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Path Y > Histopathology - Breast pathology > Flashcards

Histopathology - Breast pathology Flashcards

1
Q

what do B5a and B5b denote

A

B5a= DCIS/LCIS

B5b= invasive primary breast carcinomas

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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 B1-B5 code that is used to grade fine needle aspirate in breast cancer investigation

A

B1 - Inadequate sample
B2 - Benign
B3 - Atypia, probably benign
B4 - Suspicious of malignancy
B5 - Malignant

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4
Q

Recall some symptoms of duct ectasia

A

thick white nipple secretions

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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, surgery etc

painless breast mass
its an inflammatory reaction to damaged adipose tissue

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8
Q

What is the cause of fibrocystic disease of the breast?

A

Normal, but exaggerated, response to hormonal influences (menstrual cycle)
presents w breast lumps, tenderness
no increased risk for subsequent carcinoma

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9
Q

How can fibroadenoma be cured?

A

‘Shelling out’

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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

How can radial scars of the breast be cured?

A

Excision

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14
Q

What is another name for flat epithelial atypia?

A

Atypical ductal carcinoma

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15
Q

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

A

4 times

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16
Q

What is the main histopathological features of flat epithelial atypia?

A

Cribiform spaces

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17
Q

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

A

7-12 times increased risk

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18
Q

2 histological findings in DCIS

A

calcification
cribriform spaces

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19
Q

How should DCIS be managed?

A

Complete excision with surgical margins

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20
Q

What is the biggest risk factor for invasive breast carcinoma? list 5 others

A

Osetrogen exposure (late menopause, early menarche)
OCP
obesity
FHx
BRCA
alcohol
caucasian

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21
Q

Which genetic 2 changes is seen in invasive ductal carcinoma of the breast?

A

16q loss
e cadherin +ve

22
Q

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

A

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

23
Q

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

A

Invasive lobular carcinoma

24
Q

Which type of breast carcinoma has the worst prognosis?

A

Basal-like carcinoma
triple negative for ER/PR/HER2

25
Q

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

A

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

26
Q

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

A

Tubule formation
Nuclear pleiomorphism
Mitotic activity
score 1-3 for all

27
Q

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

A

ER - good
PR - good
HER2 - bad
Gives therapeutic and prognostic value

28
Q

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

A

screening every 3 years between the ages of 50 and 71.

29
Q

triple assesment =

A

clinical examination
imaging - mammogram or ultrasound
fna or core biopsy for histopathology

30
Q

gold standard for diagnosis of breast cancer =

A

histopathology

31
Q

3 rf for duct ectasia

A

smoking
age 40-60
multiparous

32
Q

mastitis cytology shows

A

abundance of neutrophils

33
Q

what causes non lactational mastitis

A

keratinising squamous metaplasia

34
Q

cytology of fat necrosis

A

fat cells surrounded by macrophages

35
Q

presentation of mastitis

A

tender, red breast

36
Q

state 3 inflammatory (benign) breast conditions

A

mastitis
duct ectasia
fat necrosis

37
Q

fibroadenoma is commonly referred to as

A

breast mouse
benign, freely mobile mass

38
Q

what benign condition may cause bloody discharge

A

intarductal papilloma
central papilloma = bloody discharge
peripheral = may remain clinically silent

39
Q

typical appearance of radial scar on mammograms and histology

A 
stellate appearance (mimics carcinoma) 
also on histology - peripheral proliferation of ducts and acini
40
Q

state 5 benign breast conditions

A

fibroadenoma
intraductal papilloma
fibrocystic disease
phyllodes tumour
radial scar

41
Q

state 3 proliferative conditions which may progress into invasive breast carcinoma

A

usual epithelial hyperplasia
flat epithelial atypia
in situ lobar neoplasia

42
Q

which of the 3 proliferative conditions has the highest risk of becoming invasive carcinoma

A

in situ lobar neoplasia (7-12x0

followed by flat epithelial atypia

43
Q

describe the histolgoical appearance of invasive tubular & mutinous carcinoma

A

tubular - elongated tublues
mutinous - empty spaces contain lots of mucin

44
Q

4 types of invasive breast carcinoma

A

ductal - most common
lobular
tubular
mucinous

45
Q

most common cancer in women in UK

A

invasive breast carcinoma
1 in 8 risk, increases w age

46
Q

what histological grading system

A

Nottingham modification of bloom-richardon system

47
Q

score of 3-5 =?

A

grade 1 = well differentiated
6-7 = grade 2 = moderately
8-9 = grade 3 = poorly

48
Q

what’s the most important prognostic factor

A

status of axillary lymph nodes

49
Q

what are DCIS and LCIS

A

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

50
Q

drug of choice for carcinoma if ER +VE

A

tamoxifen

51
Q

drug of choice for carcinoma if HER2 +VE

A

herceptin

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