Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pathology (Guide) > Histopathology - Breast Pathology > Flashcards

Histopathology - Breast Pathology Flashcards

1
Q

What are general presenting symptoms of breast cancer?

A
  • Pain (mastalgia/mastodynia)
  • Palpable masses
  • Nipple discharge
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the triple assessment for a breast cancer?

A
  1. Clinical examination
  2. Imaging (USS/mammography IF <35yrs)
  3. Cytology + histology
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How is the sample obtained for cytopathology in a breast cancer assessment and how is it coded?

A

Obtained via FINE NEEDLE ASPIRATION
- Cells spread across a slide, stained + coded

Coding:
- C1 = inadequate sample
- C2 = Benign
- C3 = Atypia
- C4 = Suspicious of malignancy
- C5 = Malignant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How is the sample obtained for histopathology in a breast cancer assessment and how is it coded?

A

Obtained via CORE BIOPSY
- Intact tissues removed showing architectural + cellular detail + coded

Coding:
- B1 = Normal
- B2 = Benign
- B3 = Uncertain
- B4 = Suspicious
- B5 = Malignant
- B5a = DCIS
- B5b = Invasive carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the gold standard investigation for breast cancer diagnosis?

A

Histopathology
- Normal breast histology = ductal-lobular system lined by inner glandular epithelium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are some inflammatory breast conditions?

A
  • Acute mastitis
  • Fat necrosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How does acute mastitis present, what are the different types, features, causes, cytological findings + treatment?

A

Presentation:
- Painful, red breast
- Hot to touch
- Fever

Types:
- Lactational - most common
- Non-lactational

Causes:
- Lactational = secondary to S. aureus infection (often polymicrobial) via cracks in nipple due to stasis of milk
- Non-lactational = KERATINISING SQUAMOUS METAPLASIA block in lactiferous ducts leading to peri-ductal inflammation + rupture

Cyto (FNA):
- Abundance of neutrophils

Tx:
- Continue milk expression (bilateral), warm compress, analgesia, elevation
- Abx (flucloxacillin PO)
- ?Surgical drainage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How does a breast abscess present and what is its management?

A

Presentation:
Fluctuant swelling + swinging fevers

Mx:
- IV Abx
- Incision + drainage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is a fat necrosis, its RFs, causes, presentation and cytological findings?

A
  • Inflammatory reaction to damaged adipose tissue

RFs:
- Obesity
- Middle aged
- Female

Presentation:
- Painless breast mass/skin thickening/mammographic lesion
- May mimic carcinoma displaying skin tethering/nipple retraction

Causes:
- Trauma
- Radiotherapy
- Surgery
- Nodular panniculitis

Cyto:
- Empty fat spaces (damaged fat lobules)
- Histiocytes
- Giant cells

BIG BLOCK OF CHEESE:
- Giant cells
- Recently cut (trauma)
- Full of calcium (calcified)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are some benign neoplastic conditions?

A
  • Fibroadenoma
  • Breast cyst
  • Duct ectasia
  • Intraductal papilloma
  • Radial scar
  • Phyllodes tumour
  • Fibrocystic disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is a fibroadenoma, its epidemiology, appearance, cytology + histology?

A

Benign neoplasm of a lobule; arising from fibro (stromal) + glandular (adenomal) epithelium

Epi:
- Most common lump in women 20-40yrs

Appearance:
- Size: Single, unilateral 1-5cm + mobile; varies in size during pregnancy + menstrual cycles (oestrogen driven)
- Consistency: Well demarcated, spherical, firm, smooth, rubbery
- Painless
- Mobile, “breast mouse”

Cyto:
- Branching sheet of epithelium
- bare bipolar nuclei + stroma

Histo:
- Multinodular mass of expanded intralobular stroma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is a breast cyst, its epidemiology and appearance?

A

Fluid-filled sacs in the breast

Epi:
- Peri-menopausal (50yrs)

Appearance:
- Size: Single/multiple unilateral/bilateral; pain correlates with menstrual cycle
- Consistency: Well demarcated, clear nipple discharge
- Painless, transilluminable
- Fluctuant/mobile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is a duct ectasia, its epidemiology, appearance, cytology + histology?

A

Dilatation of milk ducts due to blockage + inflammation

Epi:
- Peri/post-menopausal
- RFs: SMOKING + multiparity

Appearance:
- Size: Sub-areolar mass; nipple inversion
- Consistency: Firm, thick yellow-green-white nipple discharge; may lead to local infection if ducts get infected
- Tender
- Fixed

Cyto:
- Nipple discharge
- Proteinaceous material
- Macrophages

Histo:
- Duct dilatation
- Periductal inflammation
- Proteinaceous material inside duct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is an intraductal papilloma, how does it present and what is seen on cytology + histology?

A

Benign papillary tumour arising within the duct system of the breast
- Small terminal ductules cause peripheral papillomas which cause a clinically silent + sub-areolar mass
- Larger lactiferoud ducts cause central papillomas which result in nipple discharge

Presentation:
- Sub-areolar mass
- +/- nipple discharge
- Peri + post-menopausal

  • Not seen on mammogram *

Cyto (of nipple discharge):
- Branching papillary groups of epithelium

Histo:
- Papillary mass within a dilatated duct lined by epithelium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is a radial scar, its causes, presentation and histological features?

A

Benign sclerosing lesion - central scarring surrounded by proliferating glandular tissue in stellate pattern

Cause:
- Impaired healing, post-injury

Presentation:
- STELLATE MASS (Radial Star) on mammography
- Closely mimics carcinoma
- Lesions >1cm = complex slerosing lesions

Histo:
- Central, fubrous stellate area

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is a phyllodes tumour, its presentation, features + histolgical findings?

A

Aggressive fibroepithelial neoplasms of breast arising from interlobular stroma (like fibroadenomas) with increased cellularity + mitoses

Presentation:
- >50yrs
- Palpable mass

Features:
- Low grade or high grade lesions
- Mostly relatively benign
- Can be aggressive
- Excised with wide local excision/mastectomy to limit local recurrence
- Mets V Rare

Histo:
- Branching
- Leaf-like fronds
- Artichoke appearance

17
Q

What is fibrocystic disease, its presentation, features + histological findings?

A

Fluid-filled sacs in breast

Presentation:
- Changes according to menstrual cycle (hormone responseive)
- Lumpiness in breasts

Features:
- Occurs in 1/3 pre-menopausal women
- No increased risk for breast cancer
- Well-demarcated, fluctuant, transilluminable, clear nipple discharge

Histo:
- Dilated large ducts which may become calcified

18
Q

What are proliferative breast conditions and three types?

A

Diverse group of intraductal epithelial proliferations, associated with varying risks of developing invasive breast cancer
- Pre-malignant
- Usually asymptomatic

  • Usual epithelial hyperplasia
  • Flat epithelial atypia (atypical ductal carcinoma)
  • In situ lobular neoplasia
19
Q

What are some features of usual epithelial hyperplasia + its histological findings?

A
  • Not formally considered precursor lesion to invasive breast carcinoma
  • Slightly increased risk (1-2%) of breast cancer

Histo:
- Growth of glandular tissue + epithelial cells forming fronds

20
Q

What is the carcinoma risk of flat epithelial atypia (atypical ductal carcinoma) + its histological findings?

A
  • 4x risk of developing carcinoma

Histo:
- Multiple layers of epithelial cells
- Lumens more regular + round with punched out areas

21
Q

What is the carcinoma risk of in situ lobular neoplasia + its histological findings?

A
  • 7-12x risk for developing breast carcinoma

Histo:
- Solid proliferation of aplastic cells
- Little space
- Small residue areas where you can still see lumen

22
Q

What is the incidence, age and RFs for developing breast carcinoma?

A

Incidence:
- Most common cancer in women
- Lifetime risk = 1 in 8

Age:
- 75-80yrs
- Younger in Afro-Caribbeans
- Rare <35yrs

RFs:
- Gender
- Susceptibility genes (12%): BRCA1/BRCA2
- Hormone exposure
- Advancing age
- FHx
- Race (Caucasian > Afro-Caribbean > Asian > Hispanic)
- Obesity
- Tobacco
- Alcohol
- Radiation exposure

23
Q

What is the screening programme for breast carcinoma, and the different types of breast carcinoma?

A

Screening:
- 47Y to 73Y Women
- 3-yearly mammography testing
- Looks for abnormal areas of calcification or mass within breast

Types:
- Non-invasive: Ductal carcinoma in situ (DCIS)
- Invasive: Invasive ductal carcinoma, invasive lobular carcinoma, Paget’s disease of breast

24
Q

What are some features of gynaecomastia?

A
  • Pubertal boys
  • Older men >50yrs
  • Idiopathic/ drug associations
  • Benign
25
Q

What are some features of male breast cancer?

A
  • Rare
  • Median age = 65yrs
  • Most common presentation = palpable lump
  • Almost 1/2 = Stage 3/4 + a/w: BRCA2 carriers
26
Q

What is carcinoma in situ, its prevalence, types, features, histology + general treatment?

A

Neoplastic epithelial proliferation limited to ducts/lobules by basement membrane

Prevalence = 20%

Types:
- Lobular (LCIS)
- Ductal (DCIS)

Features:
- Inherent but not inevitable risk of progression to invasive breast cancer

Histo:
- Ducts filled with atypical epithelial cells

Tx:
- Surgical excision with clear margins

27
Q

What are some features of lobular carcinoma in situ (LCIS)?

A
  • Always incidental finding on biopsy
  • No microcalcifications/stromal reactions
  • 20-40% bilateral
  • Cells lack adhesion protein E-cadherin
  • RF for subsequent invasive basal carcinomas
28
Q

What are some features of ductal carcinoma in situ (DCIS)?

A
  • Incidence increased dramatically since development of mamography
  • Appear as areas of microcalcification
  • 10% present with clinical Sx
  • Much increased risk of progression to invasive breast carcinoma
  • High, intermediate + low grade
29
Q

What is invasive breast carcinoma, its prevalence and types (with features)?

A

Malignant epithelial tumours which infiltrate within breast, capacity to spread to distant sites

Prevalence = 80%

Invasive ductal:
- Carcinoma that can’t be subclassified into another group
- Most common
- Big, pleomorphic cells
- Invasive cells move into stroma

Invasive lobular:
- Cells aligned in single file chains/strands
- Incidental finding

Tubular carcinomas:
- Well-formed tubules
- Low grade nuclei
- Rarely palpable as <1cm

Mucinous carcinomas:
- Cells produce abundant quantities of extracellular mucin
- Mucin dissects into surrounding stroma

30
Q

How are invasive breast carcinomas graded?

A

Core needle biopsy + Nottingham Grading System

Graded /3 (/9 total score):
- Nuclear polymorphism
- Tubule formation
- Mitotic activity

Grade 1 = well differentiated (<5/9)
Grade 2 = moderately differentiated (6-7/9)
Grade 3 = poorly differentiated (8-9/9)

31
Q

What is the most important prognostic factor of breast cancer, as well as other prognostic factors?

A

Status of axillary lymph nodes - most important

  • ER/PR receptor +ve = Good prognosis (response to Tamoxifen)
  • HER2 +ve = Bad prognosis
32
Q

What is Tamoxifen?

A

Mixed agonist/antagonists of oestrogen at its receptor

33
Q

What is Herceptin/trastuzumab

A

Monoclonal Ig to HER2 (direct toxic effect on myocardium, must monitor LVEF)

34
Q

What are the general receptor statuses of different types of cancers, and which treatments do they receive?

A

Low grade tumours:
- ER/PR +ve generally
- HER2 -ve generally
- Tx: Tamoxifen

High grade tumours:
- ER/PR -ve generally
- HER2 +ve generally
- Tx: Herceptin

Basal cell carcinomas:
- ER/PR/HER2 -ve
- Triple negative

35
Q

What is the presentation of basal-like carcinomas, their histological features, associations and spread?

A

Presentation:
- Breast lump +/- Peau d’orange
- UL DVT
- Nipple retraction

Histo:
- Sheets of markedly atypical cells with lymphocytic infiltrate
- +ve stain for CK5/6/14

Associations:
- BRCA (commonly)

Spread:
- Vascular invasion
- Distant metastatic spread

Pathology (Guide) (84 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions