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
Smoking is the biggest risk factor
What would be seen upon cytological analysis of nipple discharge in duct ectasia?
Proteinaceous material and inflammatory cells only
Smoking is a big risk factor
What is the most common pathogen identified in acute mastitis?
Staphylococcus aureus
What is the cause of fat necrosis of the breast?
Trauma, Surgery, Radiation
Often presentation in clinic is of a obese middle-aged woman presenting with a painless breast mass
What is the cause of fibrocystic disease of the breast?
Normal, but exaggerated, response to hormonal influences
Common around period time
How can fibroadenoma be cured?
‘Shelling out’
Common disease in young woman, benign, often referred to as breast mouse
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
How can radial scars of the breast be cured?
Excision, same with intraductal papillomas- remove the ductal structures
What is the key histopathological feature of usual epithelial hyperplasia of the breast?
Irregular lumens-frond like growths
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 (Ductal carcinoma in situ)?
Calcified
Can also cause Paget’s disease of the nipple if the ducts below the skin of the nipple are involved
Detected incidentally on mammograms with calcification- this is what the screening for breast cancer looks for
can progress to aggressive invasive carcinoma
How should DCIS be managed?
Complete excision with surgical margins
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- indian file pattern
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
Commonly associated in BRCA patients
How can basal-like breast carcinomas be identified using immunohistocheistry?
Positive for ‘basal’ cytokeratins eg CK5/6/14
Basal-like carcinoma common in BRCA patients
Called basal-like carcinoma because these cells stain for basal markers and originate from those cells.
Nottingham grading of breast tumours:
What 3 features of a breast malignancy are examined to decide its histological grading?
Tubule formation
Nuclear pleiomorphism
Mitotic activity
Which receptors are tested for in breast cancer diagnosis, and why?
ER
PR
HER2
Gives therapeutic and prognostic value
Low-grade tumours tend to be ER/PR+ve and HER2 -ve (Treated with tamoxifen)
High grade tumours tend to be ER/PR-ve and HER2 +ve (treated with HER2 drugs)
Very aggresive tumours, e.g basal-cell like or BRCA+ve: triple negative so very hard to treat
What age group is invited to breast cancer screening in the UK?
47-73
Those at risk e.g BRCA mutations are called earlier and after 73 people can opt-in for screening, unlike cervical screening where you cannot opt-in screening
Mainly to identify DCIS
Recall the B1-B5 code used for core biopsies of breast masses
B1 = normal B2 = benign B3 = uncertain B4 = suspicious B5 = malignant
Which benign breast lesions most commonly mimic breast cancer on radiology?
Fat necrosis
Radial scars
What are three kinds of proliferative breast diseases
1) Usual epithelial hyperplasia x2 risk- frond like growth
2) Flat epithelial atypia/atypical ductal carcinoma x4 risk
3) In-situ lobular neoplasia x12 risk
They are a group of intraductal proliferations of the breast which lead to an increased risk of developing malignancy.
Typically microscopic lesions that produce no symptoms
Diagnosed on breast tissue removed for other reasons or on a mammogram if they calcify
Most common breast cancer?
Invasive ductal carcinoma
What are the benign breast pathologies?
1) Fat necrosis-trauma, surgery, radiation
2) Duct ectasia, Pain, mass, nipple inversion and discharge. Smoking is the biggest risk factor. Proteinaceous and inflammatory cells on cytology.
3) Mastitis/abscess
4) Fibrocystic disease- due to hormones, uncommon in post-menopausal
5) Fibroadenoma- due to hormones (breast mouse), uncommon in post-menopausal
6) Phyllodes tumour- “leaf like” on histology, can become malignant so should excise
7) Intraductal pappiloma- bloody discharge but benign
8) Radial scar- presents as a stellate mass, benign central scarring surrounded by proliferating glandular tissue
Peau d’orange sign
sign of breast cancer
4 types of invasive breast carcinoma:
DCIS is not invasive- but still malignant
1) Invasive ductal (most common subtype- progresses on from DCIS)
2) Invasive lobular- hard to see on mammo, do MRI
3) Tubular
4) Mucinous
