Histopathology 3 - Breast pathology

Question 1

In which type of breast cancer is MRI most useful?

Answer 1

Lobular

Question 2

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

Answer 2

16/18 guage

Question 3

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

Answer 3

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

Question 4

Recall some symptoms of duct ectasia

Answer 4

Pain, mass, nipple inversion and discharge

Question 5

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

Answer 5

Proteinaceous material and inflammatory cells only

Question 6

What is the most common pathogen identified in acute mastitis?

Answer 6

Staphylococcus aureus

Question 7

What is the cause of fat necrosis of the breast?

Answer 7

Trauma

Question 8

What is the cause of fibrocystic disease of the breast?

Answer 8

Normal, but exaggerated, response to hormonal influences

Question 9

How can fibroadenoma be cured?

Answer 9

‘Shelling out’

Question 10

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

Answer 10

Phyllodes tumours

Question 11

What is a phyllodes tumour?

Answer 11

Potentially aggressive fibroepithelial neoplasm of the breast - but usually benign

Question 12

How do phyllodes tumours tend to present?

Answer 12

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

Question 13

In what ways are intraductal papillomas comparable to polyps?

Answer 13

They have a fibrovascular core

Question 14

How can radial scars of the breast be cured?

Answer 14

Excision

Question 15

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

Answer 15

Irregular lumens

Question 16

What is another name for flat epithelial atypia?

Answer 16

Atypical ductal carcinoma

Question 17

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

Answer 17

4 times

Question 18

What is the main histopathological features of flat epithelial atypia?

Answer 18

Cribiform spaces

Question 19

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

Answer 19

7-12 times increased risk

Question 20

How will the lumens often appear in DCIS?

Answer 20

Calcified

Question 21

How should DCIS be managed?

Answer 21

Complete excision with surgical margins

Question 22

What is the biggest risk factor for invasive breast carcinoma?

Answer 22

Osetrogen exposure

Question 23

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

Answer 23

16q loss

Question 24

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

Answer 24

Ductal: Large pleiomorphic cells with huge nuclei
Lobular: Linear, MONOmorphic cells

Question 25

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

Answer 25

Invasive lobular carcinoma

Question 26

Which type of breast carcinoma has the worst prognosis?

Answer 26

Basal-like carcinoma

Question 27

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

Answer 27

Positive for 'basal' cytokeratins eg CK5/6/14

Question 28

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

Answer 28

Tubule formation Nuclear pleiomorphism Mitotic activity

Question 29

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

Answer 29

ER PR HER2 Gives therapeutic and prognostic value

Question 30

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

Answer 30

50-73

Question 31

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

Answer 31

``` B1 = normal B2 = benign B3 = uncertain B4 = suspicious B5 = malignant ```