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Y2 - Clinical App > Lecture 11 - Breast Pathology > Flashcards

Lecture 11 - Breast Pathology Flashcards

1
Q

What are the 3 normal layers to a breast acinus?

A

Basement membrane
Myoepithelial cells
Luminal cells

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2
Q

What is the smallest functional unit of a gland?

A

Acinus

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3
Q

What part of of the acinus makes the secretions?

A

Luminal cells

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4
Q

What is the terminal duct all lobule unit?

A

The terminal duct plus the multiple acini that drain into it

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5
Q

What is the clinical significance of the terminal ductal lobular units?

A

The Origin of all epithelial neoplasms of breast tissues

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6
Q

How does milk travel to the nipple?

A

Acinus to terminal ductal lobular unit to major duct to lactiferous duct to nipple

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7
Q

What cells line the ducts of the breast?

A

Cuboidal or columnar a cells

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8
Q

What is the approach to assessment for a pataienti witht potential breast disease?

A

History and examination
Imaging (ultrasound or mammogram)
Biopsy (tissue sampling)

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9
Q

What are some classifications of breast diseases?

A

Developmental disorders
Inflammatory conditions
Benign epithelial lesions
Stromal tumours
Hynaecomaastia
Breast carcinoma

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10
Q

What is duct ectasia?

A

Benign disorder of extralobular ducts

Causes stasis of secretions and dilated ducts with associated inflammation

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11
Q

What is a major risk factor for duct ectasia?

Who is it most common in?

A

Smoking

Common in peri-menopause

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12
Q

What type of discharge is seen with duct ectasia?

A

Brown

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13
Q

How does a fibroadenoma present?

A

Young
Firm
Non tender
Mobile
No skin changes

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14
Q

What is the most common tumour in young patients?

A

Fibroadenoma

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15
Q

What type of tissue does fibroadenoma arise from?

A

Lobular stroma

Is well circumscribed

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16
Q

How does fat necrosis typically present?

A

Associated with trauma or previous surgery

Mass that forms can be ill defined, spiculate and calcified

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17
Q

How does fat necrosis appear histoloiggcallly?

A

Disrupted adipocytes surrounded by foamy macrophages

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18
Q

How does gynaecomastia present?

A

Bilateral breast enlargement in males

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19
Q

How should male breast tissue normally present on histology?

A

Few glands
Very fibrous

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20
Q

What happens in male breast tissue in gynaecomastia?

A

Proliferation of ducts and stroma of the breast tissue

21
Q

What causes gynaecomastia?

A

Oestrogen and testosterone imbalance

Physiological V Pathological

22
Q

What is a physiological cause of gynaecomastia?

A

Oestrogen production peaks before testosterone during puberty

23
Q

What are some pathological caseees of gynaecomastia?

A

Lack of test:
Klinefelters
Testicular atrophy

Excess oestrogen:
Liver disease
Testicuarlr tumours
Obesity

Medication:
Spironolactone
Anabolic steroids

24
Q

What is ductal carcinoma in situ?

A

Neoplastic epithelial cells confined to the ductolobular system

There’s no invasion beyond basement membrane

25
Q

How does ductal carcinoma in situ appear histological?

A

Pleomorphism
Hyperchromatic
Necrosis in ducts
Mitotic figures

Ducts filled with atypical cells with necrosis

Doesn’t extend past basement membrane

26
Q

How is ductal carcinoma in situ managed?

A

Surgery (breast conserving or mastectomy)

Radiotherapy’s

Endocrine therapy if oestrogen receptor positive

27
Q

How can immunohistochemistry be used to confirm that a ductal carcinoma is in situ and not malignant yet?

A

Can show intact myoepithelial cells (if they are intact means basement membrane has not been breached)

28
Q

How does invasive ductal carcinoma typically present?

A

Firm
Fixed
Irregular
Skin changes

AXILLARY LUMP

29
Q

How does invasive ductal carcinoma appear on mammogram?

A

Irregular dense mass with spiculated margins

30
Q

How does invasive ductal carcinoma presetn on histological exam?

A

Atypical cells with nuclear pleomorrphism
Extension into fat

31
Q

What is the most common subtype of breast adenocarcinoma?

A

Invasive Ductal Carcinoma

32
Q

How does lobular (breast adenocarcinoma normally always appare on histology?

A

Chains of irregular pleomorphic cells

33
Q

How does tubular breast adenocarcinoma appear on histology?

A

Well formed tubular spaces

34
Q

How does micropapillary breast adenocarcinoma appear on histology?

A

Tufts of cells

35
Q

How does mucinous breast adenocarcinoma appear on histology?

A

Pools of extracellular mucin

36
Q

What features do we need to consider when grading a breast cancer?

A

Tubule formation
Nuclear pleomorphism
Mitotic count

37
Q

What stagin system is used for breast cancer?

A

TNM

38
Q

How does breast cancer spread?

A

Lymphatic vessels to local lymph nodes (Axillary)

Blood vessels to distant sites

39
Q

What causes dimpling around the nipple?

A

Lymphatic invasion

40
Q

How do clinicans identify sentinel lymph nodes to excise if the cancer has spread?

A

Injection radioactive dye into the tumour

Use Geiger counter to identify

41
Q

What type of breast cancer easily metastasises?

A

Lobular

42
Q

What are the managements of breast cancer?

A

Surgery (mastectomy)
Chemotherapy
Radiotherapy

Drugs

43
Q

What are the 2 main drugs to treat breast cancer?

A

Tamoxifen
Herceptin

44
Q

How does tamoxifen work to treat breast cancer?

A

Its a selective oestrogen receptor modulator

If cancer produces too much oestrogen driving proliferation, tamoxifen given to block the oestrogen receptors

45
Q

How does herceptin work to treat breast cancer?

A

Overproduction of human epidermal growth facotr drives proliferation

Drug blocks HER2 receptors

46
Q

What is a triple negative breast cancer?

A

Is oestrogen receptor, HER2 receptor and progesterone receptor negative

Have very poor prognosis (BRCA tumours)

47
Q

What mutations are responsible for hereditary breast cancer?

A

BRCA1/BRCA2

48
Q

What prophylactic measures is done if BRCA1/BRCA2 is identified?

A

Prophylactic mastectomy

Y2 - Clinical App (14 decks)

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