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Year 5 path SW > Histopathology 3: Breast pathology > Flashcards

Histopathology 3: Breast pathology Flashcards

1
Q

45 year old lady presents with thick, white nipple discharge and a periareolar lump. Histology shows distended lactiferous duct.

Most likely diagnosis ?

A

Mammary duct ectasia

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2
Q

Breastfeeding mother presents with a red, painful, swollen breast. Histology shows neutrophils and pus.

Most likely diagnosis ?
Likely organism ?

A

Acute mastitis

S.Aureus

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3
Q

60 year old women presents with a painless breast lump. She reports being in a RTA 10 years ago and wonders if the trauma from her seatbelt might have caused it.

Most likely diagnosis ?
Other causes ?

A

Fat necrosis

Radiotherapy, surgery, panniculitis

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4
Q

A 20 year old lady presents with a breast lump which is well demarcated, mobile and feels rubbery. Histology shows stromal (fibrous tissue) proliferation.

Most likely diagnosis ?

A

Fibroadenoma

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5
Q

Which breast tumour can originate from Fibroadenomas ?

A

Phyllodes tumour

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6
Q

A 60 year old lady presents after she noticed her breast lump previously diagnosed as a fibroadenoma has started to increase in size. Histology shows: increased cellularity + Stromal overgrowth and overlapping cells.

most likely diagnosis ?

A

Phyllodes tumour (Possibly malignant)

Normally phyllodes tumours are benign

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7
Q

45 year old lady presents with bloody nipple discharge. No lump is felt and no mass is seen on mammography.
Histology shows: Large dilated duck with fibrovascular core and stromal vessels.

Most likely diagnosis ?

A

Duct Papilloma

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8
Q

Histology shows a stellate pattern with central sclerosis surrounded by proliferating glandular tissue.

Most likely diagnosis ?

A

Radial scar

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9
Q

A 79 year old lady presents with a hard fixed lump of the breast. Paget’s disease of the breast is present and there are signs of nipple retraction.

Most likely diagnosis ?

A

Breast carcinoma

Paget’s disease of the breast is eczema affecting the nipple

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10
Q

Histology: Intraductal epithelial proliferation, with pleomorphic cells in the duct and necrotic material in the central lumen.

Mammogram: Microcalcifications

Most likely diagnosis ?

A

DCIS

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11
Q

Young women presents with multiple small lumps in the breast.

Most likely diagnosis ?

A

Fibrocystic disease

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12
Q

Histology shows linear arrangement of monomorphic cells in a distribution known as the Indian file pattern.

Most likely diagnosis ?

A

Lobular carcinoma

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13
Q

List 3 receptors tested for in breast carcinoma ?

A

Oestrogen
Progesteron
HER2

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14
Q

Which drug is used to treat HER2 positive breast carcinoma?

A

Herceptin

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15
Q

How does the E cadherin help differentiate between invasive ductal and invasive lobular carcinoma ?

A

If E cadherin +ve = invasive ductal

if E cadherin -ve = Invasive lobular

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16
Q

Describe normal breast histology

A

glandular tissue surrounded by stromal tissue
centre = duct surrounded by acini
unit = TDLU (terminal duct lobar unit)
myoepithelial cells help produce milk

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17
Q

features of duct ectasia

A

inflammatory breast disease
presents with nipple discharge - thick, white
pain, breast mass, nipple retraction
benign
duct distended with proteinaceous material and macrophages on cytology

mainly in multiparous, 40-60 yo women
mimics mammograpic appearance of cancer
smoking = biggest RF

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18
Q

features of acute mastitis

A 
acute inflammation of the breast 
lactating women 
staph 
pain, red 
treat - drain and Abx 
lots of neutrophils on cytology

non-lactational - keratinising squamous metaplasia block lactiferous ducts

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19
Q

features of fat necrosis

A

inflammatory reaction to damaged adipose tissue
trauma, surgery, radiotherapy, nodular panniculitis
painless breast mass, skin thickening, mammography lesion
cytology - fat cells surrounded by macrophages, empty spaces, histiocytes, giant cells

20
Q

list benign breast conditions

A 
fibrocystsic disease
fibroadenoma 
phyllodes tumour 
intraductal pappiloma 
radial scar
21
Q

features of fibrocystic breast disease

A

group of alterations in the breast reflecting normal, exaggerated responses to hormonal influences
common
breast lumpiness
no increased risk of subsequent breast carcinoma
hist - dilated ducts, calcified

22
Q

features of fibroadenomas

A

benign fibroepithelial neoplasm
breast mouse
mobile lump, rubbery, variable size, spherical
20-30 yrs
histology - glandular cells and stromal cells
FNA - branching sheets of epithelium, bare bipolar nuclei and stroma

23
Q

features of a phyllodes tumour

A

group of potentially aggressive fibroepithelial neoplasms of the breast
uncommon
>50 yrs
mostly benign
hist - cells not in uniform layers, cells overlapping,

24
Q

features of intraductal papilloma

A

benign papillary tumour arising within the ductal system of the breast
small terminal ductules - peripheral papilloma
central ductules - central pappiloma
40-60yrs
common
bloody discharge
NOT SEEN ON MAMMOGRAM
cytology - clusters of cells, branching papillary groups of epithelium
hist - large dilated ducts with polypoid mass in middle
fibrovascular core

25
Q

what is a radial scar

A

benign sclerosing lesion with a central zone of scarring surrounded by radiating zone of glandular tissue
response to tissue damage
stellate masses on screening mammograms

26
Q

list examples of proliferative breast disease

A

usual epithelial hyperplasia
flat epithelial atypia/atypical ductal carcinoma
in situ lobular neoplasia

27
Q

features of FEA/ ADC

A

may represent earliest morphological precursor to low grade ductal carcinoma
4x increase risk developing cancer
multiple layers of epithelial cells

28
Q

features of in situ lobular neoplasia

A

associated with increased risk of BC
occurs within acinar unit of the breast
solid proliferation of cells within the acinus

29
Q

list types of malignancy breast disease

A 
carcinoma in situ 
invasive breast carcinoma 
invasive ductal carcinoma 
invasive lobular carcionoma 
invasive tubular carcinoma 
invasive mucinous carcinoma 
basal-like carcinoma
30
Q

features of ductal carcinoma in situ

A

low grade - lumens compact and regular (cribriform DCIS)
calcification (detected on mammogram)

high grade - cells large, not many lumens left
central lumen with necrotic material
pleiomorphic cells

ducts filled with atypical epithelial cells
areas of microcalcification
inherent risk of progression to invasive breast carcinoma

31
Q

RF for invasive breast carcinomas

A 
early menarche 
late menopause
obesity 
alcohol 
OCP
FHx 
BRCA
32
Q

histology and cytology of invasive ductal carcinoma

A

pleiomorphic cells

large nuclei

33
Q

histology and cytology of invasive lobular carcinoma

A

linear arrangement
monomorphic cells
indian file pattern

34
Q

histology and cytology of invasive tubular carcinoma

A

elongated tubules of cancer cells which are invading the stroma

35
Q

histology and cytology of invasive mucinous carcinoma

A

‘empty’ spaces contain lots of mucin

36
Q

what is breast cancer grading dependent on

A

tubule formation
nuclear pleomorphism
mitotic activity
1-3 added for total 3-9

37
Q

phenotype of low grade BC

A

ER/PR positive

Her2 negative

38
Q

phenotype of high grade BC

A

ER/PR negative

Her2 positive

39
Q

phenotype of basal-like carcinomas

A

ER/PR/Her2 negative

40
Q

what is the most important prognostic factor for BC

A

status of the axillary LN

41
Q

when are women screened on the NHS

A

every 3 years between 47 and 73 yrs

mammogram

42
Q

appearance of gynaecomastia - histology

A

epithelial hyperplasia with finger-like projections extending into the duct lumen
periductal stroma cellular and oedematous
similar to fibroadenoma

43
Q

what is tamoxifen

A

mixed agonist/ antagonist of oestrogen and its receptor

44
Q

features of basal-like carcinomas

A

sheets of markedly atypical cells with lymphocytic infiltrate
stains positive for CK5/6/14
often associated with BRCA
commonly have vascular invasion and distant metastatic spread

45
Q

what gives males a higher risk of BC - BRCA 1 or 2

A

brca 1

Year 5 path SW (106 decks)

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