carcinoma:

A

Cells are small and
uniform and are arranged in strings (Indian filing)
and around ducts (targeting). Also single cells that
can be mistaken for lymphocytes

34
Q

Medullary carcinoma:

A

Cells are ploemorphic and
very large. Solid groups surrounded by a lymphoid
infiltrate. Tumour is well circumscribed

35
Q

Mucinous carcinoma:

A

pools of mucin in which small

groups of tumour cells are found

36
Q

Tubular carcinoma:

A

well formed tubular structures.

Large monomorph cells

37
Q

Papillary carcinoma:

A

forms small papillary
structures within larger glandular structures, slight
pleomorphism.

38
Q

Breast Carcinoma:

Spread

A

■ Direct:
– Skin with eventual ulceration
– Chest wall: muscle and ribs
– Via ducts to the nipple resulting in Paget disease of the nipple
(erythema and scaling, looks like eczema).

Paget disease can rarely occur without a palpable underlying mass. Accepted that at least
DCIS is present in these cases

■ Lymphatic:

  • Axillary (most common) and later supraclavicular lymph
    nodes.
  • Medial tumours spread to internal thoracic group

■ Haematogenous:
-Lungs, liver, bones, ovaries, adrenals and brain.

-Usually late, but common.

■Opposite breast:
-Spread-bilateral disease. Lobular carcinoma
commonly occur bilateral.

39
Q

Breast Carcinoma:

Prognosis

A

■ Determined by:

– Age

– Histological type

– Staging

– Receptor status

40
Q

Age

A

Young patients generally have a poorer

prognosis

41
Q

Histological Type

A

Good prognostic group: tubular, papillary, mucinous

Reasonable prognostic group: lobular, medullary

Poor prognostic group: duct carcinoma

42
Q

Staging

A

Size,Lymph node involvement, Metastases, Various systems-TMN, International Classifications

Stage I: tumour less than 5cm in diameter,
no nodes (85%)

Stage II: Tumour less than 5cm in diameter,
axillary nodes involved (65%)

Stage III: Tumour more than 5cm in
diameter (40%)

Stage IV: Distant metastases (10%)

43
Q

Receptor Status

A

Tumours with oestrogen receptors have a
better prognosis

Better differentiated

Open to hormonal manipulation eg
treatment with tamoxifen, an oestrogen
receptor antagonist

44
Q

HER2

A

The oncogene c-erbB-2/HER2 is altered in
approximately 20% of invasive breast
carcinomas

Amplification of the gene results in over
expression of the protein

Patients with HER2 positive tumours have a
poorer prognosis

Developed trastuzumab (Herceptin) for
adjuvant treatment in HER2 positive patients
45
Q

Conditions associated with a nipple

discharge

A

Duct ectasia

Intraduct papilloma and nipple adenoma

Pagets disease of the nipple

Fibrocystic disease usually NOT associated with a
nipple discharge

46
Q

Lesions in males - Gynaecomastia

A

■ The breast tissue in males contain only ductular
structures and no acini.
■ Gynaecomastia = benign enlargement of the male
breast tissue
■ 75% unilateral
■ Firm, mobile disk tissue palpable underneath the nipple
■ Micro: dilated ducts with varying grades of epithelial
hyperplasia. Surrounding stroma is oedematous and
myxoid, becomes dense and hyalanised
■ Adolescent and older patients = hormonal causes,
increased oestrogen (endocrine abnormalities –
hyperthyroidism, pituitary abnormalities, tumours of theadrenal glands and testis, prostate cancer treatment)

47
Q

Breast cancer in males

A

■ Tumour is rare in young men
■ Increased risk in patients with Klinefelter
syndrome and carriers of BRCA2 mutations
■ Clinical: lump, nipple discharge or retraction,
Paget’s disease
■ DCIS or any type of invasive carcinoma
■ Prognosis similar to females and affected by
stage, size and hormone receptor status

Genital System (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions