Female Reproductive Pathology 1

Question 1

What types of lesions do benign breast diseases cover?

Answer 1

• developmental abnormalities
• inflammatory lesions
• epithelial and stromal proliferations
• neoplasms

Question 2

How would you approach a mass in the breast clinically?

Answer 2

• because benign lesions tend to not lead to an increased risk of developing breast cancer, invasive treatment is avoided unless needed
• important to distinguish between benign and malignant using fine needle aspiration then cytology
• for more information a core biopsy can be taken for histology
• if suspected lymph node spread then sentinel node biopsy taken

Question 3

Describe the difference in appearance of normal and cancerous cells in cytology

Answer 3

Normal:

• large cytoplasm
• single nucleus
• single nucleolus
• fine chromatin

Cancerous:

• small cytoplasm
• multiple nuclei
• multiple and large nucleoli
• coarse chromatin

Question 4

What is fibrocystic change (FCC)?

Answer 4

• an exaggerated physiological response seen in benign breast disease
• non-proliferative change involving gross and microscopic cysts, apocrine metaplasia, mild epithelial hyperplasia, adenosis and increase in fibrous stroma

Question 5

List some benign breast tumours

Answer 5

• fibroadenoma
• duct papilloma
• adenoma
• connective tissue tumours

Question 6

List features of fibroadenomas

Answer 6

• arise from breast lobules and is benign
• made of fibrous and epithelial tissue
• well circumscribed, highly mobile

Question 7

What are the 2 forms of non-invasive precursors of breast cancer?

Answer 7

• ductal carcinoma in situ (unilateral)

- lobular carcinoma in situ (bilateral, can be multifocal)

Question 8

List some invasive carcinomas of the breast

Answer 8

• no special type (75-90%)
• infiltrating lobular carcinoma
• special types (less common)

Question 9

List the important features of Paget’s disease

Answer 9

• disease of the nipple
• leads to erosion of the nipple resembling eczema
• associated with underlying in situ or invasive carcinoma

Question 10

What are some clinical signs indicative of suspected breast cancer?

Answer 10

• lump in breast
• pulled in nipple
• dimpling in the skin of the breast
• discharge from nipple
• redness/rash on breast
• skin changes on breast

Question 11

List features of cervical squamous neoplasia

Answer 11

• invasive tumour of epithelial origin
• squamous differentiation
• main aetiological factor is HPV
• risk factors: HIV and smoking

Question 12

How can HPV lead to cancer?

Answer 12

• if virus is persistent it can incorporate itself into the host’s cell genome
• production of viral oncoproteins can inactivate the genes that suppress tumours (p53 and pRb)
• leading to damaged DNA replicated and not being checked or repaired
• malignant transformation of cells that proliferate uncontrollably

Question 13

List important features of invasive cervical cancer

Answer 13

• most are SCC
• minority are adenocarcinomas
• symptoms: post coital bleeding, asymptomatic in early stages

Question 14

What is the treatment for invasive SSC of the cervix?

Answer 14

• radical hysterectomy favoured for localised tumour (esp in younger women)
• for larger than 4cm or spread beyond cervix, radiotherapy with concurrent platinum based chemo is treatment