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YEAR 5: Histopathology > Histo: Breast pathology > Flashcards

Histo: Breast pathology Flashcards

1
Q

What are the three components of investigating breast disease?

A
  • Clinical examination
  • Imaging (ultrasound, mammography or MRI)
  • Pathology (cytopathology and/or histopathology)
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2
Q

Outline the coding used by cytopathologists when assessing breast aspirates.

A
  • C1 = inadequate
  • C2 = benign
  • C3 = atypia, probably benign
  • C4 = suspicious of malignancy
  • C5 = malignant
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3
Q

What is the gold standard for diagnosing breast cancer?

A

Histopathology

NOTE: 24-hour turnaround time

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4
Q

Describe the appearance of normal breast histology.

A
  • Glandular tissue will be stained purple with pink stroma around it
  • Myoepithelial cells will be seen around the outside of the epithelial cells - they help pump milk
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5
Q

What is the terminal ductal lobular unit

A

The lobule and extralobular terminal duct are together referred to as the terminal duct lobular unit (TDLU)

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6
Q

What are the acini?

A

The sack-like glandular structures within a lobule that produce milk

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7
Q

Define duct ectasia. Describe its presentation.

A
  • Blockage of lactiferous ducts leading to inflammation and dilatation
  • Usually asyptomatic, although can present with a breast lump, nipple discharge (usually greenish), and pain
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8
Q

Which group does duct ectasia typically present in?

A

50-60 yrs old muliparous women

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9
Q

Describe the histology of duct ectasia.

A
  • The duct will be distended and full of proteinaceous material
  • Foamy macrophages will also be present
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10
Q

Define acute mastitis.

A

Acute inflammation of the breast.

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11
Q

Which group of women tend to be affected by acute mastitis?

A

Often seen in lactating women due to cracked skin and stasis of breast milk.

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12
Q

Which organism is usually responsible for acute mastitis?

A

Staphylococci

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13
Q

Describe the cytological appearance of acute mastitis.

A

Lots of neutrophils

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14
Q

Define fat necrosis.

A

Death of adipose tissue due to trauma to the breast

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15
Q

Describe the cytological appearance of fat necrosis.

A

Fat cells surrounded by macrophages.

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16
Q

How to galactoceles form and how do they present?

A
  • Cystic dilatation of ducts during lactation affecting mulitple ducts
  • Present as tender papable breast nodules
  • Can present as mastitis if they become infected
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17
Q

What is fibrocystic disease of the breast and how does it present?

A
  • A group of alterations in the breast which reflect normal, albeit exaggerated, responses to hormonal influences
  • Presents with lumpy breast and CYCLICAL tenderness (cyclic mastalgia)
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18
Q

Which age group does fibrocystic diease affect

A
  • 20-50 yrs old
  • Most common benign breast lesion
  • Affects 50% of women
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19
Q

Descibe the histology of fibrocystic disease

A
  • On histology, the ducts are usually dilated and calcified
  • No increased risk of breast cancer
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20
Q

Define fibroadenoma.

A

Benign neoplasm consisting of fibrous and glandular tissue

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21
Q

Which age group does fibroadenoma effect? How does it present?

A
  • 20-30 year old women
  • Presents as well-circumscribed, mobile breast lump
  • Non-tender
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22
Q

Describe the histology of fibroadenoma.

A

Consists of lots of glandular and stromal cells.

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23
Q

How is fibroadenoma treated?

A
  • Small (<2cm) - expectant
  • Large (>2cm) or symptomatic - surgical excision
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24
Q

Define Phyllodes tumour.

A

A group of potentially aggressive fibroepithelial neoplasms of the breast.

Can develop from pre-existing fibroadenomas

NOTE: the majority are benign

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25
Q

Which age group does Phyllodes tumour effect? How do they present?

A
  • 50+ years old
  • Presents as painless, enlarging lump
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26
Q

Describe the histology of Phyllodes tumours.

A
  • Biphasic (consists of 2 cell types - epithelial and stromal)
  • Leaf-like pattern (phyllodal)
  • Whether it is benign or malignant depends degree of stromal proliferation
27
Q

How are phyllodes tumours treated?

A
  • Benign - surgical excision
  • Borderline or malignant - CT for metastases
    • No mets - wide local excision
    • Mets - surgery plus chemotherapy
28
Q

Define intraductal papilloma.

A

A benign papillary tumour arising within the duct system of the breast.

29
Q

What are the two different types of intraductal papilloma?

A
  • Peripheral papilloma - arises in small terminal ductules
  • Central papilloma - arises in large lactiferous ductules
30
Q

Describe the epidemiology of intraductal papilloma?

A
  • Common
  • Affects women aged 40-60 yrs old
31
Q

How do intraductal papillomas present?

A
  • Central papillomas present with nipple discharge
  • Peripheral papillomas usually remain clinically silent
32
Q

Describe the histology of intraductal papillomas.

A
  • Histology will show a large dilated duct with a polypoid mass in the middle
  • The mass tends to have a fibrovascular core
33
Q

How is intraductal papilloma treated?

A

Excision of involved duct

34
Q

What is a radial scar?

A
  • A benign sclerosing lesion characterised by a central zone of scarring surrounded by a radiating zone of proliferating glandular tissue
  • Reasonably common
35
Q

What pathological phenomenon is thought to be responsible for the formation of radial scars?

A

Exuberant reparative phenomenon in response to areas of tissue damage in the breast

36
Q

How do radial scars present? How are they treated?

A

Seen as stellate masses on mammograms (can mimic carcinoma)

Excision is curative

37
Q

Describe the histological appearance of radial scars.

A

Central stellate area with proliferation of ducts and acini in the periphery

38
Q

Define proliferative breast disease.

A

A diverse group of intraductal proliferative lesions of the breast associated with an increased risk of subsequent development of invasive breast cancer

39
Q

Describe the presentation of proliferative breast disease.

A

Microscopic lesions that usually produce no symptoms

Typically diagnosed in breast tissue removed for other reasons or on screening mammograms if they are calcified

40
Q

Describe the appearance of usual epithelial hyperplasia.

A

Irregular lumens with mildly abnormal cytology and tissue architecture.

41
Q

What is flat epithelial atypia/atypical ductal hyperplasia?

A
  • May be the earliest precursor to low grade DCIS
  • Frequent secretion and calcifications
  • There are multiple layers of epithelial cells and the lumens become more regular
  • Abnormal cytology and tissue architecture
42
Q

What is in situ lobular neoplasia?

A

A solid proliferation of cells within the acinus

Does not form a palpable mass

43
Q

What is Paget’s diease of the nipple and what age group does it affect?

A
  • Carcinoma in situ of the nipple areola epidermis
  • Affects women ages 60-70 years old
  • Underlying high-grade DCIS present in >95% of patients
44
Q

What is ductal carcinoma in situ? How is it diagnosed?

A
  • A neoplastic intraductal epithelial proliferation in the breast that has not breached the basement membrane
  • Largely asymptomatic - 85% present as microcalcifications on screening mammogram
  • 10% produce symptoms (e.g. lump, discharge, Paget’s disease of nipple)
45
Q

Describe the histological appearance of low grade DCIS.

A
  • Fenestrated proliferation with multiple, round, rigid extracellular lumens with punched out appearance
  • Rapid death and proliferation of cells leads to calcification
46
Q

Describe the histological appearance of high grade DCIS.

A
  • Cells are large and few lumens left
  • Cells are pleomorphic and occlude the duct
  • Comedo necrosis (necrosis of cancer cells in centre of lumen)
47
Q

How is DCIS treated?

A

Complete surgical excision with clear margins

Recurrance more likely with extensive or high-grade disease

48
Q

List some risk factors for invasive breast carcinoma.

A
  • Family history (BRCA)
  • Nulliparity
  • Early menarche
  • Late menopause
  • Obesity
  • Alcohol
  • OCP
49
Q

How does invasive breast cancer present?

A
  • Most present with present lump
  • Increasing proportion are detected whilst asymptomatic by screening mammogram
50
Q

What is the most common type of invasive breast cancer?

A

Invasive ductal carcinoma

51
Q

Describe the histological appearance of:

  1. Invasive ductal carcinoma
  2. Invasive lobular carcinoma
  3. Invasive tubular carcinoma
  4. Invasive mucinous carcinoma
A
  1. Invasive ductal carcinoma = cells are plaeomorphic and have large nuclei
  2. Invasive lobular carcinoma = cells have a linear arrangement and are monomorphic. NOTE: cords of cells are sometimes referred to as ‘Indian File’ pattern
  3. Invasive tubular carcinoma = elongated tubules of cancer cells invade the stroma
  4. Invasive mucinous carcinoma = lots of ‘empty’ spaces containing mucin
52
Q

What are basal like carcinomas? Describe their histological appearance

A
  • Recently discovered breast cancer type following genetic analysis of breast cancers
  • Sheets of markedly atypical cells with a prominent lymphocytic infiltrate
  • Central necrosis is common
  • Propensitiy for vascular invasion and subsequent metastasis
53
Q

Describe the immunohistochemistry findings in Basal-like carcinoma.

A

Positive for basal cytokeratins (CK5/6 and CK14)

NOTE: basal-like carcinoma is associated with BRCA mutations

54
Q

Which histological grading system is used for invasive breast carcinoma?

A

Nottingham Histologic Score

55
Q

What is histological grading dependent on?

A
  • Tubule/gland formation (more glands = better prognosis)
  • Nuclear pleomorphism
  • Mitotic activity

Scored out of 9 points. The higher the score, the less differentiated the tumour = worse prognosis

56
Q

Which three receptors are all invasive breast cancers assessed for?

A
  • ER
  • PR
  • Her2
57
Q

Describe the receptor phenotype of:

  1. Low grade invasive breast cancer
  2. High grade invasive breast cancer
  3. Basal-like carcinoma
A
  1. Low grade invasive breast cancer
    • ER/PR positive
    • Her2 negative
  2. High grade invasive breast cancer
    • ER/PR negative
    • Her2 positive
  3. Basal-like carcinoma
    • Triple negative
58
Q

What is the most important prognostic factor in invasive breast cancer?

A

Status of axillary lymph nodes

(other important factors include tumour type, grade, and size)

59
Q

Which age group is screened in the NHS breast screening programme? What does the mammogram looked for?

A

50-71 year olds (every 3 years)

Mammogram looks for masses and microcalcifications

60
Q

Outline the coding of histological biopsies for suspicious breast lumps.

A
  • B1 = normal breast tissue
  • B2 = benign abnormality
  • B3 = lesion of uncertain malignant potential
  • B4 = suspicious of malignancy
  • B5 = malignancy (a = DCIS; b = invasive carcinoma)
61
Q

How does the structure of the male breast differ to females

A

Ductal stuctures but no/rare acini

62
Q

Define gynaecomastia. What age group does it tend to affect?

A

Enlargement of the male breast

Affects pubertal boys and men >50 years

No increased risk of malignancy

63
Q

What is an important pathological cause of gynaecomastia

A

Hyperoestrogenism in liver cirrhosis

64
Q

Describe the histology of gynaecomastia.

A
  • Epithelial hyperplasia with finger-like projections extending into the duct lumen
  • Periductal stroma is often cellular and oedematous
  • Similar to fibroadenoma

YEAR 5: Histopathology (20 decks)

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