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REGUB > L31, 32 + 33: The Breast > Flashcards

L31, 32 + 33: The Breast Flashcards

1
Q

What is the milk line? What is the significance of it?

A
  • it extends from the axilla to the pelvis

- pathologies occur here

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2
Q

What is the function of the lobes/lobules of the breast?

A

they produce milk

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3
Q

What is the function of the ducts of the breast?

A

it transports milk to the nipple

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4
Q

What is the terminal duct lobular unit (TDLU)? Why is it significant?

A
  • functional unit
  • terminal branches of ducts, lobules + surrounding connective tissue
  • most cancers arise here
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5
Q

Which part of the breast do most cancers arise in?

A

the terminal duct lobular unit (TDLU)

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6
Q

What is the normal thickness of the ducts and lobules of the breast?

A

2 cell layer (superficial and deep layer)

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7
Q

What are the 2 cell layers of the ducts and lobules of the breast?

A
  1. Superficial Layer - epithelial cells

2. Deep Cell Layer - myoepithelial cells

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8
Q

What cell type makes up the deep cell layer of the ducts and lobules of the breast?

A

myoepithelial cells

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9
Q

What cell type makes up the superficial cell layer of the ducts and lobules of the breast?

A

epithelial cells

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10
Q

Describe the histology of the breast before puberty (pre-pubertal)

A
  • branching ducts connected to nipple
  • no glandular component
  • similar to a male breast
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11
Q

Describe the histology of the breast after puberty (post-pubertal)

A
  • terminal ducts give rise to lobules
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12
Q

What is galactorrhoea?

A
  • milk production outside of lactation
  • not a symptom of breast cancer
  • may occur to a pituitary tumour (prolactinoma)
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13
Q

What are supernumerary nipples/breasts?

A
  • most common congenital anomaly

- heterotropic glands along the milk line

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14
Q

What is the most common congenital anomaly associated with the breast?

A

supernumerary nipples/breasts

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15
Q

List the common clinical presentations of breast disease (in general)

A
  • breast pain (mastalgia)
  • palpable mass
  • nipple discharge
  • mammographic abnormality
  • skin (peau-d’orange)
  • nipple retraction
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16
Q

Why is a mammogram difficult to do in younger patients?

A

b/c breast tissue is more dense

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17
Q

What imaging technology is used in younger women to examine their breasts?

A

Ultrasound

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18
Q

What is Triple Assessment of the breast? What is it used for?

A

Triple Assessment = clinical, radiology and pathology

if all 3 tests are benign = leave lump - do not need to remove

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19
Q

What is the point of “BreastCheck”, a breast screening program?

A

to detect small NON-PALPABLE breast carcinomas at an early stage

  • mammogram done every 2 years
  • usually done in women 50-64
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20
Q

List some of the mammographic signs of breast malignancy

A
  • calcifications* (small, irregular, clustered, linear or branching)
  • densities
  • architectural distortion
  • asymmetry
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21
Q

What biopsy method is used to examine breast tissue for a pathological diagnosis?

A

needle core biopsy

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22
Q

When is an open biopsy of a breast tissue done?

A

if there is uncertainty following triple assessment

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23
Q

What is acute mastitis?

A
  • acute inflammatory condition of the breast
  • usually from cracked nipple during lactation
  • bacteria invades through ducts (usually S. aureus or Strep)
  • fever, pain, erythema, purulent nipple discharge
  • treat w/ antibiotics
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24
Q

What are the symptoms of acute mastitis?

A

fever, pain, erythema, purulent nipple discharge

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25
Q

How can acute mastitis be treated?

A

w/ antibiotics

rarely surgical drainage

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26
Q

What is the most common organism a/w acute mastitis?

A

Staph. aureus

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27
Q

What is periductal mastitis?

A
  • chronic inflammatory condition of the breast
  • squamous metaplasia of ducts (therefore keratin production which plugs the duct and causes inflammation
  • painful subareolar mass, inverted/retraction of nipple
  • needs surgical excision of involved duct
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28
Q

What is the clinical presentation of periductal mastitis?

A

painful subareolar mass, inverted/retracation of nipple

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29
Q

What is the treatment of a periductal mastitis?

A

surgical excision of the involved duct

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30
Q

What is a mammary duct ectasia?

A
  • chronic inflammatory condition of breast
  • have inflammation and dilation of subareolar ducts
  • have palpable periareolar mass w/ thick green/brown nipple discharge
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31
Q

What is the clinical presentation of a mammary duct ectasia?

A

palpable periareolar mass with thick green/brown nipple discharge

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32
Q

What is the presentation of fat necrosis on mammography?

A

dystrophic calcification

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33
Q

Dystrophic Calcification vs. Metastatic Calcification

A

Dystrophic Calcification - in injured or necrotic tissue in a normal serum calcium level
– Abnormal Tissue, Normal Calcium

Metastatic Calcification - with hypercalcemia occurs when calcium deposits in previously normal tissue
— Normal Tissue, Raised Calcium

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34
Q

What is lymphocytic mastitis?

A
  • chronic inflammatory condition of breast
  • a/w T1DM (diabetic mastopathy)
  • palpable mass (usually bilateral + subareolar)
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35
Q

What is the presentation of lymphocytic mastitis?

A

palpable mass (usually bilateral + subareolar)

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36
Q

What is granulomatous mastitis?

A
  • chronic inflammatory condition of breast

- idiopathic or a/w systemic granolumatous disease (e.g. sarcoidosis)

37
Q

What is a galactocoele?

A
  • cystic dilation of duct during lactation (it contains milk)
  • may become infected (acute mastitis)
  • may form an abscess
38
Q

Why do fibrocystic changes of the breast occur?

A

due to oestrogen/progesterone imbalance

39
Q

What are the clinical features of fibrocystic disease of the breast?

A
  • discomfort (cyclical)
  • nodularity
  • discrete lump (firm/rubbery)
  • nipple discharge

note: atypical hyperplasia a/w increased risk of carcinoma

40
Q

What is non-proliferative fibrocystic change of the breast?

A
  • increase in cysts + apocrine metaplasia

- fibrosis of stroma

41
Q

What is proliferative fibrocystic change of the breast?

A
  • epithelial hyperplasia (more than 2 cell layers)
  • – can have no atypia or atypia
  • intraductal papilloma
42
Q

What is an intraductal papilloma?

A
  • type of proliferative fibrocystic change of the breast
  • benign growth w/in lactiferous duct
  • premenopausal women
  • presents w/ serous or bloody nipple discharge
  • can recur
43
Q

Which population do intraductal papillomas normally affect?

A

premenopausal women

44
Q

How does an intraductal papilloma present?

A

serous or bloody nipple discharge

45
Q

What is gynecomastia?

A

enlargement of the male breast (usually unilateral)

46
Q

List the 3 possible causes of gynecomastia

A
  1. Oestrogen Excess
  2. Drugs
  3. Prolactin Excess (e.g. pituitary tumour)
47
Q

List the drugs that can lead to gynecomastia

A
  • spirinolactone
  • chlorpromazine
  • cimetidine
  • androgens
  • alcohol
  • marijuana
  • heroin
48
Q

List some of the risk factors for developing breast cancer [lots of them!]

A
  • female
  • increasing age
  • early menarche + late menopause
  • exposure to oestrogen (e.g. oral contraceptive)
  • nullparity and older age @ first birth
  • family history + genetic predisposition
  • carcinoma of the endometrium
  • atypical epithelial hyperplasia (fibrocystic disease)
  • radiation exposure
  • post-menopausal obesity
  • alcohol
  • race
  • radiation exposure
49
Q

What are the main 2 genes are associated with an increased risk of breast cancer? Which chromosome is each gene on?

A

BRCA 1 - Chromosome 17

BRCA 2 - Chromosome 13

50
Q

List the 2 mechanisms by which oestrogen and its metabolites can cause sporadic breast cancer

A
  1. Oestrogen causes proliferation of pre-malignant lesions + cancers
  2. Metabolites of Oestrogen cause mutations or generate DNA damaging free radicals
51
Q

List 4 genetic conditions/mutations that can lead to hereditary breast cancer

A
  1. BRCA 1
  2. BRCA 2
  3. Li-Fraumeni Syndrome
  4. Cowden’s Disease
52
Q

What symptoms/presentation would be present to suggest a hereditary breast cancer?

A
  • bilateral breast cancer
  • breast and ovarian cancer
  • male breast cancer
  • breast cancer < 40
  • multiple 1st degree relatives w/ breast cancer
53
Q

What are the 2 types of carcinoma in-situ of the breast?

A
  1. Ductal Carcinoma In-Situ (DCIS)

2. Lobular Carcinoma In-Situ (LCIS)

54
Q

What is DCIS of the breast?

A

Ductal Carcinoma In-Situ

  • malignant cells in TDLU
  • classified as low grade, intermediate and high grade
  • 5 architectural subtypes
55
Q

What are the 5 different types of architectural subtypes of DCIS?

A
  • comedo
  • solid
  • cribriform
  • papillary
  • micropapillary
56
Q

Which architectural subtype of DCIS has the worst prognosis?

A

comedo necrosis DCIS

57
Q

What is the treatment/management plan for DCIS?

A
  • wide local excision ± radiotherapy

- mastectomy (sometimes

58
Q

What is Paget’s Disease of the nipple?

A
  • form of ductal carcinoma
  • malignant cells arising from DCIS extend into ducts and into nipple skin w/o crossing BM
  • erythematous eruption w/ scale crust
  • ulceration of nipple + redness
59
Q

What is lobular carcinoma in-situ (LCIS)?

A
  • abnormal cells fill lobules
  • does not cross BM
  • have dyscohesive cells lacking E-Cadherin
60
Q

A DCIS increases the risk of what type of carcinoma?

A

ductal carcinoma only

61
Q

A LCIS increases the risk of what type of carcinoma?

A

lobular OR ductal carcinoma

62
Q

If there are dyscohesive cells lacking E-Cadherin what does this suggest?

A

a LCIS

63
Q

Is invasive ductal or lobular breast cancer more common?

A

invasive ductal cancer

64
Q

What type of breast cancer is the most comon?

A

invasive ductal cancer

65
Q

How does an invasive ductal carcinoma of the breast normally present?

A
  • hard mass detected by exam or mammogram
  • have irregular border
  • advanced tumour have dimpling of skin + retraction of the nipple
66
Q

List the 5 type of “special type” invasive carcinomas

A
  1. Invasive Lobular Carcinoma
  2. Invasive Mucinous (Colloid) Carcinoma
  3. Invasive Medullary Carcinoma
  4. Invasive Tubular Carcinoma
  5. Invasive Papillary Carcinoma
67
Q

What is an invasive lobular carcinoma?

A
  • special type invasive carcinoma of breast
  • young women
  • bilateral
  • cells invade cords (single-file)
  • – “Indian Filing”
  • have loss of adhesion molecules (E-cadherin)
68
Q

What is an invasive tubular carcinoma?

A
  • special type invasive carcinoma of breast
  • well differentiated (prominent tubules/ducts)
  • good prognosis
69
Q

What is an invasive mucinous (colloid) carcinoma?

A
  • special type invasive carcinoma of breast
  • elderly women
  • has abundant extracellular pools of mucin
  • good prognosis
70
Q

What is an invasive medullary carcinoma?

A
  • special type invasive carcinoma of breast
  • circumscribed edge
  • large malignant cells
  • surrounding lymphocytic response
71
Q

What is an inflammatory cancer of the breast?

A
  • any type of breast cancer that has infiltrated the dermal lymphatics
  • red, swollen and oedematous breast
  • a/w poor prognosis
72
Q

What is the Scarff Bloom Richardson used for? What are the 3 features that are calculated?

A
  • used for histological grading of breast cancer
  1. % of Tubule Formation
  2. Mitotic Count
  3. Nuclear Pleomorphism
73
Q

According to the Scarff Richardson score, what is considered grade 1 breast cancer?

A

score 3 -5

74
Q

According to the Scarff Richardson score, what is considered grade 2 breast cancer?

A

score 6-7

75
Q

According to the Scarff Richardson score, what is considered grade 3 breast cancer?

A

score 8-9

76
Q

List some of the prognostic factors for breast cancer

A
  • invasive or in-situ
  • stage
  • inflammatory carcinoma (a/w higher stage)
  • histological grade
  • histological subtype of tumour
  • adequacy of excision
  • lymphovascular invasion
  • proliferative rate
  • angiogenesis
77
Q

List 2 factors which predict a breast tumour’s response to treatment

A
  1. expression of hormone receptors (oestrogen + progesterone)
  2. expression of c-erb B2 (HER-2)
78
Q

What is considered a triple negative tumour?

A

negative for ER, PR, and HER2

- has a poor prognosis b/c treatment is more difficult

79
Q

List the 5 possible treatments for breast cancer

A
  1. Surgery
  2. Axilla - Sentinel Lymph Node Biopsy ± Axillary Clearance
  3. Radiotherapy
  4. Systemic Therapy (hormonal therapy e.g. tamoxifen, trastuzumab)
  5. Chemotherapy
80
Q

What is the typical presentation of a carcinoma of the male breast?

A

invasive carcinoma

81
Q

What are the 3 stromal tumours of the breast?

A
  1. Fibroadenoma (benign)
  2. Phyllodes Tumour (in between)
  3. Sarcomas (malignant)
82
Q

What is the most common benign tumour of the breast?

A

fibroadenoma

83
Q

What is a fibroadenoma of the breast?

A
  • benign tumour
  • solitary lesion
  • freely movable mass
  • responds to oestrogen and progesterone (may change w/ menstrual cycle and pregnancy)
84
Q

What is Phyllodes tumour?

A
  • stromal tumour of breast
  • resembles fibroadenoma
  • – “leaf-like” clefts and slits
  • can be benign or malignant
85
Q

How old/young must a woman be for them to be considered for an ultrasound rather than an MRI for investigating breast lumps?

A

< 35 years old

86
Q

What 3 chemotherapy drugs are used for treating breast cancer?

A
  • cyclophosphamide
  • methotrexate
  • 5-fluorouracil
87
Q

What is Lead Time Bias?

A

an apparent increase in survival time without reduction in mortality

88
Q

What is Length Bias?

A

clinical outcome observations that are not adjusted for the rate of progression of disease

REGUB (22 decks)

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