Breast Pathology + Disease Flashcards
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Multiple stroma + terminal duct lobular unit > major duct > lactiferous duct > nipple
What makes up the terminal ductal lobular unit?
Terminal duct + multiple acini
Where do epithelial cancers of the breast arise?
Terminal ductal lobular unit
What epithelium line the ducts and acini of the breast?
Low columnar or cuboidal epithelium
Surrounding myoepithelial cells
What are the three steps of breast cancer assessment
History + assessment
USS or mammogram
Biopsy
What does bloody nipple discharge suggest?
Intraductal papilloma
What does clear nipple discharge suggest?
Mammary duct ectasia
What does milky nipple discharge suggest?
Breastfeeding
Hormone-related causes
Galactorrhea
What does yellow nipple discharge suggest?
Infection
What does green nipple discharge suggest?
Fibrocystic disease
What does brown nipple discharge suggest?
Fibrocystic disease
Mammary duct ectasia
What is mammary duct ectasia?
Benign disorder of extralobular ducts causing stasis of secretions > dilated ducts + inflammation
Who is mammary duct ectasia common?
Peri-menopausal women
Risk factor for mammary duct ectasia?
Smoking
Managment of mammary duct ectasia
Observation
+/- antibiotics
+/- excision
What is the most common breast tumour in young patients?
Fibroadenoma
What is a fibroadenoma?
Benign neoplasm of glands + stromal elements
Management of breast friboadenoma
No treatment vs conservative surgical excision
What is gynaecomastia due to?
Oestrogen testosterone imbalance
Physiological causes of gynaecomastia
Oestrogen production peaks before testosterone during puberty
Pathological causes of gynaecomastia
- lack of testosterone: klinefelter’s, testicular atrophy
- excess oestrogen: liver disease, testicular tumours, obesity
- medication: spironolactone, anabolic steroids
What is breast ductal carinoma in situ?
Neoplastic epithelial cells confined to ductolobular system with no invasion beyond basement membrane
What testing can be done to see if there has been invasion through basement membrane?
Immunohistochemistry showing intact myoepithelial cells = no invasion
Management of ductal lobular carinoma in situ
- Surgery: breast conserving vs mastectomy
- consider radiotherapy
- consider endocrine therapy if ER positive
What is the most common subtype of breast adenocarcinoma?
Invasion ductal carcinoma
Types of breast adenocarcinoma
- invasive ductal (most common)
- lobular
- tubular
- mucinous
- micropapilary
What parameters are looked at in breast cancer grading?
Tubule formation
Nuclear pleomorphism
Mitotic count
What is used to stage breast cancer?
TNM
Managment of breast cancer
- surgery
- sentinel lymph node biopsy
- chemotherapy
- radiotherapy
Systemic therapies of breast cancer
Tamoxifen
Herceptin
How does tamoxifen work in breast cancer treatment
Selective oestrogen receptor modulator
Blocks receptor and prevents over production of oestrogen driving proliferation
How does Herceptin work as a treatment in breast cancer?
Blocks HER2 receptor and prevents over production of HER2 driving proliferation
What is peau d’orange?
Orange skin appearance of breast
What is Paget’s disease of the nipple?
What is it assocaited with?
- Unilateral red, bleeding eczematous lesion > erosion
- Associated with ductal carcinoma in situ or invasive carcinoma
Risk factors of breast cancer
- increasing age
- previous breast cancer
- BRCA1+2
- dense breast tissue
- benign breast diseases
- hormonal factors e.g. HRT, COCP, early menarche/late menopause + nulliparity
- obesity
- alcohol
- smoking
Presentaion of breast cancer
- Breast lump - often tethered + painless
- nipple symptoms
- skin changes
What is intra ductal papiloma?
Being tumour inside milk duct > bloody nipple discharge
