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Female GU and Breast Flashcards

1
Q

What are the two main components of the breast?

A
  • Stromal/connective tissue

- Epithelial

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2
Q

Describe the changes in breast tissue according to the menstrual cycle

A
  • Proliferative Phase (days 3-7) - Proliferation
  • Follicular Phase (days 8-14) - Decrease in size
  • Luteal Phase (days 15-20) - Myoepithelial changes and proliferation

Variations in stromal water content throughout

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3
Q

Describe the changes in breast tissue throughout pregnancy

A

Early Pregnancy - Lobular Enlargement to prepare for milk production and stromal depletion
Rest of Pregnancy - Secretory changes and lobular enlargement

Around 3 months after lactation has ceased, the breasts will have returned to normal

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4
Q

Describe the classification of the results of a fine needle aspirate

A 
C1 - Insufficient
C2 - Benign 
C3 - Atypical and probably benign 
C4 - Atypical and probably malignant 
C5 - Malignant
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5
Q

Describe the classification of the results of a core biopsy

A 
B1 - Normal or insufficient 
B2 - Benign 
B3 - Atypical and probably benign 
B4 - Atypical and probably malignant 
B5 - A - Insitu malignant 
        B - Invasive malignant
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6
Q

What is a fibroadenoma?

A

Smal benign lumps of stroma and epithelium that are very motile and often seen in young women aged 20-30

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7
Q

What are fibroadenomatoids?

A

Small lumps that are similar to fibroadenomas but have a stroma that appears abnormal. They are well defined, rounded and opaque

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8
Q

What are phyllodes tumours?

A

Small lumps similar to fibroadenomas that have a very well defined margin and a stroma that is much more cellular. The stroma may display;

  • Pleomorphism
  • Mitotic activity
  • Overgrowth
  • Necrosis
  • Malignancy
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9
Q

What is a fibrocytic lesion?

A

A lump due to cysts or nodular formation that tend to present in older women (30-40) and are more prominent and painful in the secretory phase of the menstrual cycle. On examination there is usually evidence of fibrosis and epithelial hyperplasia

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10
Q

What is duct ectasia?

A

Shortening of the ducts close to the onset of menopause that usually presents with nipple changes and discharge associated with pain
NB: A mammary fistula may occur, causing chronic nipple discharge

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11
Q

What is a papillary lesion?

A

A central mass that is accompanied by nipple discharge that is often blood stained. Upon imaging there is often micro-calcification and cytology can range from C1-C5

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12
Q

What is Pseudoangiomatous Stromal Hyperplasia? (PASH)

A

A hard palpable lump that clinically appears to be malignant but is infact benign

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13
Q

What is Granulomatous Mastitis?

A

A distinct hard lump that can be associated with chronic inflammation and pain. It is usually found in younger women who have had childre.

NB: Granulomatous conditions e.g. TB must be ruled out

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14
Q

What is a ductal carcinoma in situ?

A

A carcinoma that is confined to the ducts and can present with a lump, nipple discharge or nipple eczema.

NB: If left untreated (excision, mastectomy or radiotherapy) then 30% will develop into an invasive carcinoma in 15 years

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15
Q

What is a lobular carcinoma in situ?

A

Usually a chance finding in breast biopsies with no clinical or mammographic features; however it is usually multifocal and bilateral so is a risk factor for developing invasive carcinoma

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16
Q

What is invasive ductal carcinoma?

A

This is the most common form of breast cancer (>70%) and has many different microscopic features so if no typical features of other breast cancers can be found then IDC is diagnosed.

NB: Can be grade 1, 2 or 3

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17
Q

What is an invasive lobular carcinoma?

A

The second most common form of invasive breast cancer (10%). Microscopically signet ring cells can be seen and the cancer is diffusely infiltrative. This type of cancer is often mutlicentric and bilateral

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18
Q

What is a tubular carcinoma?

A

A very well differentiated grade 1 cancer that has a 95% 5 year survival

  • 3% of all breast cancers
  • 9% of all screening diagnoses
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19
Q

What is a mucinous/mucoid carcinoma?

A

This is the most common breast cancer in women aged 75+. On x-ray the lesion appears as a benign, well circumscribed tumour with lakes of mucin and well differentiated cells

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20
Q

What three morphological features are considered when grading breast cancer?

A
  • Tubules
  • Pleomorphism
  • Mitoses
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21
Q

What five main features impact prognosis in breast cancer?

A

1) Size of the tumour
2) Type of the tumour
3) Grade of the tumour
4) Node status
5) Hormone receptor status (oestrogen and progesterone)

22
Q

Describe the Nottingham Prognostic Index

A

Grade - 1 = 1 point
2 = 2 points
3 = 3 points
Nodal status - 0 nodes = 1 point
- 1-3 nodes = 2 points
- 4+ nodes = 3 points
Size - cm x 0.2

23
Q

What is endometriosis?

A

The presence of endometrial tissue outside of the uterus. Most commonly this will be the ovaries and uterine ligaments but can also be the appendix, colon etc.

24
Q

What is Polycystic Ovarian Syndrome? (PCOS)

A

Increased androgen biosynthesis in the ovaries with multiple cortical cysts and stromal hyperplasia. These changes can lead to annovulation.

25
What is stromal hyperplasia?
A condition similar to PCOS but one that occurs in post-menopausal women. There is bilateral enlargement of the ovaries due to increased stromal cellularity NB: Increased oestrogen production can promote endometrial hyperplasia and eventually endometrial cancer
26
Describe the different types of ovarian tumours
1) Surface Epithelial Tumours - a) Serous - Type I (low grade) - Type II (high grade) - b) Mucinous - c) Endometrioid 2) Germ cell tumours 3) Sex-cord tumours 4) Secondary ovarian tumours
27
Describe the staging of serous ovarian tumours
1) Ovary only 2) Confined to pelvis 3) Outside the pelvis or in the lymph nodes 4) Distant metastases
28
What is a fibroma?
A spindle cell tumour that produces collagen. It is hard, white and fibrous
29
What is a thecoma?
A stromal tumour with lipid containing cells. They are often benign but secrete oestrogen which increases the risk of endometrial adenocarcinoma and post-menopausal bleeding
30
What is a granulosa?
Soft, fleshy, focally haemorrhagic tumours that appear yellow due to their steroid content
31
Describe the layers of the wall of the uterus
- Mucosa - Endometrium - Muscularis - Myometrium - Serosa - Perimetrium
32
Describe the layers of the endometrium
Functional Layer - Stratum compactum - Stratum spongiosum Basal Layer
33
What are the different regions of the cervix?
Endocervix Ectocervix External Os
34
What infections are important with regards to developing cervical cancer?
HPV 16 and 18
35
What are the different possible results of smear tests?
Negative - Repeat in 3 years Borderline Nuclear Abnormality - Repeat in 6 months, however after 3 BNAs, refer to colposcopy Low Grade Dyskaryosis - After two results refer to colposcopy High Grade Dyskaryosis - Refer to colposcopy Glandular Abnormality - Refer to colposcopy Features of Invasion - Urgent referral to colposcopy
36
What is CIN?
Cervical Intraepithelial Neoplasia Dysplasia/Neoplasia confined to the cervical epithelium. This can be either; - Low Grade - CIN1 - High Grade - CIN2 and 3
37
Describe the layers of the endometrium
Functional Layer - Stratum compactum - Stratum spongiosum Basal Layer
38
What are the different regions of the cervix?
Endocervix Ectocervix External Os
39
What infections are important with regards to developing cervical cancer?
HPV 16 and 18
40
What are the different possible results of smear tests?
Negative - Repeat in 3 years Borderline Nuclear Abnormality - Repeat in 6 months, however after 3 BNAs, refer to colposcopy Low Grade Dyskaryosis - After two results refer to colposcopy High Grade Dyskaryosis - Refer to colposcopy Glandular Abnormality - Refer to colposcopy Features of Invasion - Urgent referral to colposcopy
41
What is CIN?
Cervical Intraepithelial Neoplasia Dysplasia/Neoplasia confined to the cervical epithelium. This can be either; - Low Grade - CIN1 - High Grade - CIN2 and 3
42
What is cGIN?
Cervical Glandular Intraepithelial Neoplasia Dysplasia/Neoplasia of the endocervical glandular epithelium. This can develop into an adenocarcinoma which is not always detected as the CSP is aimed at squamous carcinomas
43
What is VIN?
Vulval Intraepithelial Neoplasia VIN1 - Mitotic cells in the deepest 1/3 VIN2 - Mitotic cells in the deepest 2/3 VIN3 - Mitotic cells throughout VIN1 = Low grade VIN and 3 = High grade
44
What is VaIN?
Vaginal Intraepithelial Neoplasia Tends to give rise to squamous carcinoma, as in cervical cancer
45
Describe the three ways in which hyperplasia can manifest in the endometrium
- Simple - Increase in gland number and complexity with slight crowding - Complex - Further crowding - Atypical - Abnormal nuclear features which means that the cells have a higher risk of progressing to carcinoma
46
Describe the staging of endometrial tumours
1A - Myometrium not involved or just the inner half 1B - Outer half of the myometrium involved 2 - Cervical stromal involvement 3A - Involvement of the serosal surface of the adnexae 3B - Involvement of the vagina or parametrium 3C - Involvement of the pelvic or para-aortic nodes 4A - Invasion of the bladder and bowel mucosa 4B - Distant metastases via lymphatics
47
What is a leiomyoma?
A benign tumour of smooth muscle that often has multiple primaries and can vary greatly in size. They occur in many parts of the body however there are very common in the uterus as they respond to oestrogen
48
What is a leiomyosarcoma?
A malignant tumour of the smooth muscle that is softer and less well circumscribed than leiomyomas. These tumours are susceptible to haemorrhaging and necrosis. They are able to metastasise fairly early to the lungs via the blood stream
49
What is adenomyosis?
A condition caused when endometrial tissue moves into the myometrium and causes uterine thickening. There can also be blood filled cysts found in the myometrium
50
What are endometrial polyps?
Benign outgrowths of endometrial tissue growing into the uterine activity that can cause irregular bleeding. There can be other types of polyp e.g. ones caused by tamoxifen

Female GU and Breast (1 decks)

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