Histopathology - Breast pathology Flashcards
what do B5a and B5b denote
B5a= DCIS/LCIS
B5b= invasive primary breast carcinomas
What guage needle is used for core biopsy in breast cancer investigiation?
16/18 guage
Recall the B1-B5 code that is used to grade fine needle aspirate in breast cancer investigation
B1 - Inadequate sample
B2 - Benign
B3 - Atypia, probably benign
B4 - Suspicious of malignancy
B5 - Malignant
Recall some symptoms of duct ectasia
thick white nipple secretions
What would be seen upon cytological analysis of nipple discharge in duct ectasia?
Proteinaceous material and inflammatory cells only
What is the most common pathogen identified in acute mastitis?
Staphylococcus aureus
What is the cause of fat necrosis of the breast?
trauma, surgery etc
painless breast mass
its an inflammatory reaction to damaged adipose tissue
What is the cause of fibrocystic disease of the breast?
Normal, but exaggerated, response to hormonal influences (menstrual cycle)
presents w breast lumps, tenderness
no increased risk for subsequent carcinoma
How can fibroadenoma be cured?
‘Shelling out’
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
How can radial scars of the breast be cured?
Excision
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
2 histological findings in DCIS
calcification
cribriform spaces
How should DCIS be managed?
Complete excision with surgical margins
What is the biggest risk factor for invasive breast carcinoma? list 5 others
Osetrogen exposure (late menopause, early menarche)
OCP
obesity
FHx
BRCA
alcohol
caucasian
Which genetic 2 changes is seen in invasive ductal carcinoma of the breast?
16q loss
e cadherin +ve
What is the histological appearance of invasive ductal carcinoma vs lobular carcinoma?
Ductal: Large pleiomorphic cells with huge nuclei
Lobular: Linear, MONOmorphic cells
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
triple negative for ER/PR/HER2
How can basal-like breast carcinomas be identified using immunohistocheistry?
Positive for ‘basal’ cytokeratins eg CK5/6/14
What 3 features of a breast malignancy are examined to decide its histological grading?
Tubule formation
Nuclear pleiomorphism
Mitotic activity
score 1-3 for all
Which receptors are tested for in breast cancer diagnosis, and why?
ER - good
PR - good
HER2 - bad
Gives therapeutic and prognostic value
What age group is invited to breast cancer screening in the UK?
screening every 3 years between the ages of 50 and 71.
triple assesment =
clinical examination
imaging - mammogram or ultrasound
fna or core biopsy for histopathology
gold standard for diagnosis of breast cancer =
histopathology
3 rf for duct ectasia
smoking
age 40-60
multiparous
mastitis cytology shows
abundance of neutrophils
what causes non lactational mastitis
keratinising squamous metaplasia
cytology of fat necrosis
fat cells surrounded by macrophages
presentation of mastitis
tender, red breast
state 3 inflammatory (benign) breast conditions
mastitis
duct ectasia
fat necrosis
fibroadenoma is commonly referred to as
breast mouse
benign, freely mobile mass
what benign condition may cause bloody discharge
intarductal papilloma
central papilloma = bloody discharge
peripheral = may remain clinically silent
typical appearance of radial scar on mammograms and histology
stellate appearance (mimics carcinoma) also on histology - peripheral proliferation of ducts and acini
state 5 benign breast conditions
fibroadenoma
intraductal papilloma
fibrocystic disease
phyllodes tumour
radial scar
state 3 proliferative conditions which may progress into invasive breast carcinoma
usual epithelial hyperplasia
flat epithelial atypia
in situ lobar neoplasia
which of the 3 proliferative conditions has the highest risk of becoming invasive carcinoma
in situ lobar neoplasia (7-12x0
followed by flat epithelial atypia
describe the histolgoical appearance of invasive tubular & mutinous carcinoma
tubular - elongated tublues
mutinous - empty spaces contain lots of mucin
4 types of invasive breast carcinoma
ductal - most common
lobular
tubular
mucinous
most common cancer in women in UK
invasive breast carcinoma
1 in 8 risk, increases w age
what histological grading system
Nottingham modification of bloom-richardon system
score of 3-5 =?
grade 1 = well differentiated
6-7 = grade 2 = moderately
8-9 = grade 3 = poorly
what’s the most important prognostic factor
status of axillary lymph nodes
what are DCIS and LCIS
neoplastic epithelial proliferation limited to ducts/lobules by basement membrane
both risk factors for invasive carcinoma (DCIS higher risk)
LCIS always incidental finding on biopsy
drug of choice for carcinoma if ER +VE
tamoxifen
drug of choice for carcinoma if HER2 +VE
herceptin
