Histopath - Breast Flashcards by Alexandra Santos

What are the 3 conditions that fall under inflammatory breast disease?

Duct ectasia
Acute mastitis
Fat necrosis

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What is duct ectasia?

Inflammation and dilatation of large breast ducts

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Duct ectasia presentation

Nipple discharge ± may cause breast pain, breast mass and nipple retraction

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Biggest RF for duct ectasia

Smoking

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Histopathology of duct ectasia

Dipple d/c cytology: proteinaceous material and
inflammatory cells

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Is duct ectasia malignant?

Benign w/ NO incr risk malig

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What is acute mastitis?

Acute inflammation in the breast

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What population is acute mastitis usually seen in?

lactating women due to milk stasis and cracked skin

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Which organism usually causes acute mastitis?

Staphylococcus

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How does acute mastitis present?

Painful, red breast and fever

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Mx of acute mastitis

continued milk expression, drainage (if abscess), and antibiotics

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What is fat necrosis?

Inflammatory reaction to damaged adipose tissue (benign)

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What is fat necrosis caused by?

trauma, surgery or radiotherapy

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How does fat necrosis present?

Painless breast mass in obese, middle-aged women

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What are 5 benign breast diseases?

Fibrocystic disease
Fibroadenoma (breast mouse)
Phyllodes tumour
Intraductal papilloma
Radial scar

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What is fibrocystic disease?

Breast lumpiness due to normal responses to hormonal influences

(aspirate brown fluid, cysts)

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What is fibroadenoma?

Common, benign fibroepithelial neoplasm of the breast

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*How does breast fibroadenoma often present?

Circumscribed mobile breast lump in young women aged 20-30

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What is phyllodes tumour?

Uncommon potentially aggressive fibroepithelial neoplasm of breast w/ stromal elements

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What can phyllodes tumours form from?

Fibroadenomas

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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?

1. Ductal carcinoma in situ 2. Invasive breast carcinoma 3. 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