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YEAR 5: HISTOPATH > 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

taken from fine needle aspirate or nipple discharge, very rapid + safe

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3
Q

Main disadvantage of FNA cytology

A

can’t tell difference between in situ carcinoma and invasive cancer

as it does not show surrounding tissue architecture

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4
Q

What is the gold standard for diagnosing breast cancer?

A

Histopathology

NOTE: 24-hour turnaround time

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5
Q

Describe the appearance of normal breast histology.

A
  • Lobules and ducts interspersed within connective stroma
  • Functional unit - Lobule and extralobular terminal duct are the terminal duct lobular unit (TDLU)
  • 2 types of storma - interlobular and intralobular
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6
Q

what are acini lined by
why is this clinically relevant

A

Luminal epithelial cells

Myoepithelial cells - around the outside of the epithelial cells - they help pump milk

Once cancer invades myoepithelial layer –> worse prognosis

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7
Q

benign inflammatory breast disease

A

acute mastitis
duct ectasia
fat necrosis

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8
Q

Define duct ectasia. Describe its presentation.

A
  • Inflammation and dilatation of large breast ducts.
  • Typically presents with a breast lump and nipple discharge.

Menopausal women - around time breast tissue involutes

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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

If duct ruptures –> acute inflammaotry response in surrounding tissue

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10
Q

Define acute mastitis

What is presentation

A

Acute inflammation of the breast.

red hot swollen 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

S.aureus

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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

Inflammatory reaction to damaged adipose tissue

in response to trauma

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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

What are benign neoplasms of the breast

A

fibroadenoma
fibrocytic disease

very rare, have slight capacity to become malignant:
phyllodes
intraductal papilloma

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17
Q

Define fibrocystic disease.

A
  • A group of alterations in the breast which reflect normal, albeit exaggerated, responses to hormonal influences
  • On histology, the ducts are usually dilated and calcified
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18
Q

Define fibroadenoma.

A

Benign neoplasm composed of stromal and glandular tissue (fibroepithelial)

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19
Q

Management of fibroadenoma.

A

lumpectomy if > 4cm
otherwise no treatement required

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20
Q

Define Phyllodes tumour.

A

A group of potentially aggressive fibroepithelial neoplasms of the breast.

NOTE: the majority are benign

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21
Q

Describe the histology of Phyllodes tumours.

A
  • Cells do not form uniform layers - stroma is overgrown
  • Whether it is benign or malignant depends on the cellularity of the stroma
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22
Q

Define intraductal papilloma.

A

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

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23
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
24
Q

How do intraductal papillomas present?

A
  • Central papillomas present with nipple discharge
  • Peripheral papillomas usually remain clinically silent
25
Describe the histology of intraductal papillomas.
* Histology will show a large dilated duct with a polypoid mass in the middle * The mass tends to have a fibrovascular core
26
What is a radial scar?
A benign sclerosing lesion characterised by a central zone of scarring surrounded by a radiating zone of proliferating glandular tissue
27
What pathological phenomenon is thought to be responsible for the formation of radial scars?
Exuberant reparative phenomenon in response to areas of tissue damage in the breast
28
How do radial scars present?
Seen as stellate masses on mammograms
29
Describe the histological appearance of radial scars.
Central stellate area with proliferation of ducts and acini in the periphery
30
Define proliferative breast disease.
A diverse group of intraductal proliferative lesions of the breast associated with an increased risk of subsequent development of invasive breast cancer
31
Describe the presentation of proliferative breast disease.
Microscopic lesions that usually produce no symptoms
32
Describe the appearance of usual epithelial hyperplasia.
Irregular lumens
33
What is flat epithelial atypia/atypical ductal hyperplasia?
* May be the earliest precursor to low grade DCIS * There are multiple layers of epithelial cells and the lumens become more regular
34
what are the in-situ breast diseases
ductal carcinoma in situ in situ lobular neoplasia
35
What is *in situ* lobular neoplasia?
A solid proliferation of cells within the acinus has increased risk of breast carcinoma in EITHER breast --> have MRI surveillance
36
What is ductal carcinoma *in situ*?
A neoplastic intraductal epithelial proliferation in the breast that has not breached the basement membrane - will still have myoepithelial layer risk of progression to invasive breast carcinoma screening designed to triage these women
37
How is DCIS classified
low, intermediate, high-grade
38
How are DCIS detected
85% - mammography as microcalcification only 10% symptomatic - e.g. lump, nipple discharge, skin changes 5% - incidentally
39
Describe the histological appearance of low grade DCIS.
* Lumens are compact and regular (cribriform (punch out) appearance) * Rapid death and proliferation of cells leads to calcification
40
Describe the histological appearance of high grade DCIS.
* Cells are large and few lumens left * Cells are pleomorphic and occlude the duct * necrosis and calcified
41
List some risk factors for invasive breast carcinoma.
* Early menarche * Late menopause * Nulliparity * Obesity * HRT * OCP * Alcohol * Family history | ALL TO DO WITH INCREASED ESTROGEN EXPOSURE
42
Describe the two genetic pathways that result in DCIS.
* **Low grade** - arise from low grade DCIS or *in situ* lobular neoplasia and show 16q loss * **High grade** - arise from high grade DCIS and show complex karyotypes with unbalanced chromosomal aberrations
43
Describe the histological appearance of: 1. Invasive ductal carcinoma 2. Invasive lobular carcinoma 3. Invasive tubular carcinoma 4. Invasive mucinous carcinoma
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 'single file' pattern 3. **Invasive tubular carcinoma** = elongated tubules of cancer cells invade the stroma 4. **Invasive mucinous carcinoma** = lots of 'empty' spaces containing mucin | 3,4 are rare don't focus
44
Describe the histological appearance of Basal-like carcinoma.
* Sheets of markedly atypical cells with a prominent lymphocytic infiltrate * Central necrosis is common
45
Describe the immunohistochemistry findings in Basal-like carcinoma.
Positive for basal cytokeratins (CK5/6 and CK14) NOTE: basal-like carcinoma is associated with BRCA mutations
46
Which histological grading system is used for invasive breast carcinoma?
Nottingham modification of the Bloom-Richardson system
47
how is male breast different to female
male breast has ducts within collagenized stroma but no/very few acini
48
What is histological grading dependent on?
* Tubule formation * Nuclear pleomorphism * Mitotic activity
49
Which three receptors are all invasive breast cancers assessed for?
* ER * PR * Her2
50
Describe the receptor phenotype of: 1. Low grade invasive breast cancer 2. High grade invasive breast cancer 3. Basal-like carcinoma
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
51
What is the most important prognostic factor in invasive breast cancer?
Status of axillary lymph nodes
52
Which age group is screened in the NHS breast screening programme?
50-71 year olds (every 3 years)
53
Outline the coding of biopsies for suspicious breast lumps.
* B1 = normal breast tissue * B2 = benign abnormality * B3 = lesion of uncertain malignant potential * B4 = suspicious of malignancy * B5 = malignancy (a = DCIS; b = invasive carcinoma) | core biopsy, stained with H&E
54
Define gynaecomastia. causes
Enlargement of the male breast Pre-pubertal, over 50, drugs | benign
55
what is paget's disease
in situ carcinoma of the nipple --> proliferation of malignant glandular epithelial cells in nipple areaolar epidermis | uncommon presentation of breast cancer
56
histology of male breast cancer
very similar to invasive ductal carcinoma 0.2% of all cancers
57
Describe the histology of gynaecomastia.
* Epithelial hyperplasia with finger-like projections extending into the duct lumen * Periductal stroma is often cellular and oedematous * Similar to fibroadenoma

YEAR 5: HISTOPATH (20 decks)

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