IOD Breast Pathology Flashcards
How do the causes of breast lumps vary to age?
Young-fibroadenoma and fibrocystic change more, cancer less
Old-cancer more, fibroadenoma and fibrocystic changes less
What is the triple assessment?
• Clinical -history and examination
• Radiological (mammography, ultrasound)
• mammography (usually in older patients >35yr). identifies microcalcifications and densities.
• ultrasound (usually in younger patients <35y because their breast tissue is too dense for
mammography) good for distinguishing solid and cystic lesions, and it can guide a needle test.
• Pathological - a needle test: FNA and/or core biopsy.
What is the reporting categories?
C1/B1- inadequate C2/B2 benign C3/B3 equivocal favour benign C4/B4 equivocal favour malignant C5/B5 malignant
Accuracy in MDT?
99%
Fibroadenoma?
Common benign breast tumour
frim painless mobile lump
well-circumscribed and has well-differentiated glands in CT stroma
Fibrocystic?
Minor aberrations/cysts and fibrosis in second half of cycle
pain, tenderness, lumps
25-45 yrs
analgesics and aspiration/excision
Lifetime risk of breast cancer?
1 in 8
more common in?
40-70 yrs
major risk fctors?
oestrogen exposure, Fh and alcohol
oestrogen exposure?
female,age,obesity,early menarche,, late menopause,COC, HRT >10 yrs
Family history?
BRCA 1 and 2-AD
TP53
How many are familial?
5-10%
Risk reducing surgery?
bilateral mastectomy and salpingo-oophorectomy
alcohol?
risk increases by 10% for each drink
Clinical features?
upper outer quadrant of breast hard painless lump nipple inversion and skin dimpling ulceration/fungation peau d'orange nipple eczema palpable axillary nodes metastatic disease
MDT?
oncologist, radiologist, pathologist, endocrinologist, specialist nurses etc
pathology?
Ductal-75%
Lobular-10-15%
Both present in terminal duct lobular unit
DCIS?
Epithelial cells showing signs of malignancy are in the TDLU but have not invaded past the basement membrane
IDC?
Tumour cells invaded past the basement membrane into surrounding tissue and has potential to mets
Features of DCIS?
carcinoma in situ confined by BM pre-cancerous not always a mass linked to microcalcifications-mammography unifocal lesion on one area surgically excised
Features of IDC?
invasive growth and met potential
palpable breast mass
Pagets disease?
DCIS cells in epidermis spreading to nipple and areola, causing inflammation
Pagets features?
underlying invasive carcinoma
not all women with DCIS have it
not linked to P disease of bone
Invasive lobular carcinoma
tumour cells infiltrating normal breast tissue linearly-loss of E cadherin catenin cell adhesion system
