Histo - Breast Flashcards
Painful, red breast and fever. Lactation and breast feeding. Histo shows neutrophil infiltration
Acute mastitis Staph aureus Rx Continue lactation - stop abscess Abx and drainage if nec
Smoker, mastitis
Histo shows keratinising squamous epithelium
Periductal mastitis
Benign, no malignant potential
3 children, 50 years old, thick white nipple secretions. Histo shows granulomatous inflammation and dilation
Mammary Duct Ectasia
Benign, no malignant potential
Coding of breast lump aspirates
Pathologist says grade is C3, what do you do?
Refer for core biopsy + histology
C1 = inadequate
C2 = benign
C3 = atypia, probably benign
Probably chase and do a core biopsy + histology
C4 = suspicious of malignancy
C5 = malignant
Had trauma to the chest. Presents with a breast mass: hard, firm lump.
Cytology: inflammatory cell infiltrates into adipose tissue, multinucleate giant cells (clumped macrophages)
Fat Necrosis
Inflammatory reaction to damaged adipose tissue e.g. after trauma, surgery, radiotherapy Benign condition
Breast lumpiness in cycle with periods. Histo shows calcifications
Fibrocystic disease
Group of alterations in the breast leading to fibrosis and cystic changes
Normal, albeit exaggerated, response to hormonal changes
Very common, no malig risk
Painless, firm, solitary, mobile, slowly growing lump in the breast of a woman of child-bearing years
Cytology: mix of glandular cells ("epithelial") and proliferating stromal cells ("fibro")
Fibroadenoma
‘Breast mouse’
Similar to fibroadenoma presentation
Cytology: Cells are overlapping due to excess glandular and stromal proliferations
“Leaf-like, broad swaths of stroma, surrounded by glandular epithelial cells”
Stroma begins to appear blue due to overgrowth/stromal cellularity
Phyllodes tumour
A group of potentially aggressive fibroepithelial neoplasm
“Leaf-like” by name, and by shape
Uncommon
Usually seen in women in their 50s.
Vast majority are benign, but small majority are aggressive, therefore excision is necessary
A benign tumour arising from the duct system of the breast. Bloody discharge.
Pedunculated on a stalk, with a fibrovascular core
Arise within small terminal ductules (peripheral papillomas) or large lactiferous ductules (central papillomas)
Intraductal papilloma
Think of this like you would a polyp
Common, seen mostly in ages 40-60
Central papillomas: present with nipple discharge
Peripheral papillomas: can remain silent if small
Excision of involved duct is curative
A benign sclerosing lesion characterised by central zone of scarring, surrounded by radiating zone of proliferating glandular tissue
Radial scar
Proliferative breast disease, what is interesting with how the duct presents?
Doesn’t necessarily have a lesion unless calcified. Luminal change is most obvious sign.
Lumen are typically irregular and oblong.
Usual epithelial hyperplasia
Marker for ↑risk of malignancy (1.5 to 2x depending on severity of hyperplasia)
Lumen are typically round and punched-out from the surrounding tissue, which is a marker for atypical disease
Flat epithelial atypia (FEA)/Atypical ductal carcinoma
Evidence suggests that FEA may represent the earliest morphological precursor to low-grade ductal carcinoma in-situ 4x relative risk of developing cancer
In-situ lobular neoplasia
Increased risk of invasive breast cancer
Relative risk of 7-12 times
Calcification. 10% might have lump or discharge
Histology
Punched-out, well-circumscribed lumen of the duct Overlapping, rapidly developing cells Calcifications
Histology (high-grade)
Large, pleomorphic cells which completely occlude the distended duct's lumen
Ductal carcinoma in situ (DCIS)
the CALCIFICAITON is the giveaway
10% - lump, discharge, eczematous change in nipple (paget’s disease of nipple)
Complete excision or mastectomy, depending on size.
Invasive carcinoma
Pleomorphic cells. Large, nucleated, ↑nuclear:cytoplasm ratio.
Invading stroma beyond the ducts
Ductal
Large cells, abnormal, variable size. Lobular is more linear and smaller and similar size.
Invasive carcinoma
Tend to have linear arrangement
Tend to be less horrific looking, with monomorphic
(similar sized) cells
Indian file pattern: single line of monomorphic cells
Lobular
Linear whilst ductal is variable
Little tubules which are round and elongated, where the cancer invades into
Tubular
Mucin-containing cells
Mucinous
What is the most important prognostic factor?
Invasion into the apical lymph nodes - this is why you always check these LN on breast exam
Sheets of atypical cells with prominent lymphocytic infiltrate, and central necrosis
BRCA - Basal like carcinoma
Seems to metastasize very easily Tends to be triple negative (ER, PR, HER2)
Neoplastic epithelial proliferation limited to ducts/lobules by basement membrane
LCIS
How does ER/PR/HER2 affect prognosis?
ER/PR receptor positive associated with good prognosis because it predicts response to tamoxifen
HER 2 positive associated with bad
prognosis
HER2 mAb - herceptin
Tamoxifen - Oestrogen inhibitor at breast site - oestrogen ↑cancer so inhib is good
