Histopathology 3 - Breast pathology Flashcards by Adam Haq

In which type of breast cancer is MRI most useful?

Lobular

How well did you know this?

Not at all

Perfectly

What guage needle is used for core biopsy in breast cancer investigiation?

16/18 guage

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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)

How well did you know this?

Not at all

Perfectly

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)

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

What is the cause of fat necrosis of the breast?

Trauma - An inflammatory reaction to damaged adipose tissue

How well did you know this?

Not at all

Perfectly

What is the cause of fibrocystic disease of the breast?

Normal, but exaggerated, response to hormonal influences

presents as breast lumpiness

How well did you know this?

Not at all

Perfectly

How can fibroadenoma be cured?

‘Shelling out’

Benign fibroepithelial neoplasm of the breast

How well did you know this?

Not at all

Perfectly

Which breast tumours can be described as ‘leaf like’?

Phyllodes tumours

How well did you know this?

Not at all

Perfectly

What is a phyllodes tumour?

Potentially aggressive fibroepithelial neoplasm of the breast - but usually benign

How well did you know this?

Not at all

Perfectly

How do phyllodes tumours tend to present?

Usually as an enlarging breast mass in women >50 - often in pre-existing fibroadenomas

How well did you know this?

Not at all

Perfectly

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 well did you know this?

Not at all

Perfectly

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)

How well did you know this?

Not at all

Perfectly

What is the key histopathological feature of usual epithelial hyperplasia of the breast?

Irregular lumens

How well did you know this?

Not at all

Perfectly

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