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Histopathology > Histopathology 3 - Breast pathology > Flashcards

Histopathology 3 - Breast pathology Flashcards

1
Q

In which type of breast cancer is MRI most useful?

A

Lobular

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2
Q

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

A

16/18 guage

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3
Q

Recall the C1-C5 code that is used to grade fine needle aspirate in breast cancer investigation

A

C1 - Inadequate sample
C2 - Benign
C3 - Atypia, probably benign
C4 - Suspicious of malignancy
C5 - Malignant

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4
Q

Recall some symptoms of duct ectasia

A

Pain, mass, nipple inversion and discharge (thick, white)

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5
Q

What would be seen upon cytological analysis of nipple discharge in duct ectasia?

A

Proteinaceous material and inflammatory cells only

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6
Q

What is the most common pathogen identified in acute mastitis?

A

Staphylococcus aureus

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7
Q

What is the cause of fat necrosis of the breast?

A

Trauma–> inflammatory reaction

also: radiotherapy, surgery, nodular panniculitis

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8
Q

What is the cause of fibrocystic disease of the breast?

A

Normal, but exaggerated, response to hormonal influences

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9
Q

How can fibroadenoma be cured?

A

‘Shelling out’
**you take it all out in one go without any margins (i.e. not wide local excision)

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10
Q

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

A

Phyllodes tumours

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11
Q

What is a phyllodes tumour?

A

Potentially aggressive fibroepithelial neoplasm of the breast - but usually benign

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12
Q

How do phyllodes tumours tend to present?

A

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

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13
Q

In what ways are intraductal papillomas comparable to polyps?

A

They have a fibrovascular core

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14
Q

How can radial scars of the breast be cured?

A

Excision

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15
Q

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

A

Irregular lumens

**almost counterintuitive- usual vs irregular**

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16
Q

What is another name for flat epithelial atypia?

A

Atypical ductal carcinoma

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17
Q

How much is risk of malignancy increased by flat epithelial atypia?

A

4 times

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18
Q

What is the main histopathological features of flat epithelial atypia?

A

Cribiform spaces (punched out areas)

**instead of being completely infiltrated with cancer cells** like a less severe version of invasive carcinoma

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19
Q

How much is risk of malignancy increased by in situ lobar neoplasia?

A

7-12 times increased risk

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20
Q

How will the lumens often appear in DCIS?

A

Calcified

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21
Q

How should DCIS be managed?

A

Complete excision with surgical margins

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22
Q

What is the biggest risk factor for invasive breast carcinoma?

A

Osetrogen exposure

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23
Q

Which genetic change is seen in low grade invasive ductal carcinoma of the breast?

A

16q loss

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24
Q

What is the histological appearance of invasive ductal carcinoma vs lobular carcinoma?

A

Ductal: Large pleiomorphic cells with huge nuclei. E CADHERIN POSITIVE
Lobular: Linear, MONOmorphic cells. E CADHERIN NEGATIVE

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25
Q

Which type of breast pathology would show an “Indian file pattern” of cells under the microscope?

A

Invasive lobular carcinoma

**file pattern = linear

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26
Q

Which type of breast carcinoma has the worst prognosis?

A

Basal-like carcinoma

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27
Q

How can basal-like breast carcinomas be identified using immunohistocheistry?

A

Positive for ‘basal’ cytokeratins eg CK5/6/14

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28
Q

What 3 features of a breast malignancy are examined to decide its histological grading?

A

Tubule formation
Nuclear pleiomorphism
Mitotic activity

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29
Q

Which receptors are tested for in breast cancer diagnosis, and why?

A

ER
PR
HER2
Gives therapeutic and prognostic value

ER/PR receptor positive associated with good prognosis because it predicts response to tamoxifen.

HER 2 positive associated with bad prognosis.

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30
Q

What age group is invited to breast cancer screening in the UK?

A

47 to 73yr

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31
Q

Recall the B1-B5 code used for core biopsies of breast masses

A 
B1 = normal 
B2 = benign 
B3 = uncertain 
B4 = suspicious 
B5 = malignant
32
Q

What are the 3 inflammatory breast conditions?

A
  1. acute mastitis
  2. mammary duct ectasia
  3. fat necrosis
33
Q

What is acute mastitis?

A

Presentation: painful, red breast, hot to touch and fever

• Either lactational (more common) or non-lactational
• Lactational is usually secondary to staphylococcal infection (often polymicrobial) via cracks in the nipple & due to stasis of milk • FNA cytology shows an abundance of neutrophils • Tx: continued expression of milk + antibiotics +/- surgical drainage • Non-lactational – keratinising squamous metaplasia block
lactiferous ductsleading to peri-ductal infalmation and rupture.

34
Q

What is mammary duct ectasia?

A

Inflammation and dilatation of large breast ducts

35
Q

What is the biggest risk factor for mammary duct ectasia?

A

smoking

36
Q
A
37
Q

Pathophysiology of mammary duct ectasia

A

Inflammation and dilatation of large breast ducts
• Poorly defined palpable periareolar mass with thick, white nipple
secretions.
• Dilatation in one or more of the larger lactiferous ducts, which fill with a
stagnant brown or green secretion. This may discharge. These fluids then set up an irritant
reaction in surrounding tissue leading to periductal mastitis or even abscess and fistula
formation.
• In some cases, a chronic indurated mass forms beneath the areola, which
mimics a carcinoma. Fibrosis eventually develops, which may cause slit-
like nipple retraction

38
Q

What does mammary duct ectasia look like on mammography?

A

Mimics breast cancer

39
Q

Typical demographic affected by fat necrosis?

A

(typically obese, middle-
aged women

40
Q

Cytology of fat necrosis?

A

empty fat spaces , histiocytes and giant cells

**histiocyte - tissue resident macrophage

41
Q

What are the benign neoplastic conditions?

A
  1. Fibroadenoma
  2. intraductal papilloma
  3. radial scar
  4. phyllodes tumour
  5. fibrocystic disease
42
Q

What is the most common benign tumour of the breast?

A

Fibroadenoma

43
Q

Clinical features of fibroadenoma

A

Spherical, freely mobile, variable size and rubbery.

44
Q

Cytology and histology of fibroadenoma

A

branching sheets of epithelium, bare bipolar nuclei and stroma

45
Q

What are the two types of intraductal papilloma?

A

Peirpheral: arise in small terminal ductules

Central: arise in large lactiferous ducts

46
Q

Clinical features of intraductal papilloma

A

Bloody discharge

not seen on mammogram

47
Q

Cytology and histology of intraductal papilloma

A

Cytology of nipple discharge – branching papillary groups of epithelium • Histology – papillary mass within a dilated duct lined by epithelium

48
Q

Key features of radial scar

A
49
Q

Key features of phylloides tumour

A

Arise from interlobular stroma (like fibroadenomas – can arise within existing
fibroadenomas) with increased cellularity and mitoses.

• Present >50yrs as palpable mass

• Low grade or high grade lesions. Mostly relatively benign, but can be aggressive therefore
excised with wide local excision/mastectomy to limit local recurrence.

• Mets very rare

50
Q

Key features of fibrocystic disease

A
51
Q

What are the proliferative breast conditions?

A
  1. usual epithelial hyperplasia - not a precursor lesion. growth of galndular tissue and epithelial cells forming FRONDS
  2. flat epithelial atypia/ atypical ductal carcinoma- precurosr to low grade DCIS
  3. in situ lobular neoplasia - precurosr to lobular carcinoma??
52
Q

What is the precurosr lesion of low grade DCIS?

A

flat epithelial atypia (atypical ductal carcinoma)

53
Q
A
54
Q

Histology of in situ lobular neoplasia

A

solid proliferation of aplastic cells with little space with small
residue areas where you can still see lumen

*solid proliferation of cells within acinus*

55
Q

What are the malignant neoplastic breast conditions?

A

1) Carcinoma in situ

  • ductal carcinoma in situ
  • lobular carcinoma in situ

2) invasive carcinoma

  • ductal
  • lobular
  • tubular
  • basal
56
Q

Presentation of breast cancer

A

Presentation: hard fixed lump, Paget’s disease (eczema of the nipple first then areola –
normal eczema never affects the nipple), peau d’orange, nipple retraction.

57
Q

What % of malignant breast tumours are in situ vs invasive?

A

70% invasive

30% in situ

58
Q

What changes are detected on mammography?

A

Calcification and masses

**that’s why it only picks up the tumours that show calcification

59
Q

Main difference between LCIS and DCIS

A

DCIS shows calcification - picked up on mammography

LCIS no calcification

60
Q

Histology of DCIS

A

ducts filled with atypical epithelial cells

61
Q

Two grades of DCIS

A

low grade

high grade

62
Q

categories of invasive breast carcinoma

which is the most common?

A
  1. ductal
  2. lobular
  3. tubular
  4. mucinous

**ductal carcinoma is the most common

63
Q

Histology of invasive ductal carcinoma

A

Big, pleiomorphic cells – invasive cells move intro stroma

64
Q

Histology of invasive lobular carcinoma

A

cells aligned in single file chains/strands.

65
Q

Histology of tubular carcinoma

A

well-formed tubules with low grade nuclei. Rarely palpable as
<1cm.

66
Q

Histology of mucinous carcinoma

A

Mucinous carcinoma cells produce abundant quantities of extracellular mucin which
dissects into surrounding stroma.

67
Q

MOst important prognostic factor for breast cancer

A

status of axillary lymph nodes

68
Q

drugs for breast cancer

A

Tamoxifen = mixed agonist/antagonists of oestrogen at its receptor. Herceptin/trastuzumab = monoclonal Ig to Her2 (direct toxic effect on myocardium, must monitor LVEF)

69
Q

histology of basal like carcinoma

A

Histologically - sheets of markedly atypical cells with lymphocytic infiltrate

often associated with BRCA

70
Q

In familial cases of male breast cancer, what value does BRCA have?

A

BRCA2 carriers are at higher risk

not BRCA 1

71
Q

Calcification: is that a distinguishing feature of in situ caricnoma or invasive carcinoma?

A

Distinguishes DCIS from LCIS - only DCIS shows calcification and ish ence picked up on mammography

Not a feature of invasive ductal or lobular carcinoma

72
Q

Is fibrocystic disease more common in pre-menopausal or post-menopausal women?

What about fibroadenoma?

Phylloides?

A

Pre-menopausal

Pre-menopausal

Post-menopausal

73
Q

Breast tumour also known as ‘no specific type (NST)

A

invasive ductal carcinoma

74
Q

What is the most common breast cancer?

A

invasive ductal carcinoma

75
Q

Which tumour is associated with e-cadherin?

A

invasive ductal carcinoma

Histopathology (18 decks)

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