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MBBS II ERS > L31 - Pathology of the breast > Flashcards

L31 - Pathology of the breast Flashcards

1
Q

Define the breast tissue type?

A

modified sweat gland

three major components consist of  the skin
 the subcutaneous adipose tissue
 the functional glandular tissue.

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2
Q

Describe the internal structure of the breast?

A

15-25 lobes with own terminal duct-lobular unit (milk secreting)

Each lobe has 20-40 lobules

Nipple > Lactiferous sinus > Lactiferous duct > Segmental duct > Terminal duct lobular unit

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3
Q

Correlate the diseases that arise from segmental duct, adipose tissue, terminal duct lobular unit of the breast?

A

Segmental duct = Papillomas

Adipose tissue = fat necrosis

Terminal duct lobular unit:

  • Fibroadenoma, cysts
  • Hyperplasia, Most carcinoma
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4
Q

Explain why the breast is predisposed to many pathological conditions?

A

High sensitivity for ovarian hormones, sex hormones and growth factors

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5
Q

General clinical presentation of breast diseases?

A

Pain
Presence of dominant lump
Abnormal nipple discharge

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6
Q

Define the most common breast pathologies.

A

40% - Fibrocystic change **

30% - No disease
13% - Benign lesions
10% - Cancer
7% - Fibroadenoma

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7
Q

List 4 main categories of benign breast pathologies?

A

Inflammatory lesions

Fibrocystic disease

Proliferative lesions

Benign tumors

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8
Q

List 4 inflammatory lesions of the breast?

A

Acute mastitis and breast abscess

Mammary duct ectasia

Fat necrosis

Granulomatous mastitis

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9
Q

Typical cause of Acute mastitis and breast abscess?

A

infection via the nipple due to abrasion or crack from baby’s mouth

Not common except during lactation and breastfeeding

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10
Q

Pathogenesis of mammary duct ectasia?

A

Ulceration of ducts liberate LIPID into connective tissue stroma

> > Chronic granulomatous inflammatory reaction**

> > Dilated ducts with cheesy material adjacent to aerola

> > Fibrosis, nipple retraction

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11
Q

Pathogenesis of fat necrosis in breast?

A

Trauma/ obesity

> > Traumatic rupture of fat cells
Foreign-body granulomatous reaction and fibrosis
Localized firm/ hard mass

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12
Q

List some causes of Granulomatous mastitis?

A
  • Paraffin wax or silicone fluid for breast enhancement
  • Pulmonary tuberculosis (uncommon)
  • Idiopathic granulomatous mastitis (autoimmune)
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13
Q

List 3 Fibrocystic diseases of the breast?

A

Cystic formation and fibrosis

Apocrine metaplasia

Epithelial hyperplasia

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14
Q

Typical clinical presentation and epidemiology of Fibrocystic disease of the breast?

A
  • 30 years old female, rarely postmenopausal
  • PAINFUL, firm, fixed clusters of nodules
  • Large cysts CHANGE SIZE with menstrual cycle
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15
Q

Define causes of Fibrocystic disease of the breast?

A

Hormone imbalance: HIGH ESTROGEN, LOW PROGESTERONE

  • Abnormal end-organ hormone metabolism
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16
Q

Compare the pathohistological features of the 3 types of fibrocystic disease of breasts?

A

Cystic formation and fibrosis: Increase in fibrous stroma + cyst formation

Apocrine metaplasia: ductal epithelium change to apocrine type: pink cells with budding

Epithelial hyperplasia: Proliferation of ductal lining epithelium

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17
Q

Which type of fibrocystic disease of the breast is most likely to progress into malignancy?

A

EPITHELIAL HYPERPLASIA

increased chance of malignancy, the more severe and atypical the degree of hyperplasia

18
Q

List 3 proliferative lesions of the breast?

A
  1. Hyperplasia: Ductal or Lobular
  2. Sclerosing adenosis
  3. Radial scars (complex sclerosing lesions)
19
Q

Etiology and pathogenesis of Sclerosing adenosis?

A
  • Enlarged breast lobules distorted by fibrous tissue = simulate malignancy
  • Child-bearing and premenopausal women
20
Q

Which type of proliferative lesion is only detected radiologically?

A

Radial scars (complex sclerosing lesions)

epithelial hyperplasia and fibrosis = distortion of normal architecture

mimic carcinoma both clinically and radiologically

21
Q

List 2 benign tumours of the breast?

A

INTRADUCT PAPILLOMA

FIBROADENOMA

22
Q

What is the most common cause of palpable breast lump up to age 30?

A

Fibroadenoma

Most common under 30, but can occur at any age

23
Q

Pathogenesis and clinical presentation of Fibroadenoma of breast?

A

Benign glandular epithelium + proliferation of connective tissue/ stroma

> > compress ducts into slits

Present as well-circumscribed firm, mobile and painless lump.

24
Q

What is the most common cause of bloody nipple discharge in women?

A

Intraduct Papilloma

UNILATERAL discharge if bilateral, consider hormonal origin

25
Q

Define the anatomical location of Intraduct papilloma of the breast. Etiology?

A

Solitary large ducts or multiple small ducts involved within 4 cm of the nipple

Occurs any age

26
Q

Compare Fibroadeoma and Fibrocystic disease clinical presentation?

A

Fibroadenoma = smooth, painless, mobile, well-circumscribed mass

Fibrocystic disease = painful, not solid, not mobile, well-circumscribed mass

27
Q

Which breast tumour closely resembles Phylloides tumour? How to DDx the two?

A

Fibroadenoma

differentiated from a fibroadenoma by a frond-like arrangement of the fibroepithelial element/ overgrowth of stroma

28
Q

Define whether Phylloides tumour of the breast is benign or malignant? How to ddx the two?

A
  • Majority benign
  • 3-12% metastasize

distinguishing the malignant form:

(i) increased mitoses
(ii) cellular atypia,
(iii) invasive edge,
(iv) stromal overgrowth.

29
Q

Treatment for phylloides tumour?

A

Benign = wide excision

Malignant = Mastectomy

30
Q

Describe the etiology of breast cancer?

A

1 in 15 chance

Incidence increases with age, highest chance postmenopausal

Top cancer in young females

31
Q

Genetic risk factors for breast cancer?

A
  • Positive family history: 3 or more related individuals
  • BRCA-1 and BRCA-2 breast and ovarian cancer susceptibility genes: 85% chance of breast cancer
  • Others: HNPCC, Concurrent ovarian tumours
32
Q

Genetic inheritance pattern of BRCA-1 and 2?

A

autosomal dominant

Mendelian inheritance: transmitted by either parent

33
Q

Onset and severity of hereditary breast cancer?

A

early age of onset

bilateral or multifocal breast cancer

34
Q

Criteria of assessment of high risk patients for breast cancer?

A

1) number of affected relatives
2) presence of ovarian cancer in family
3) relationship of affected relatives
4) age at diagnosis of breast cancer

> > 3 or more members of direct lineage with breast and / or ovarian cancer

35
Q

List some hormonal risk factors for development of breast cancer?

A

Increased exposure to estrogen peaks:

1) long duration of reproductive life: early menache (<12 years) and late menopause (>54 years)
2) nulliparity (no kids) or late age at first child
3) Functioning ovarian tumours

36
Q

List some environmental risk factors for development of breast cancer?

A

Dietary fats

obesity (endogenous hormonal modifications)

Radiation exposure (e.g. multiple CXR for pulmonary TB)

37
Q

List all the investigative methods for breast cancer screening?

A

Mammography

Ultrasound and MRI

Fine needle aspiration cytology

38
Q

What can mammography identify when investigating breast cancer?

A

size and extent of lesion

presence of DCIS

non-palpable abnormalities

detection of multifocal disease: check for bi-laterality.

39
Q

Mammography is the definitive Dx test for breast cancer. T or F?

A

False

10-20% of carcinomas may still be undetectable by mammography

40
Q

Which investigative technique is used for pre-operative Dx of breast cancer?

A

Fine needle aspiration cytology: detect palpable and non-palpable lesions

Core-cut biopsies

41
Q

Most common disease of male breast?

A

gynaecomastia

42
Q

Causes of Gynaecomastia?

A

cirrhosis of the liver with failure of oestrogen breakdown

Klinefelter’s syndrome

testicular tumours

Drugs: FSH, LH therapy, Dopamine receptor blocker antipsychotics (tuberoinfundibular pathway - Prolactin), K+ sparing diuretics, Aldosterone antagonist

MBBS II ERS (37 decks)

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