Histopathology 3: Breast pathology Flashcards
45 year old lady presents with thick, white nipple discharge and a periareolar lump. Histology shows distended lactiferous duct.
Most likely diagnosis ?
Mammary duct ectasia
Breastfeeding mother presents with a red, painful, swollen breast. Histology shows neutrophils and pus.
Most likely diagnosis ?
Likely organism ?
Acute mastitis
S.Aureus
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 ?
Fat necrosis
Radiotherapy, surgery, panniculitis
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 ?
Fibroadenoma
Which breast tumour can originate from Fibroadenomas ?
Phyllodes tumour
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 ?
Phyllodes tumour (Possibly malignant)
Normally phyllodes tumours are benign
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 ?
Duct Papilloma
Histology shows a stellate pattern with central sclerosis surrounded by proliferating glandular tissue.
Most likely diagnosis ?
Radial scar
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 ?
Breast carcinoma
Paget’s disease of the breast is eczema affecting the nipple
Histology: Intraductal epithelial proliferation, with pleomorphic cells in the duct and necrotic material in the central lumen.
Mammogram: Microcalcifications
Most likely diagnosis ?
DCIS
Young women presents with multiple small lumps in the breast.
Most likely diagnosis ?
Fibrocystic disease
Histology shows linear arrangement of monomorphic cells in a distribution known as the Indian file pattern.
Most likely diagnosis ?
Lobular carcinoma
List 3 receptors tested for in breast carcinoma ?
Oestrogen
Progesteron
HER2
Which drug is used to treat HER2 positive breast carcinoma?
Herceptin
How does the E cadherin help differentiate between invasive ductal and invasive lobular carcinoma ?
If E cadherin +ve = invasive ductal
if E cadherin -ve = Invasive lobular
Describe normal breast histology
glandular tissue surrounded by stromal tissue
centre = duct surrounded by acini
unit = TDLU (terminal duct lobar unit)
myoepithelial cells help produce milk
features of duct ectasia
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
features of acute mastitis
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
features of fat necrosis
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
list benign breast conditions
fibrocystsic disease fibroadenoma phyllodes tumour intraductal pappiloma radial scar
features of fibrocystic breast disease
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
features of fibroadenomas
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
features of a phyllodes tumour
group of potentially aggressive fibroepithelial neoplasms of the breast
uncommon
>50 yrs
mostly benign
hist - cells not in uniform layers, cells overlapping,
features of intraductal papilloma
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
what is a radial scar
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
list examples of proliferative breast disease
usual epithelial hyperplasia
flat epithelial atypia/atypical ductal carcinoma
in situ lobular neoplasia
features of FEA/ ADC
may represent earliest morphological precursor to low grade ductal carcinoma
4x increase risk developing cancer
multiple layers of epithelial cells
features of in situ lobular neoplasia
associated with increased risk of BC
occurs within acinar unit of the breast
solid proliferation of cells within the acinus
list types of malignancy breast disease
carcinoma in situ invasive breast carcinoma invasive ductal carcinoma invasive lobular carcionoma invasive tubular carcinoma invasive mucinous carcinoma basal-like carcinoma
features of ductal carcinoma in situ
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
RF for invasive breast carcinomas
early menarche late menopause obesity alcohol OCP FHx BRCA
histology and cytology of invasive ductal carcinoma
pleiomorphic cells
large nuclei
histology and cytology of invasive lobular carcinoma
linear arrangement
monomorphic cells
indian file pattern
histology and cytology of invasive tubular carcinoma
elongated tubules of cancer cells which are invading the stroma
histology and cytology of invasive mucinous carcinoma
‘empty’ spaces contain lots of mucin
what is breast cancer grading dependent on
tubule formation
nuclear pleomorphism
mitotic activity
1-3 added for total 3-9
phenotype of low grade BC
ER/PR positive
Her2 negative
phenotype of high grade BC
ER/PR negative
Her2 positive
phenotype of basal-like carcinomas
ER/PR/Her2 negative
what is the most important prognostic factor for BC
status of the axillary LN
when are women screened on the NHS
every 3 years between 47 and 73 yrs
mammogram
appearance of gynaecomastia - histology
epithelial hyperplasia with finger-like projections extending into the duct lumen
periductal stroma cellular and oedematous
similar to fibroadenoma
what is tamoxifen
mixed agonist/ antagonist of oestrogen and its receptor
features of basal-like carcinomas
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
what gives males a higher risk of BC - BRCA 1 or 2
brca 1
