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Edit YEAR 5: Histopathology > Breast_Pathology_Flashcards > Flashcards

Breast_Pathology_Flashcards

1
Q

Who is the speaker and what are the main focus areas of the breast pathology lecture?

A

Dr. Suchana Mukhopadhyay. Focus areas include breast physiology, common pathologies, NHS Breast Screening Program (NHSBSP), and novel prognostic factors.

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2
Q

What is the breast, and how does it differ between males and females?

A

The breast is a modified sweat gland, complex in females (undergoes changes during pregnancy, lactation, and menopause) and rudimentary in males.

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3
Q

What are the key components of the ‘Rule of Two’ in breast histology?

A

Two main structures: enlarged ducts (lactiferous ducts) and terminal duct lobular units. Two types of epithelial cells: luminal and myoepithelial. Two types of stroma: intralobular and interlobular.

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4
Q

What does the microscopic view of the breast include?

A

It includes lobular duct units with external lobular ducts and lobules, ducts supported by fibrous adipose connective tissue, and various structures and cell types essential for understanding pathology.

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5
Q

What are the common symptoms of breast disease?

A

Palpable lump or nodule, pain, and nipple discharge.

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6
Q

What are the statistics associated with the presentation of breast disease?

A

40% benign, 30% no disease despite lumpiness, 10% malignant.

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7
Q

How are many breast diseases detected?

A

Through abnormal screening programs.

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8
Q

What does triple assessment for breast disease investigation include?

A

Physical examination, imaging (ultrasound, mammography, MRI), and pathology (cytopathology or biopsy).

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9
Q

What is Fine Needle Aspiration Cytology (FNAC) and its limitations?

A

FNAC is used for palpable lumps or nipple discharge, safe and cost-effective, provides good cellular details, but lacks architectural details, cannot distinguish certain conditions, and no ancillary testing.

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10
Q

What are the two types of smear preparation and their significance?

A

Air-dried and alcohol-fixed smears, each providing different morphology for analysis.

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11
Q

What are the limitations of cytology smears?

A

Cannot differentiate atypical ductal hyperplasia from low-grade cancer, cannot differentiate high-grade in situ carcinoma from invasive cancer, and ancillary testing is not possible.

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12
Q

What do the categories C1 to C5 in cytopathology represent?

A

C1: Inadequate, C2: Benign, C3: Probably benign, C4: Suspicious, C5: Malignant.

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13
Q

What is core needle biopsy and its processing steps?

A

A procedure performed under imaging guidance with a 14-16 gauge needle, involving tissue fixation in formalin, embedding in paraffin, slicing, and staining before examination.

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14
Q

When is vacuum-assisted biopsy used and what is the needle size?

A

Used for larger or variegated lesions, with an 11-8 gauge needle.

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15
Q

What do the categories B1 to B5 in histopathology represent?

A

B1: Normal or inadequate, B2: Benign, B3: Uncertain malignant potential, B4: Suspicious, B5: Malignant (further classified into B5a, B5b, and B5c).

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16
Q

What is acute mastitis and its typical cause?

A

An inflammatory disease almost always seen in lactating women, commonly caused by Staphylococcus, presenting as painful, red, inflamed breast treated with antibiotics.

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17
Q

What is duct ectasia and its clinical presentation?

A

Inflammation of large breast ducts, presenting with nipple discharge, breast mass, or nipple retraction, with no increased risk of malignancy.

18
Q

What causes fat necrosis and how does it present?

A

Caused by trauma or post-treatment, presenting as a breast mass, benign condition with histology showing foamy macrophages, giant cells, and lipid vacuoles.

19
Q

What is a galactocele and its relation to lactation?

A

A condition related to lactation, affecting multiple ducts leading to tender nodules, which can progress to acute mastitis or abscess formation.

20
Q

What is fibrocystic disease and its histological components?

A

Reflects exaggerated responses to hormones, producing lumpiness without increased cancer risk, components include fibrosis, cystic changes, and adenosis.

21
Q

What is a radial scar and its significance?

A

A benign condition that mimics carcinoma on imaging, with a central area of fibrosis and radiating ducts, sometimes associated with underlying cancer.

22
Q

What is usual ductal hyperplasia and its risk?

A

A proliferation of luminal and myoepithelial cells in a haphazard way, not a direct precursor to invasive disease but slightly increases cancer risk.

23
Q

What is atypical ductal hyperplasia?

A

A potential precursor to ductal carcinoma in situ, showing cells with atypical features and apical snouts.

24
Q

What is a fibroadenoma?

A

The most common benign breast neoplasm, composed of fibrous and glandular tissue, occurring in women aged 20-30.

25
Q

What is a phyllodes tumor?

A

A potentially aggressive, uncommon tumor occurring in slightly older women, with histology showing stromal proliferation forming leaf-like structures.

26
Q

What is an intraductal papilloma?

A

A benign tumor arising in the duct system, causing nipple discharge, with histology showing proliferation within the duct with fibrovascular cores.

27
Q

What is Paget’s disease of the nipple?

A

A rare condition affecting both men and women, often associated with underlying carcinoma, characterized histologically by large atypical cells in the epidermis.

28
Q

What is DCIS and its detection method?

A

A non-invasive but high-risk breast cancer detected by mammography through microcalcifications, with histology showing cells within ducts with central necrosis and calcification.

29
Q

What is invasive ductal carcinoma?

A

The most common type of breast cancer, presenting as a lump, with histology showing cells infiltrating adjacent tissues.

30
Q

What is invasive lobular carcinoma?

A

A type of breast cancer affecting lobules, often multifocal and bilateral, with histology showing cells in a single-file arrangement, ‘Indian file’ pattern.

31
Q

What is tubular carcinoma?

A

A breast cancer with a good prognosis, characterized histologically by small, well-formed tubular structures in fibrous stroma.

32
Q

What is mucinous carcinoma?

A

A breast cancer with a good prognosis, with histology showing cancer cells floating in mucin pools.

33
Q

What is basal-like carcinoma?

A

A high-grade breast cancer with poor prognosis, showing sheets of atypical cells with lymphocytic infiltrate, positive for basal markers (CK5/6, CK14).

34
Q

What are the most important prognostic factors in breast cancer?

A

Lymph node involvement, tumor size, histological type, grade, hormone receptor status (ER, PR, HER2).

35
Q

What is the target demographic for the NHS Breast Screening Program (NHSBSP)?

A

Women aged 47-73, with mammography every three years.

36
Q

What percentage of abnormal mammograms lead to further investigation in the NHSBSP, and how many lives does it save annually?

A

5% of abnormal mammograms lead to further investigation, saving approximately 1200 lives annually, though there are concerns about overdiagnosis.

37
Q

What is gynaecomastia and its associated histology?

A

Enlargement of the male breast, occurring in pubertal boys and older men, associated with hyperestrogenism, with histology showing epithelial hyperplasia with finger-like projections.

38
Q

What is the median age of male breast cancer presentation and its histology?

A

Rare, with a median age of 65, presenting as a palpable lump, with histology similar to female breast cancer but lobular cancers are rare in males.

39
Q

What is Oncotype DX and its purpose?

A

A genetic test for estrogen-positive, low-grade cancers, predicting benefit from adjuvant therapy.

40
Q

What does a high Ki-67 Proliferation Index indicate?

A

Indicates a higher recurrence risk, with an index >7% correlating with a poorer prognosis.

41
Q

Why is the tumor immune environment important in breast cancer?

A

The presence and type of immune cells in the tumor microenvironment can guide potential targeted therapy, such as PD-L1 inhibitors.

42
Q

What are the key challenges and future directions in breast pathology?

A

Understanding breast pathology is crucial for accurate diagnosis and treatment. Challenges include differentiating benign from malignant conditions, optimizing screening programs, and addressing overdiagnosis concerns. Future directions focus on research on predictive methods, improving diagnostic accuracy, and developing novel treatments.

Edit YEAR 5: Histopathology (26 decks)

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