Histopathology - Breast Pathology Flashcards
What are general presenting symptoms of breast cancer?
- Pain (mastalgia/mastodynia)
- Palpable masses
- Nipple discharge
What is the triple assessment for a breast cancer?
- Clinical examination
- Imaging (USS/mammography IF <35yrs)
- Cytology + histology
How is the sample obtained for cytopathology in a breast cancer assessment and how is it coded?
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 is the sample obtained for histopathology in a breast cancer assessment and how is it coded?
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
What is the gold standard investigation for breast cancer diagnosis?
Histopathology
- Normal breast histology = ductal-lobular system lined by inner glandular epithelium
What are some inflammatory breast conditions?
- Acute mastitis
- Fat necrosis
How does acute mastitis present, what are the different types, features, causes, cytological findings + treatment?
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 does a breast abscess present and what is its management?
Presentation:
Fluctuant swelling + swinging fevers
Mx:
- IV Abx
- Incision + drainage
What is a fat necrosis, its RFs, causes, presentation and cytological findings?
- 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)
What are some benign neoplastic conditions?
- Fibroadenoma
- Breast cyst
- Duct ectasia
- Intraductal papilloma
- Radial scar
- Phyllodes tumour
- Fibrocystic disease
What is a fibroadenoma, its epidemiology, appearance, cytology + histology?
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
What is a breast cyst, its epidemiology and appearance?
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
What is a duct ectasia, its epidemiology, appearance, cytology + histology?
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
What is an intraductal papilloma, how does it present and what is seen on cytology + histology?
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
What is a radial scar, its causes, presentation and histological features?
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
What is a phyllodes tumour, its presentation, features + histolgical findings?
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
What is fibrocystic disease, its presentation, features + histological findings?
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
What are proliferative breast conditions and three types?
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
What are some features of usual epithelial hyperplasia + its histological findings?
- 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
What is the carcinoma risk of flat epithelial atypia (atypical ductal carcinoma) + its histological findings?
- 4x risk of developing carcinoma
Histo:
- Multiple layers of epithelial cells
- Lumens more regular + round with punched out areas
What is the carcinoma risk of in situ lobular neoplasia + its histological findings?
- 7-12x risk for developing breast carcinoma
Histo:
- Solid proliferation of aplastic cells
- Little space
- Small residue areas where you can still see lumen
What is the incidence, age and RFs for developing breast carcinoma?
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
What is the screening programme for breast carcinoma, and the different types of breast carcinoma?
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
What are some features of gynaecomastia?
- Pubertal boys
- Older men >50yrs
- Idiopathic/ drug associations
- Benign
