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Cardio > Histopathology Breast Pathology > Flashcards

Histopathology Breast Pathology Flashcards

1
Q

Anatomy of the Breast Disease

A
  • The breast is a modified sweat gland covered by skin and subcutaneous tissue
  • It rests on the pectoralis muscle from which it is separated by a fascia
  • Dense connective tissue extends from the underlying pectoralis fascia to the skin of the breast called Cooper’s ligament. These ligaments hold the breast upward.
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2
Q

Histology →

A
  1. Histologically breast consists of glandular (parenchymal) and supporting (connective) tissue.
  2. Glandular element is divided into branching duct system and terminal duct lobular units (TDLU)
    • Epithelial element → functional and therefore called parenchymal.

• Accini (collection of lobules (numerous).
q

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3
Q

The TDLU Formed by →

A

The lobule and terminal ductile and represents the secretory portion of the gland.

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4
Q

The TDLU → Connects with the

A

Sub-segmental duct, which in turn leads to a segmental duct and this to a collecting/lactiferous duct which, empties into the nipple. The latter are 15-30 in number on each side.

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5
Q

Histology of the ductal –lobular system

A

The breast is lined by two cell types
• The inner epithelial cells
• The outer myoepithelial cells – contraction function to propel fluid.

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6
Q

Histology knowledge is clinically important because

A

For treatment:
In situ can’t metastisise to maxilla (lymph): excision = cure
Invasive (into BM) can

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7
Q

Gland without myo-epithelial layer means

A

Pathological as malignant cant build moepithlial layer but can have BM (check this)

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8
Q

Reliable marker of epithelial cells

A

Various types of cutokeratins and epithelial membrane antigen.

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9
Q

Best marker for myoepitheial cells is

A

p63

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10
Q

BM stain

A

Reticulin stains, ultra structurally or with immune-histochemical reactions for laminin or type IV collagen.

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11
Q

Diseases of Breast → Classification

A
  1. Inflammatory
  2. Proliferative
  3. Neoplasia
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12
Q

Inflammatory

A

Acute mastitis
Chronic mastitis – lymphocytic lobulitis
Mammary duct ectasia (dilatation)
Fat necrosis – tissue death (various types) (Type 1)

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13
Q

Proliferative

A

Fibrocystic change

Radial Scar

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14
Q

Lymphocytic Lobulitis definition and histological

A

Chronic inflammation that presents like cancer → commonly seen in diabetics = hard mass.
Histologically: dese fibrosis and lymphocyte infiltration.

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15
Q

Mammary duct ectasia features

A

Bloody nipple discharge biopsy reveals inflammation and ectasia

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16
Q

Chronic granulomastitis description and treatment

A 
Collection of epithelial histocytes
Cause:
1.	TB
2.	Leprosie
3.	Sarcoidosis
4.	Syphilis
5.	Idiopathic (common)

Conservative. By operating it triggers a flare

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17
Q

Fat necrosis description

A

Death of fat cells. Release fat and macrophage eat up = lipid containing. Calcification can occur.
This is similar to cancer as it has irregular density with calcification.

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18
Q

Proliferative:

Radial Scar

A

Radiologically: exaggerated form of sclerosis adenosis. Fibrosis of epithelial glands produces fibrosheaths (stellate shaped). This looks like a carcinoma as it has an irregular border.

Tubules with 2 cell layers meaning it is benign

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19
Q

Proliferative:

Tubular carcinoma

A

Biopsy radial scare looks very similar

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20
Q

Proliferative:
Protocol for radial s
carring

A

Remove all

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21
Q

Neoplastic: Types

A

Benign

Malignant

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22
Q

Neoplastic: Benign types

A

Benign

Malignant

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23
Q

Neoplastic: Benign types

A

Adenoma –epithelial differentiation
Fibroadenoma – mixed glands and neoplastic prolif of fibroelastic element
Papilloma – finger like structures

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24
Q

Malignant types

A

Carcinoma – epithelial differentiation
Sarcoma – mesenchymal origin
Pagets disease (nipple and vulva)
Phylloides tumour – mixed – prolif or epi + mesenchymal elements

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25
Q

Neoplastic:

Signs and symptoms:

A

Lump typed and associated underlying pathology

Nipple changes and associated underlying pathology
Breast Pain
Skin features
Micro-calcification

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26
Q

Lump typed and associated underlying pathology

A 
Diffuse – fibrosis/ fibrocystic change
Discrete – neoplasm/ cyst/abscess/ hamartoma (dev. malformation
Mobile – Benign neoplasm 
Tethered – Carcinoma
* See Pie chat pg 117
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27
Q

Nipple changes and associated underlying pathology

A

Discharge
• Milky – Pregnancy
• Bloody – duct papilloma/carcinoma
Retraction – invasive arcinoma (due to fibroelastic reaction)
Erythema – Pagets disease or eczema and scaling

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28
Q

Breast Pain

A

Cyclical – benign breast diseases

On palpation – inflammatory

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29
Q

Skin features

A

Oedema –peau d’orrange – carcinoma (lymph cells blocked lymph drainage)

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30
Q

Micro-calcification

A

DCIS or fat necrosis

31
Q

Adenoma: Fibrocystic change

A

Different terminology
Common in 25-45 yrs age group
Pathogenesis – hormones

32
Q

Adenoma: Fibrocystic changes microscopic picture

A
  • TDLU
  • Cysts formation
  • Fibrosis – surrounding tissue from cyst rupture
  • Apocrine metaplasia – epithelial cells modify themselves
  • Calcification secretions
33
Q

Fibroadenoma: Epi

A

Commonest benign breast tumour

B/W the ages of 20-35 yrs

34
Q

Fibroadenoma: Morphology

A

Increases in size during pregnancy

Decrease in size with age

35
Q

Fibroadenoma:

A

Composed of both proliferating ducts and connective tissue stroma.
Proliferation of mesenchymal and epithelial cells – no atipia or mitotic activity

36
Q

Fibroadenoma: Rx

A

Surgery is not recommended

37
Q

Phylloides tumour: Description

A

Phylloides is a Greek word means leaf-like

38
Q

Phylloides tumour: Epi

A

Usually occurs in 4th and 5th decade of life.

39
Q

Phylloides tumour: M/s

A

It is composed of epithelial and mesenchymal elements

40
Q

Phylloides tumour: Epithelial cell spread

A

Takes lymphatic route

41
Q

Phylloides tumour: Mesenchymal cells spread

A

Travel via blood and therefore in this don’t excise the lymph nodes therefore this is the malignancy element.

42
Q

Phylloides tumour: Presentation

A

It can be benign borderline and malignant

43
Q

Phylloides tumour: Benign

A

Circumscribed

Low mitotic activity

44
Q

Phylloides tumour:

Malignancy

A

It is the mesenchymal component which is malignant and produce metastasis through haematogenous route.

45
Q

Phylloides tumour:

Malignant

A

Irregular margins
High mitotic count
Stromal overgrowth

46
Q

Phylloides tumour:

Treatment

A

Wide local excision

Recurrence is common

47
Q

Carcinoma:Epi

A
  • 20% of all cancers in women
  • In the UK 1 in 8 women develop breast cancer
  • Commonest cause of death in women in 35-55 yrs age group.
48
Q

Carcinoma: Risk Factors

A 
•	Female sex and age
•	Reproductive history (increased estrogen exposure)
→Early menarche
→ Late menopause
→ Nulliparous women
→ 1st pregnancy after 30 yrs of age
•	Obesity
•	Family history in 1st degree relative
→1.5-2x if 1 relative
  • Geography
  • Atypical hyperplasia (increased risk of breast cancer)
49
Q

Carcinoma: Aetiological mechanisms

A 
•	Hormonal Factors
•	Genetic factors
→ BRCA 1, ch 17, ovary and breast
→ BRCA 2, ch 13
•	Environmental influences
50
Q

Carcinoma: Classification

A

Carcinoma of breast are broadly classified on the basis of two criteria
• Invasion of BM
• Morphology

51
Q

Carcinoma: Invasion of BM

A

In-situ

Invasive

52
Q

Carcinoma:Morphology

A

Ductal

Lobular

53
Q

Carcinoma: Insitu Carcinoma

A

Ductal Carcinoma in situ

Lobular Carcinoma in situ

54
Q

Carcinoma: Invasive Carcinoma

A

Invasive ductal carcinoma NST (75-85%)
Invasive lobular carcinoma (10%)
Others (5%)

55
Q

Carcinoma: DCIS

A

High grade – invasive disease

56
Q

Carcinoma: Ductal vs. lobular

A

Behave differentially
DCIS – develops invasively im
LCIS – can develop into invasive disease (can develop in another breast or other quadrant.

57
Q

LCIS histology

A

Lobule w/ epithelial proliferation – myoepithelium containing the cells in accini.

58
Q

Treatment

A

Surgery – DCIS, invasive carcinoma
Chemotherapy – reduce in size and clearer margins
Radiotherapy – Conservative
Hormonal treatment – tamoxifen or element X inhib. (post menopause)/ |Herceptin

59
Q

Prognosis

A 
Size of tumour
Grade of the tumour
Histological type of tumour
Vascular invasion
Stage of the tumour – nodal status
Receptor status of the tumour
60
Q

Pagets disease of the nipple: Associated with

A

Underlying (2%) ductal carcinomas

61
Q

Pagets disease of the nipple: M/s

A

There is involvement of epidermis by malignant ductal carcinoma cells.

62
Q

Pagets disease of the nipple: Clinically there is

A

Roughing

Reddening and slight ulceration of skin

63
Q

Pagets disease of the nipple: Histologically

A

Stratified Squamous – proliferation of neoplastic cells in epidermis

64
Q

What is the marker for breast cancer →

A

Micro-calcification

65
Q

Where do we see this micro-calcification histologically?

A

It is usually associated with DCIS mostly high grade with central necrosis.

66
Q

It is always malignant?

A

No, micro-calcification can be associated with benign fibrocystic change.

67
Q

Do all breast cancers have micro-calcification?

A

No

68
Q

What other mammographic appearances can one have with breast cancers?

A

Stellate lesion

Circumscribed soft tissue density/mass lesion

69
Q

Are these appearances specific for breast cancer?

A

No

70
Q

What other lesions can mimic breast cancer radio logically?

A

Micro-calficification
Stellate lesion
Circumscribed soft tissue density

71
Q

Micro-calcification

A

Fibrocystic change
Fat necrosis
Calcified eggs of parasites (nearly)

72
Q

Stellate Lesion

A

Radial scar

73
Q

Circumcised soft tissue density

A

Fibroadenoma and Phylloides tumour

74
Q

What is Triple Approach?

A

All breast cases are discussed in a multidisciplinary meeting every week.
Breast Clinicians, Radiologists and thus we use triple approach to triple approach to reach a final diagnosis and decide best management for the patient

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