Histopathology 3 - Breast pathology Flashcards
In which type of breast cancer is MRI most useful?
Lobular
What guage needle is used for core biopsy in breast cancer investigiation?
16/18 guage
Recall the C1-C5 code that is used to grade fine needle aspirate in breast cancer investigation
C1 - Inadequate sample C2 - Benign C3 - Atypia, probably benign C4 - Suspicious of malignancy C5 - Malignant
Recall some symptoms of duct ectasia
Pain, mass, nipple inversion and discharge
DEFINITION: Inflammation and dilation of large breast ducts (BENIGN no increased chance of malignancy)
What would be seen upon cytological analysis of nipple discharge in duct ectasia?
Proteinaceous material and inflammatory cells only
DEFINITION: acute inflammation of the breast (glandular tissue)
What is the most common pathogen identified in acute mastitis?
Staphylococcus aureus
Often seen in lactating women due to cracked skin and stasis of milk
What is the cause of fat necrosis of the breast?
Trauma - An inflammatory reaction to damaged adipose tissue
What is the cause of fibrocystic disease of the breast?
Normal, but exaggerated, response to hormonal influences
presents as breast lumpiness
How can fibroadenoma be cured?
‘Shelling out’
Benign fibroepithelial neoplasm of the breast
Which breast tumours can be described as ‘leaf like’?
Phyllodes tumours
What is a phyllodes tumour?
Potentially aggressive fibroepithelial neoplasm of the breast - but usually benign
How do phyllodes tumours tend to present?
Usually as an enlarging breast mass in women >50 - often in pre-existing fibroadenomas
In what ways are intraductal papillomas comparable to polyps?
They have a fibrovascular core
benign papillary tumour arising in the duct system of the
breast (40-60y old)
How can radial scars of the breast be cured?
Excision
A benign sclerosing lesion characterised by a central zone of
scarring surrounded by a radiating zone of proliferating glandular tissue
stellate masses on screening mammograms (may closely
resemble carcinoma)
What is the key histopathological feature of usual epithelial hyperplasia of the breast?
Irregular lumens
What is another name for flat epithelial atypia?
Atypical ductal carcinoma
How much is risk of malignancy increased by flat epithelial atypia?
4 times
What is the main histopathological features of flat epithelial atypia?
Cribiform spaces
How much is risk of malignancy increased by in situ lobar neoplasia?
7-12 times increased risk
How will the lumens often appear in DCIS?
Calcified
How should DCIS be managed?
Complete excision with surgical margins
a neoplastic intraductal epithelial proliferation in the breast
within an inherent risk of progression to breast cancer (has NOT breached the
basement membrane)
What is the biggest risk factor for invasive breast carcinoma?
Osetrogen exposure
Which genetic change is seen in low grade invasive ductal carcinoma of the breast?
16q loss
What is the histological appearance of invasive ductal carcinoma vs lobular carcinoma?
Ductal: Large pleiomorphic cells with huge nuclei
Lobular: Linear, MONOmorphic cells
Which type of breast pathology would show an “Indian file pattern” of cells under the microscope?
Invasive lobular carcinoma
Which type of breast carcinoma has the worst prognosis?
Basal-like carcinoma
Sheets and sheets of very atypical pleiomorphic-type cells with
prominent lymphocytic infiltrate
How can basal-like breast carcinomas be identified using immunohistocheistry?
Positive for ‘basal’ cytokeratins eg CK5/6/14
What 3 features of a breast malignancy are examined to decide its histological grading?
Tubule formation
Nuclear pleiomorphism
Mitotic activity
Nottingham Modification of Bloom-Richardson System
Each parameter is scored from 1-3 and the three values are added together to
produce total scores from 3-9
o Grade 1= 3-5 points (well differentiated)
o Grade 2= 6-7 points (moderately differentiated)
o Grade 3= 8-9 points (poorly differentiated)
Which receptors are tested for in breast cancer diagnosis, and why?
ER
PR
HER2
Gives therapeutic and prognostic value
Phenotype
o LOW grade = ER/ PR positive and Her2 negative
o HIGH grade = ER/ PR negative and Her2 positive
o Basal-like Carcinomas = ER/ PR/ Her2 negative (triple negative)
What age group is invited to breast cancer screening in the UK?
50-73
Recall the B1-B5 code used for core biopsies of breast masses
B1 = normal B2 = benign B3 = uncertain B4 = suspicious B5 = malignant
B5a= DCIS B5b= invasive carcinoma
How does Acute mastitis present/ how is it treated
painful (tender to touch), red breast, lumpy
Often have an abscess
Treatment: drainage and antibiotics
Whether the breast tumour is benign or malignant is determined based on?
the cellularity of the stroma:
high cellularity + stromal overgrowth = malignant
Benign- no stromal overgrowth or cellularity
Malignant- very pleiomorphic and atypical cells and
overgrowth
What are the proliferative breast disease
DEFINITION: A diverse group of intraductal proliferative lesions of the breast
accompanied with an increased risk of subsequent development of invasive breast carcinoma
Usual epithelial hyperplasia
Flat epithelial atypia
In site Lobular Neoplasia
Most important prognostic factor in breast cancer
The status of the axillary lymph nodes
What are the Invasive breast carcinomas
invaded through the basement membrane and into the stromal
tissue
Invasive ductal/lobular/tubular/mucinous carcinoma
Basal-like carcinoma
(NB: DCIS is malignant but has not breached the basement membrane)
Histology of gynaecomastia
-Epithelial hyperplasia with finger-like projections extending into the
duct lumen
-Periductal stroma is often cellular and oedematous
-There is concentric fibrosis of the stroma
-Similar to fibroadenoma
