Female reproductive pathology II Flashcards
Describe the glandular architecture of the breast [4]
Secretory alveoli
* Cells in lobules of tubuloalveolar glands release milk
Intralobular ducts
* Collect alveolar secretions and convey them to:
Interlobular ducts
* Coalesce into about 15-25
Lactiferous ducts
* Drain milk toward the nipple
Which glands does the breast tissue contain? [3]
Sebaceous glands
Sweat glands
Modified mammary glands
What are the components of milk? [2]
Merocrine proteins (exocytotic release of protein)
Apocrine proteins / fatty component released in membrane enclosed droplets
What is a terminal duct lobular unit? [2]
Unit comprised of:
- Branched tubuloalveolar glands organised into lobes
- A duct that opens into a bout 10-12 acini
What are the two cell types found in each breast lobule / duct? [2]
What is the whole structure surrounded / bound by? [1]
Cell types:
* Outer myoepithelial layer (arrow)
* Inner epithelial cells (arrowhead)
Whole structure is bounded by a basement membrane
How would you determine if breast carcinoma was in situ or invasive? [1]
If basement membrane that surrounds the myopeithelial and inner epithelial cells is in tact
How does breast tissue change during early infant [1], puberty [1] to pregnancy [1]
In early infant: breast tissue is just ducts (lobules at end)
Puberty: lobules grow a bit and divide into 10/12 acini at end found interminal duct lovular unit
Pregnancy: further development of TDLU: grow bigger. cells undergrow hypertrophy and produce merocrine and apocrine proteins
Which hormones drive each stage of breast development?:
Young adult [1]
Adult [1]
Lactating adult [2]
Young adult: oestrogen stimulates duct growth
Adult: Progesterone: stimulates secretory alveoli
Lacating: Prolactin stimulates milk protein & fat synthesis, oxytocin: milk let down
The lactiferous duct is lined by what type of epithelial cell & is supported which type of cell? [2]
Lactiferous duct:
* Columnar epithelial cells
* Supported by myoepithelial cells
The majority of breast disease originates from which part of the breast? [1]
Lactiferous duct
What is the lactiferous sinus and role? [2]
an dilation within areolar, in a lactiferous duct at the base of the nipple in which milk accumulates so that can be released on demand
Why are mammograms difficult for women under 50?
The breasts are dense so hide pathology. As age the breast tissue gets more fatty and can see irregularities
A-D young –> old (dense glands –> fatty tissue)
What positions do you take photos of when undertaking mammogram screen [2]
Top & Side
What might mammograpy reveal on breast tissue? [1]
What could they be? [2]
Microcalcifications: calcium deposits - usually calcium oxalate
Could be usual duct hyperplasia (benign) OR neoplastic
What would next step be if ID microcalfications on mammography? [1]
Why? [2]
Biopsy - to determine if normal duct hyperplasia or cancerous
Label the mammory gland
4: Pec major
12: Pectoral fascia
13: mammory gland
14: serratus anterior
9: areolar
10: nipple
15: lactierous siinus
16 Apical lymph nodes
17 Axillary lymph nodes
23 Pectoralis minor muscle
4: Pectoralis major muscle
20 Lymph vessels
10: nipple
17 Axillary lymph nodes
[18 Intercostobrachial nerve]
19 Lateral thoracic vein
20 Lymph vessels
8 Breast tissue
10 Nipple (papilla)
21 Serratus anterior muscle
22 Medial branches of intercostal
arteries
4 Pectoralis major muscle
Young women often find palpable lumps, which turn out to be fibrocystic changes. Name 4 ways the fibrocystic changes may occur [4]
Fibrosis: dense pink collagen among the lobules
Cysts: often visible without a microscope – thin walled and full of clear fluid (arrow)
Usual duct hyperplasia
Adenosis: too many glands or lobules (proliferation of acini, with 2 layers (inner epithelial and outer myoepithelial), surrounded by basement membrane, without distortion of lobular architecture)
What is sclerosing adenosis of breast tissue & is it pathological. Explain your answer [3]
Sclerosing adenosis:
- proliferating lobules are squeezed together: makes them appear small and infiltrating
- BUT: cuboidal epithelial, myoepithelial cells and basement membrane remain
- Therefore: Benign
Define apocrine metaplasia [1]
Describe cell structure of Apocrine metaplasia [2]
Apocrine metaplasia: is a benign fibrocystic change characterized by dilated acini lined by columnar cells with apocrine features.: the transformation of breast epithelial cells into an apocrine or sweat‐gland type of cells
Single layer of cuboidal to columnar cells that have lumpy / scalloped appearance with enlarged nuclei with prominent nucleoli
Secretions are common in the apocrine metaplasia
What is the definition of fibroadenomas? [1]
Benign breast tumours characterized by proliferation of ducts (adenoma) and stroma (fibro)
Describe histological changes in fibroadenomas
Ducts & Stroma proliferating:
* Proliferating stoma compressed ducts to slits
* Old fibroadenomas become hyalinized and calcified
Arrowhead: stroma, Arrow: compressed ducts
Where does breast cancer pre-dominately occur? [1]
within ducts
Describe the the difference in cell structure of normal ducts [1], usual ductual hyperplasia [1] and Ductal carcinoma in situ (DCIS) [1]
Normally: one layer of cuboidal cells
Usual ductal hyperplasia: stratified cuboidal hyperplasia
Ductal carcinoma in situ (DCIS): stratified cuboidal hyperplasia with atypical nuclei & unusual nuclei: cytoplasm ratio changes. can become invasive and break down basement membrane
What is the most common type of breast cancer? [1]
Invasive ductal carcinoma
Desribe pathophysiology of invasive ductal carcinoma [1]
when BM breached and malignant cells try to create small ducts - get sheets of cells penetrating the SMC & stroma
Describe the pathology of invasive lobular carcinoma [1]
get sheets of cells penetrating the SMC & stroma
Malignant cells form single file lines or single cells
Often show vacuoles within cytoplasm
What is the structure highlighted? [1]
Describe the cells surrounding it [2]
Lactiferous Duct - each lobe is drained by a single lactiferous duct that opens into the nipple. It is lined by a double layer of cuboidal or columnar cells surrounded by a sheath of connective tissue with myoid cells.
Difference between lactating and non-lactating mammory glands histoligically
R: Lactating
What type of breast cancer is depicted? [1]
classic invasive lobular carcinoma
What type of breast cancer is depicted? [1]
ductal carcinoma in situ (DCIS)
What type of breast cancer is depicted? [1]
DCIS
What alteration to the breast tissue has occured? [1]
Figure 2 – Histology showing ductal carcinoma in-situ (DCIS), demonstrating the malignant cells confined to the mammary ducts
What type of pathology is depicted in this breast tissue?
Invasive ductal carcinoma
DCIS
Invasive lobular carnicoma
What type of pathology is depicted in this breast tissue?
Invasive ductal carcinoma
DCIS
Invasive lobular carnicoma
What type of pathology is depicted in this breast tissue?
Invasive ductal carcinoma
DCIS
Invasive lobular carnicoma
What type of pathology is depicted in this breast tissue?
Invasive ductal carcinoma
DCIS
Invasive lobular carnicoma
Which change to breast tissue is depicted here
Cysts
DCIS
Fibroadenoma
Sclerosing adenosis
Apocrine metaplasia
Which change to breast tissue is depicted here
Cysts
DCIS
Fibroadenoma
Sclerosing adenosis
Apocrine metaplasia
Apocrine metaplasia with eosinophilic cytoplasm and apical snouts involving dilated cysts. Notice the transition from single to multiple layered epithelium to true papillary configuration in the same cystic space.
Which change to breast tissue is depicted here
Cysts
DCIS
Fibroadenoma
Sclerosing adenosis
Apocrine metaplasia
Which change to breast tissue is depicted here
Cysts
DCIS
Fibroadenoma
Sclerosing adenosis
Apocrine metaplasia - abundant eosinophilic granular cytoplasm, prominent nucleolus and apocrine snouts.
What change to breast tissue is depicted here? [1]
Microcalcifications tend to be less common in fibrocystic change than in carcinoma. They tend to be coarse and irregular.
Which change to breast tissue is depicted here
Cysts
DCIS
Fibroadenoma
Sclerosing adenosis
Apocrine metaplasia
Which change to breast tissue is depicted here
Cysts
DCIS
Fibroadenoma
Sclerosing adenosis
Apocrine metaplasia
Some of the larger cysts in fibrocystic change may have a bluish appearance from outside (blue-domed cysts). The cyst lining is flattened or absent in some cases. In the center of this image, cysts are lined by apocrine epithelium. Note the focus of adenosis above it.
Which change to breast tissue is depicted here
Cysts
DCIS
Fibroadenoma
Sclerosing adenosis
Apocrine metaplasia
Which change to breast tissue is depicted here
Cysts
DCIS
Fibroadenoma
Sclerosing adenosis
Apocrine metaplasia
Sclerosing adenosis is a benign hyperplastic process that may be mistaken for carcinoma. The average age at presentation is about 30 yrs. The lesion retains is lobular configuration and is more cellular centrally.
Which change to breast tissue is depicted here
Cysts
DCIS
Fibroadenoma
Sclerosing adenosis
Apocrine metaplasia
Which change to breast tissue is depicted here
Cysts
DCIS
Fibroadenoma
Sclerosing adenosis
Apocrine metaplasia
The proliferating tubules may be elongated and have attenuated lumens. There is preferential preservation of myoepithelial cells in the tubules and epithelial cells are less conspicuous. Some degree of lobular fibrosis is usually present.
Which change to breast tissue is depicted here
Cysts
DCIS
Fibroadenoma
Sclerosing adenosis
Apocrine metaplasia
Which change to breast tissue is depicted here
Cysts
DCIS
Fibroadenoma
The tubules and glands in a fibroadenoma are lined by cuboidal or low columnar epithelium with uniform nuclei and surrounded by a myoepithelial layer. The stroma is made up of loose connective tissue. If the stroma is hypercellular, the diagnosis of phyllodes tumor should be excluded.
Sclerosing adenosis
Apocrine metaplasia
Which change to breast tissue is depicted here
Cysts
DCIS
Fibroadenoma
Sclerosing adenosis
Apocrine metaplasia
Which change to breast tissue is depicted here
Cysts
DCIS
Fibroadenoma
Sclerosing adenosis
Apocrine metaplasia
Higher magnification view of intracanalicular pattern in a fibroadenoma. The stromal connective tissue invaginates into the glandular epithelium and appears to be contained within it.
Which breast pathology is depicted here? [1]
Lobular carcinoma-in-situ (LCIS) is a non-palpable lesion which is usually an incidental finding in breasts removed for other reasons. It is multicentric in 70% of cases and bilateral in 30% to 40% of cases. The lobules are distended with uniform round or oval, medium sized cells. The nuclei are uniform and normochromatic. This image shows LCIS involving several lobules. A few uninvolved lobules can be seen on the right.
What is this breast pathology depicted? [1]
Ductal carcinoma in situ
The tumor cells with high nuclear grade nearly fill the lumen in this example of DCIS. The cytoplasmic borders are sharply demarcated.
What breast pathology is depicted here [1]
High power view of cribriform DCIS showing microcalcifications.
What breast pathology is depicted here? [1]
This case of high-grade invasive ductal carcinoma was composed mostly of solid areas, showed no evidence of tubule formation and was assigned score of 3 for tubule formation.
Which of the these photos is invasive ductal or invasive lobular breast cancer? [2]
L: invasive ductal carcinoma showed tubule formation
R: Invasive lobular carcinoma The tumor cells are arranged in slender linear strands one to two cells across
Which of the these photos is invasive ductal or invasive lobular breast cancer? [2]
R: invasive ductal carcinoma showed tubule formation
L: Invasive lobular carcinoma
Which of the following best describes the slide
Stromal fibrosis
Cysts
Adenosis
Apocrine metaplasia
Cysts
(apocrine are more eosinophilic)
Which of the following best describes the slide
Stromal fibrosis
Cysts
Adenosis
Apocrine metaplasia
Apocrine metaplasia
Label the folllowing with
Stromal fibrosis
Cysts
Adenosis
Apocrine metaplasia
