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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
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
26
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

27
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

28
Q

How do radial scars present?

A

Seen as stellate masses on mammograms

29
Q

Describe the histological appearance of radial scars.

A

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

30
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

31
Q

Describe the presentation of proliferative breast disease.

A

Microscopic lesions that usually produce no symptoms

32
Q

Describe the appearance of usual epithelial hyperplasia.

A

Irregular lumens

33
Q

What is flat epithelial atypia/atypical ductal hyperplasia?

A
  • May be the earliest precursor to low grade DCIS
  • There are multiple layers of epithelial cells and the lumens become more regular
34
Q

what are the in-situ breast diseases

A

ductal carcinoma in situ
in situ lobular neoplasia

35
Q

What is in situ lobular neoplasia?

A

A solid proliferation of cells within the acinus

has increased risk of breast carcinoma in EITHER breast –> have MRI surveillance

36
Q

What is ductal carcinoma in situ?

A

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
Q

How is DCIS classified

A

low, intermediate, high-grade

38
Q

How are DCIS detected

A

85% - mammography as microcalcification

only 10% symptomatic - e.g. lump, nipple discharge, skin changes

5% - incidentally

39
Q

Describe the histological appearance of low grade DCIS.

A
  • Lumens are compact and regular (cribriform (punch out) appearance)
  • Rapid death and proliferation of cells leads to calcification
40
Q

Describe the histological appearance of high grade DCIS.

A
  • Cells are large and few lumens left
  • Cells are pleomorphic and occlude the duct
  • necrosis and calcified
41
Q

List some risk factors for invasive breast carcinoma.

A
  • Early menarche
  • Late menopause
  • Nulliparity
  • Obesity
  • HRT
  • OCP
  • Alcohol
  • Family history

ALL TO DO WITH INCREASED ESTROGEN EXPOSURE

42
Q

Describe the two genetic pathways that result in DCIS.

A
  • 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
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 ‘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
Q

Describe the histological appearance of Basal-like carcinoma.

A
  • Sheets of markedly atypical cells with a prominent lymphocytic infiltrate
  • Central necrosis is common
45
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

46
Q

Which histological grading system is used for invasive breast carcinoma?

A

Nottingham modification of the Bloom-Richardson system

47
Q

how is male breast different to female

A

male breast has ducts within collagenized stroma but no/very few acini

48
Q

What is histological grading dependent on?

A
  • Tubule formation
  • Nuclear pleomorphism
  • Mitotic activity
49
Q

Which three receptors are all invasive breast cancers assessed for?

A
  • ER
  • PR
  • Her2
50
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
51
Q

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

A

Status of axillary lymph nodes

52
Q

Which age group is screened in the NHS breast screening programme?

A

50-71 year olds (every 3 years)

53
Q

Outline the coding of 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)

core biopsy, stained with H&E

54
Q

Define gynaecomastia.

causes

A

Enlargement of the male breast

Pre-pubertal, over 50, drugs

benign

55
Q

what is paget’s disease

A

in situ carcinoma of the nipple –> proliferation of malignant glandular epithelial cells in nipple areaolar epidermis

uncommon presentation of breast cancer

56
Q

histology of male breast cancer

A

very similar to invasive ductal carcinoma

0.2% of all cancers

57
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: HISTOPATH (20 decks)

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