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CP reviewer 1 > Breast Pathology > Flashcards

Breast Pathology Flashcards

1
Q

What is breast cancer screening?

A

The process of identifying people who appear healthy but may be at an increased risk of a disease or condition. Screening finds breast cancers at an early stage when they are too small to see or feel.

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2
Q

When do breast cancer screens aim to provide results?

A

within 2 weeks of attendance (>90% cases)

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3
Q

Prevalence vs incidence screen?

A
  • Prevalence screen*: First screen
  • Incidence screen*: Returning screen due to picking something atypical up
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4
Q

Who is eligible for breast cancer screen?

A
  • 50 – up to 71st birthday.
  • Invited every 3 years.
  • Age extension 47-73 years – in some areas.
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5
Q

main tool used in breast cancer screening?

A

mammography

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6
Q

Symptomatic presentation of breast pathology?

A
  • a lump or thickening in the breast
  • a change in the nipple
    • The nipple might be pulled back into the breast, or change shape
    • Rash that makes the nipple look red and scaly
    • Blood or fluid coming from nipple
  • a change in how the breast feels or looks.
    • Heavy, warm or uneven
    • Skin may look dimpled
  • pain or discomfort in the breast or armpit
  • a swelling or lump in the armpit
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7
Q

What does a breast triple assessment involve?

A
  1. Clinical examination
  2. Radiological examination
  3. Pathological examination
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8
Q

What is involved in the clinical examination during a triple breast assessment?

A
  • Detailed history
  • Examination performed by breast surgeon or specialist
    • Full breast examination focuses around breast palpation and assessment of axillary nodes.
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9
Q

What is involved in the imaging examination during a triple breast assessment?

A
  • Based around either mammography (screening tool) or US (usually symptomatic patients).
    • Ultrasound is more useful in women <35 years of age and then when due to density of breast tissue in identifying anomalies.
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10
Q

Why are ultrasounds more useful in breast imaging in women <35?

A

More successful at identifying anomalies due to breast tissue being much more dense in women <35

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11
Q

What is involved in the pathology examination during a triple breast assessment?

A

FNA (fine needle aspiration) or core biopsy

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12
Q

In the pathology examination during a triple breast assessment, when would a FNA be used? When would a core biopsy be used?

A
  • FNA (fine needle aspiration) is usually used for cystic lesions
  • Core biopsy is used for any suspicious mass or lesion.
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13
Q

After a triple assessment, what is the % of a confident diagnosis?

A

99.9%

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14
Q

Results of triple assessment explained

A
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15
Q

Results of breast screening explained

A
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16
Q

What does an excision biopsy involve?

A

Involves surgical removal of tumour and some normal tissue around it

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17
Q

What is the method of choice for diagnosis of cystic lesions and suspicious axillary lymph node in patients with breast tumours?

A

FNA biopsy

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18
Q

What is the method of choice for diagnosis of focal breast lesions?

A

Core needle biopsy

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19
Q

Male vs female breast tissue?

A

Male breasts:

  • No lobules
  • No TDLU’s
  • No Cooper’s ligaments
    • No fibroadenomas
    • No cysts (arising from breast stroma)
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20
Q

Surface anatomy of the breast:

  • What is the nipple?
  • What is the areola?
A
  • Nipple:
    • At the centre of the breast
    • Composed mostly of smooth muscle fibres.
  • Areolae:
    • A pigmented area of skin surrounding the nipple
    • There are numerous sebaceous glands within the areolae – these enlarge during pregnancy, secreting an oily substance that acts as a protective lubricant for the nipple.
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21
Q

The breast is composed of mammary glands surrounded by a connective tissue stroma.

What are mammary glands? What do they consist of?

A
  • The mammary glands are modified sweat glands.
  • They consist of a series of ducts and secretory lobules (15-20).
  • Each lobule consists of many alveoli drained by a single lactiferous duct. These ducts converge at the nipple like spokes of a wheel.
    • Each lobule consists of many alveoli which come together to form a terminal duct lobular unit (lobule)
    • All lobes converge to form a lactiferous duct
    • All lobes converge towards the areola to form the lactiferous sinus
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22
Q

What is the connective tissue stroma of the breast?

A
  • The connective tissue stroma is a supporting structure which surrounds the mammary glands. It has a fibrous and a fatty component.
  • The fibrous stroma condenses to form suspensory ligaments (of Cooper). These ligaments have two main functions:
    • Attach and secure the breast to the dermis and underlying pectoral fascia.
    • Separate the secretory lobules of the breast.
23
Q

Glandular parenchyma of breast

A
24
Q

What is an acinus? How does this relate to the mammary gland?

A
  • A small ball of secretory epithelial cells containing a tiny central lumen
  • The mammary gland is composed of a series of branched ducts that connect the functional glandular units (acini) to the nipple
25
Q

2 layers of cells line the acinus. What are these?

A
  • Inner ductal epithelial cells
  • Outer myoepithelial cells
26
Q

How can the layers of cells that line the acinus be used in diagnoses of breast pathology?

A

Presence or absence of an intact myoepithelial cell layer around the luminal cells is by far the major diagnostic criteria that pathologists use to differentiate in situ from invasive carcinoma. Myoepithelial cells are virtually absent or markedly reduced in invasive carcinoma compared to DCIS lesions.

27
Q

What is a carcinoma?

A

forms in the skin or tissue cells that line the body’s internal organs, such as the kidneys and liver.

28
Q

What is a sarcoma?

A

grows in the body’s connective tissue cells, which include fat, blood vessels, nerves, bones, muscles, deep skin tissues and cartilage

29
Q

What is a fibroadenoma?

A

benign fibroepithelial lesion

30
Q

What is a Phyllodes tumour?

A

when fibroepithelial lesions are borderline or malignant

31
Q

What is Paget disease of the breast?

A

It causes eczema-like changes to the skin of the nipple and the area of darker skin surrounding the nipple (areola). It’s usually a sign of breast cancer in the tissue behind the nipple.

32
Q

Location of disorders of the breast

A
33
Q

In the breast, where do carcinomas arise?

A

Terminal duct lobular units

34
Q

In the breast, where do sarcomas arise?

A

Interlobular stroma

35
Q

In the breast, where do fibroadenomas and Phyllodes tumours arise?

A

Lobular stroma

36
Q

In the breast, where does Paget disease of the breast arise?

A

Nipple and areola

37
Q

What is fibrocystic disease? Can this lead to carcinoma?

A

A constellation of benign, hormonally mediated breast changes including cyst formation, stromal fibrosis and mild epithelial hyperplasia without atypia. No increased risk for subsequent carcinoma development.

38
Q

Clinical presentation of fibrocystic disease?

A
  • 20-45 years age.
  • Usually bilateral and multifocal.
  • Lumpy, premenstrually painful breasts.
  • FCC symptomatology generally ceases 1-2 years following menopause.
39
Q

What is a fibroadenoma? Clinical presentation? Epidemiology?

A
  • Mobile, painless, well defined breast lump.
  • Incidence – Common.
  • Usually in women 20-30 years.
  • More common in Afro-Caribbean women.
40
Q

What can breast calcifications suggest?

A

Breast calcifications are small calcium deposits that develop in a woman’s breast tissue. They are very common and are usually benign (noncancerous). In some instances, certain types of breast calcifications may suggest early breast cancer.

41
Q

What is a DCIS?

A
  • Ductal Carcinoma in Situ is a non-invasive breast cancer that hasn’t spread beyond the milk duct but abnormal cells are present. These are graded B5a.
    • Malignant clonal proliferation of cells within breast parenchymal structures.
  • A precursor of invasive carcinoma; has the potential to progress to invasion if left.
42
Q

How are DCIS’s most commonly identified?

A

as microcalcifications on screening

43
Q

When is HER2 therapy used?

A

Only used in invasive carcinomas that are HER2 positive

44
Q

What 3 molecular markers are tested for in breast cancer?

A
  1. ER
  2. PR
  3. HER2
45
Q

What is ER? What is PR?

A

These are hormone receptors:

  • If breast cancer cells have oestrogen receptors, the cancer is called ER-positive breast cancer.
  • If breast cancer cells have progesterone receptors, the cancer is called PR-positive breast cancer.
  • If the cells do not have either of these 2 receptors, the cancer is called ER/PR-negative.
46
Q

What is HER2?

A
  • HER2-positive breast cancer is a breast cancer that tests positive for a protein called human epidermal growth factor receptor 2 (HER2).
  • This protein promotes the growth of cancer cells.
47
Q

What is the most common tool that doctors use to stage cancer?

A

TNM Staging System for Cancer:

  • T – Tubule formation (Score 1 to 3)
  • N – Nuclear pleomorphism (Score 1 to 3)
  • M – Mitosis (Score 1 to 3)

Total score:

3-5 Grade 1

6-7 Grade 2

8-9 Grade 3

48
Q

What system is used to assess the “grade” of breast cancers?

A

Nottingham Grading System

  • A well-differentiated tumor (grade 1) that demonstrates high homology to the normal breast terminal duct lobular unit, tubule formation (>75%), a mild degree of nuclear pleomorphism, and low mitotic count.
  • (b) A moderately differentiated tumor (grade 2)
  • (c) A poorly differentiated (grade 3) tumor with a marked degree of cellular pleomorphism and frequent mitoses and no tubule formation (<10%).
49
Q

What are the risk factors for breast cancer?

A
  • Oestrogens.
  • Early menarche
  • late menopause
  • obesity in postmenopausal women
  • OCP’s and hormonal therapy for menopause
  • alcohol
50
Q

When reporting a breast pathology, what information should be included?

A
  • In situ or invasive
  • Type
  • Grade
  • Size
  • Vascular invasion.
  • Nodal status
  • Relationship to margins
  • Molecular marker status: ER, PR, HER2
51
Q

Breast cancer classification

A
52
Q

What is the Nottingham prognostic index (NPI)?

A

The Nottingham prognostic index (NPI) is used to determine prognosis following surgery for breast cancer.

  • Grade + nodal status (0- score 1, 1-3- score 2 and 4 or more score 3) + 0.2 x tumour size)
  • 3.4 or less à good 80%+ 16-year survival
  • 3.41-5.4 à moderate 46%
  • 5.41+ à poor 10%
53
Q

What is Trastuzumab, sold under the brand name Herceptin? What type of cancer is it used to treat?

A

Trastuzumab, sold under the brand name Herceptin among others, is a monoclonal antibody used to treat breast cancer and stomach cancer. It is specifically used for cancer that is HER2 receptor positive.

54
Q

What action does Tamoxifen have in breast cancer?

A

Tamoxifen is the oldest of the hormonal therapies, drugs that block the effects of oestrogen in the breast tissue

CP reviewer 1 (59 decks)

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