Histopath - Breast

Question 1

Painful red breast - Dx?
Cause?
Image on cytology?

Answer 1

• Acute mastitis
• Caused by staph infection often due to breastfeeding (cracks in skin)
• Cytology - necrosis + inflammatory cell infiltration

Question 2

3 point tx plan for acute mastitis

Answer 2

Continue milk expression
Antibiotics
+/- surgical drainage

Question 3

Main clinical symptom of duct ectasia?

Answer 3

Thick white nipple secretions + periareolar mass

Question 4

Duct ectasia - appearance on mammogram?
Cytology?
Risk of malignancy?

Answer 4

Mimics cancer on mammogram
Cytology - proteinaceous material + inflammatory cells
No increased risk of malignancy

Question 5

Fat necrosis - what is it?

Answer 5

Inflammatory reaction to damaged adipose tissue (eg trauma) –> painless lump

Question 6

Most common benign proliferative disease? What causes it?

Answer 6

Fibrocystic disease/fibroadenosis

Caused by an exaggerated normal response to hormones

Question 7

3 types of changes seen in fibrocystic disesase

Answer 7

1) cystic change - often calcified
2) fibrosis - secondary to cyst rupture
3) adenosine - increased number of acini per lobule

Question 8

20-30 yo, bilateral multiple rubbery lumps

Answer 8

Fibroadenoma

Question 9

What happens to fibroadenomas in pregnancy? and after menopause?

Answer 9

Increase in size during pregnancy
Calcify after menopause

• this is because the epithelium is responsive to hormones!

Question 10

A benign tumour arising within the duct system of the breast

Answer 10

Duct papilloma

Question 11

How does duct papilloma present?

Answer 11

Bloody discharge + often, no lump

Question 12

Duct papilloma - how is it visualised?

Answer 12

Galactogram

Question 13

Cytology and management of duct papilloma?

Answer 13

Cytology - 3d clusters of cells

Mx - excise! risk of malignancy

Question 14

A benign neoplastic condition which is only found incidentally on mammogram?

Answer 14

Radial scar

Question 15

Central fibrosis surrounded by proliferating glandular tissue in a stellate pattern - what is this?

Answer 15

Radial scar

Question 16

Risk factors for breast carcinoma

Answer 16

E2 exposure - early menarche, late menopause, HRT, late 1st live birth, OCP
Obesity, smoking, EtOH
Susceptibility genes - BRCA 1/2, 16q loss
FHx

Question 17

Presentations of breast cancer?

Answer 17

• Fixed hard lump
• Peau d’orange
• Paget’s disease (periareolar eczema)
• nipple retraction

Question 18

Screening schedule for breast cancer?

Answer 18

47-73yo women are invited every 3 years for mammography.

If abnormal –> do a core biopsy

Question 19

What is carcinoma in situ? 2 types

Answer 19

Neoplastic epi- proliferation which is limited by basement membrane
Ductal and lobular

Question 20

Which carcinoma in situ is only ever an incidental finding? why?

Answer 20

Lobular carcinoma in situ - no micro calcifications or stromal reactions

Question 21

Management of DCIS? Histology?

Answer 21

Complete excision with clear margins, due to greatly increased risk of invasion

Histology - punched out, ‘cribiform’

Question 22

Types of invasive breast carcinoma?

Answer 22

Ductal
Lobular
Tubular
Mucinous

Question 23

Invasive breast carcinoma which has linear cells in strands?

Answer 23

Invasive lobular breast carcionma

Question 24

Histological appearance of mucinous breast carcinoma?

Answer 24

Extracellular mucin which dissects into surrounding stroma

Question 25

What is triple assessment?

Answer 25

1) Examination 2) Imaging - mammogram <35yo. USS>35 3) FNA + cytology

Question 26

Coding of cytology results

Answer 26

``` C1: inadequate C2: normal C3: atypic C4: suspicious of malignancy C5: malignant ```

Question 27

Gold standard for diagnosis of breast carcinoma

Answer 27

Core needle biopsy

Question 28

What 3 factors are looked at when grading core biopsy samples?

Answer 28

Mitotic activity Nuclear pleomorphism Tubule formation

Question 29

Alongside grading, what else is looked at in core needle biopsy?

Answer 29

Oestrogen and progesterone and HER2 receptor status?

Question 30

What is the usefulness in knowing if a tumour is Oestrogen/progesterone/HER2 receptor positive?

Answer 30

ER/PR receptor +ve = good prognosis + response to tamoxifen HER2 receptor +ve = bad prognosis ER/PR/HER2 -ve in most basal like cancers

Question 31

Which invasive breast carcinoma is the only one to show WBC infiltration?

Answer 31

Basal like carcinoma

Question 32

Which breast carcinoma is most associated with BRCA mutations?

Answer 32

Basal like carcinoma

Question 33

Basal like carcinoma - what does it stain +ve for?

Answer 33

CK5/6/14

Question 34

Which drug is used to target cancers with HER2 receptor +ve?

Answer 34

Perception/trastuzumab | mAb to HER2

Question 35

Which drug is used to lower E2 levels?

Answer 35

Anastrazole

Question 36

Leaf like tumour?

Answer 36

Phyllodes tumour.

Question 37

Phyllodes tumour - how doe they present and in whom?

Answer 37

in >50yos. Palpable lump, can be from pre-existing fibroadenoma

Question 38

Management of phyllodes tumour

Answer 38

Wide local excision + mastectomy - due to potential aggressive nature

Question 39

Mass around the nipple + v thick white discharge from nipple. No increased risk of cancer

Answer 39

mammary duct ectasia

Question 40

What are the changes (on a cellular level) in firboadenosis?

Answer 40

- Small cysts form and eventually calcify - Once cysts rupture, they fibrose - Increased number of acini per lobule (often during pregnancy)