Histopath - Breast Flashcards
What are the 3 conditions that fall under inflammatory breast disease?
- Duct ectasia
- Acute mastitis
- Fat necrosis
What is duct ectasia?
Inflammation and dilatation of large breast ducts
Duct ectasia presentation
Nipple discharge ± may cause breast pain, breast mass and nipple retraction
Biggest RF for duct ectasia
Smoking
Histopathology of duct ectasia
Dipple d/c cytology: proteinaceous material and
inflammatory cells
Is duct ectasia malignant?
Benign w/ NO incr risk malig
What is acute mastitis?
Acute inflammation in the breast
What population is acute mastitis usually seen in?
lactating women due to milk stasis and cracked skin
Which organism usually causes acute mastitis?
Staphylococcus
How does acute mastitis present?
Painful, red breast and fever
Mx of acute mastitis
continued milk expression, drainage (if abscess), and antibiotics
What is fat necrosis?
Inflammatory reaction to damaged adipose tissue (benign)
What is fat necrosis caused by?
trauma, surgery or radiotherapy
How does fat necrosis present?
Painless breast mass in obese, middle-aged women
What are 5 benign breast diseases?
- Fibrocystic disease
- Fibroadenoma (breast mouse)
- Phyllodes tumour
- Intraductal papilloma
- Radial scar
What is fibrocystic disease?
Breast lumpiness due to normal responses to hormonal influences
(aspirate brown fluid, cysts)
What is fibroadenoma?
Common, benign fibroepithelial neoplasm of the breast
*How does breast fibroadenoma often present?
Circumscribed mobile breast lump in young women aged 20-30
What is phyllodes tumour?
Uncommon potentially aggressive fibroepithelial neoplasm of breast w/ stromal elements
What can phyllodes tumours form from?
Fibroadenomas
What presentation would you see with Phyllodes tumour?
Enlarging masses in women >50y/o
Phyllodes tumour Mx
Local excision/ mastectomy
*What is an intraductal papilloma?
Benign papillary tumour
*Presentation of intraductal papilloma
Bloody discharge
What is a radial scar?
Benign central scarring surrounded by proliferating glandular tissue
What are 3 malignant breast diseases?
- Ductal carcinoma in situ
- Invasive breast carcinoma
- Basal-like carcinoma
What is ductal carcinoma in situ?
Neoplastic intraductal epithelial proliferation in breast with an increased risk of progression to invasive breast carcinoma
What do screening programmes for ductal carcinoma in situ look for?
Areas of microcalcification
- aiming to detect breast ca at duct carcinoma in situ (DCIS) stage
What are invasive breast carcinomas?
Group of malignant epithelial tumours which infiltrate within the breast and can metastasise
What are the 4 subtypes of invasive breast carcinoma?
- Invasive ductal
- Most common
- Invasive lobular
- Tubular
- Mucinous
Histopathology of invasive ductal breast carcinoma
Big, pleomorphic cells that move into the stroma
Histopathology of invasive lobular breast carcinoma
Cells in single file chains + E cadherin related
Histopathology of tubular breast carcinoma
Well-formed tubules with low grade nuclei
Histopathology of invasive mucinous breast carcinoma
Lots of extraceullular mucin which goes into surrounding stroma
What are the RFs of developing invasive breast carcinoma?
- Early menarche
- Late menopause
- +ve FHx
- Increased weight
- BRCA mutation
- Oral contraceptive use
- High alcohol consumption
What method is used for screening of invasive breast carcinoma?
USS in younger pts (30s and below ish)
Mammogram in older pts
Malignant breast disease Ix
Triple assessment
- Examination
- Radiology
- Core needle biopsy
Which receptors are assessed for in malignant breast disease?
- Oestrogen receptors
- Progesterone receptors
- HER2 receptors
What is the prognosis like for invasive breast carcinoma?
If responsive to
- ER/PR = good prognosis (as responds to Tamoxifen)
- HER2 = poor prognosis
Histology for basal-like carcinoma
- Sheets of atypical cells with lymphocytic infiltrate
- Immunohistochemically stain positive for CK 5/6 and 14
Basal-like carcinoma receptor response
ER/PR/Her2 negative
What are 2 male breast conditions?
Gynaecomastia and male breast ca
What is the cause of gynaecomastia?
Idiopathic or associated with drugs
How does male breast ca present?
Most commonly presents with a palpable lump
Which stage(s) is male breast ca often at?
Stage 3 or 4
(+ associated with BRCA 2 carriers)
*Woman with known breast cancer has a red and rough nipple
Paget’s disease of the nipple
*Woman with breast lump, FNA shows C5 grading
DCIS or other invasive breast ca
(C5=malignant)
*Most common breast malignancy
Invasive ductal carcinoma
*Which/What cancer is also known as non-specific type?
Invasive ductal carcinoma
*Which/What cancer is associated with presence of E cadherins
Invasive ductal carcinoma
(inv lobular if E cad neg)
*histopath of phyllodes tumour
Fibro-epithelial tumour with abundant stromal elements
Periductal mastitis
keritanising squamous epithelium in smokers breast
