HD EOYS6 (mostly breast histology qs) Flashcards
The majority of breast disease originates from which part of the breast? [1]
Terminal ductal lobular unit
Intralobular duct
Lactiferous duct
Interlobular duct
The majority of breast disease originates from which part of the breast? [1]
Terminal ductal lobular unit
Intralobular duct
Lactiferous duct
Interlobular duct
During pregnancy there is a drastic [increase / decrease] in adipose tissue in breast
During pregnancy there is a drastic [increase / decrease] in connective tissue in breast
During pregnancy there is a drastic decrease in adipose tissue in breast
During pregnancy there is a drastic decrease in connective tissue in breast
Pregnancy and breast tissue
[] secretion is also known as exocytosis
Apocrine
Merocrine
Exocrine
Endocrine
[] secretion is also known as exocytosis
Apocrine
Merocrine
Exocrine
Endocrine
TL: invasive ductal
TR: insitu ductal
BL: invasive lobu
BR: insitu lobular
BR; invasive ductal
BL: dcis
TR: invasive lobular
TL: insitu loblar
When should the cranial sutures close?
After 6 months
After 8 months
After 12 months
After 18 months
When should the cranial sutures close?
After 6 months
After 8 months
After 12 months
After 18 months
Growth hormone deficiency characterised by? [3]
Growth hormone deficiency characterised by:
- decreased growth velocity
- delayed skeletal maturation
- in the absence of other explanations
**Normal birth weight and only slighly reduced length **
Normal growth: but after 7 / 8 years growth plateaus (regains after GH treatment)
Why does GH deficiency suggest that GH is only a minor contributor to intrauterine growth? [1]
Children with GHD have normal birth weight and only slightly reduced length
If you have short stature or decreased growth rate - what would screening studies try and rule out / discover? [2]
If no findings were found for ^, what would you diagnose? [1]
Growth Hormone Deficiency
Another underlying disease
No findings of GHD: Idiopathic short stature
What type of drug is oxandrolone and what does it help to treat? [1]
Androgen anoblic steroid: can improve height in Tuner syndrome; but not for ISS
Name two types of ISS [2]
constitutional growth delay
familial short stature
When does puberty begin in boys [1] and girls [1]
Puberty starts in 95%:
Girls between 8 -13 years
Boys between 9-14 years
What are the 5 stages of James Tanner puberty?
Tanner stage 1 = pre-puberty
Tanner stage 2 = start of puberty
Tanner stage 5 = sexual maturity
You are posted in a Paediatric endocrinology placement where you are seeing multiple cases of girls being diagnosed with precocious puberty by your consultant. Precocious puberty is defined as the onset of secondary sexual characteristics before what age?
5 years
7 years
8 years
9 years
You are posted in a Paediatric endocrinology placement where you are seeing multiple cases of girls being diagnosed with precocious puberty by your consultant. Precocious puberty is defined as the onset of secondary sexual characteristics before what age?
5 years
7 years
8 years
9 years
What would the precocious puberty be classified as in girls [1] and boys? [1]
What is most common cause? [1]
Reach Tanner stage 2 before age of 8 (female) or 9 (male)
Most common cause is premature production of GnRH (stage 2)
How do you treat precocious puberty? [1]
Give GnRH to overstimulate pituitary and desensitised and stops producing gonadotrophins
At what stage of James Tanner puberty is irreversible to treatment for precocious puberty? [1]
Stage 3
What would an individual with low or normal serum LH and FSH levels but a normal growth rate be likely to suffering from? [1]
GnRH deficiency or Constitutional delay of growth and puberty (CDGP)
What would an individual with low or normal serum LH and FSH levels but a slow growth rate be likely to suffering from? [1]
Functional hypogonadotropic hypogonadism
What would an individual with elevated serum LH and FSH levels after 13 /14 years be suffering from? [1]
Primary hypogonadism
What are the 3 potential causes of functional hypogonadotropic hypogonadism?
If have a low BMI? [1]
If have a normal BMI? [3]
If have a high BMI? [1]
What are the 3 potential causes of functional hypogonadotropic hypogonadism?
If have a low BMI: GI disorder (underfeeding)
If have a normal BMI: hypothyroidsm; hyper-PRL; GHD
If have a high BMI: Iatrogenic (corticoids)
What do you need to take into account when assessing disablity and developmental delay in pre-term children? [1]
Preterm birth: need to ensure have a corrected age vs chronological age for developmental purposes up to 2yrs age
(e.g. Born at 28/40weeks at 1 year age is actually like a 9month old developmentally)
Explain the tests you would conduct for a newly diagnosed Downs Syndrome baby and why [4]
Cardiac assessment (echocardiogram): Between 40 and 60% of babies with Down syndrome have congenital heart defects
Hearing tests: sensorineural hearing loss identified at newborn hearing screening in children with Down syndrome is higher than in the general population at 4-6%.
Ophthalmology: increase in congenital cataract AND infantile glaucoma
Ensure feeding established and no vomiting: congenital malformations of their gastrointestinal tract
Autistic spectrum disorder refers to the full range of people affected by a deficit in []? [3]
Autistic spectrum disorder refers to the full range of people affected by a deficit in social interaction, communication and flexible behaviour.
A mutation in which gene can cause bilateral progressive sensorineural hearing loss?
Bilateral progressive sensorineural hearing loss with A1555G mutation.
What would a mother with A1555G mutation, causing Bilateral progressive sensorineural hearing loss in their child, be be advised to avoid? [1]
Mother advised to avoid aminoglycosides
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
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:
- A benign (not cancerous) condition in which scar-like fibrous tissue is found in the breast lobules
- 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
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.
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
