Lecture 11 - Breast Pathology Flashcards
What are the 3 normal layers to a breast acinus?
Basement membrane
Myoepithelial cells
Luminal cells
What is the smallest functional unit of a gland?
Acinus
What part of of the acinus makes the secretions?
Luminal cells
What is the terminal duct all lobule unit?
The terminal duct plus the multiple acini that drain into it
What is the clinical significance of the terminal ductal lobular units?
The Origin of all epithelial neoplasms of breast tissues
How does milk travel to the nipple?
Acinus to terminal ductal lobular unit to major duct to lactiferous duct to nipple
What cells line the ducts of the breast?
Cuboidal or columnar a cells
What is the approach to assessment for a pataienti witht potential breast disease?
History and examination
Imaging (ultrasound or mammogram)
Biopsy (tissue sampling)
What are some classifications of breast diseases?
Developmental disorders
Inflammatory conditions
Benign epithelial lesions
Stromal tumours
Hynaecomaastia
Breast carcinoma
What is duct ectasia?
Benign disorder of extralobular ducts
Causes stasis of secretions and dilated ducts with associated inflammation
What is a major risk factor for duct ectasia?
Who is it most common in?
Smoking
Common in peri-menopause
What type of discharge is seen with duct ectasia?
Brown
How does a fibroadenoma present?
Young
Firm
Non tender
Mobile
No skin changes
What is the most common tumour in young patients?
Fibroadenoma
What type of tissue does fibroadenoma arise from?
Lobular stroma
Is well circumscribed
How does fat necrosis typically present?
Associated with trauma or previous surgery
Mass that forms can be ill defined, spiculate and calcified
How does fat necrosis appear histoloiggcallly?
Disrupted adipocytes surrounded by foamy macrophages
How does gynaecomastia present?
Bilateral breast enlargement in males
How should male breast tissue normally present on histology?
Few glands
Very fibrous
What happens in male breast tissue in gynaecomastia?
Proliferation of ducts and stroma of the breast tissue
What causes gynaecomastia?
Oestrogen and testosterone imbalance
Physiological V Pathological
What is a physiological cause of gynaecomastia?
Oestrogen production peaks before testosterone during puberty
What are some pathological caseees of gynaecomastia?
Lack of test:
Klinefelters
Testicular atrophy
Excess oestrogen:
Liver disease
Testicuarlr tumours
Obesity
Medication:
Spironolactone
Anabolic steroids
What is ductal carcinoma in situ?
Neoplastic epithelial cells confined to the ductolobular system
There’s no invasion beyond basement membrane
How does ductal carcinoma in situ appear histological?
Pleomorphism
Hyperchromatic
Necrosis in ducts
Mitotic figures
Ducts filled with atypical cells with necrosis
Doesn’t extend past basement membrane
How is ductal carcinoma in situ managed?
Surgery (breast conserving or mastectomy)
Radiotherapy’s
Endocrine therapy if oestrogen receptor positive
How can immunohistochemistry be used to confirm that a ductal carcinoma is in situ and not malignant yet?
Can show intact myoepithelial cells (if they are intact means basement membrane has not been breached)
How does invasive ductal carcinoma typically present?
Firm
Fixed
Irregular
Skin changes
AXILLARY LUMP
How does invasive ductal carcinoma appear on mammogram?
Irregular dense mass with spiculated margins
How does invasive ductal carcinoma presetn on histological exam?
Atypical cells with nuclear pleomorrphism
Extension into fat
What is the most common subtype of breast adenocarcinoma?
Invasive Ductal Carcinoma
How does lobular (breast adenocarcinoma normally always appare on histology?
Chains of irregular pleomorphic cells
How does tubular breast adenocarcinoma appear on histology?
Well formed tubular spaces
How does micropapillary breast adenocarcinoma appear on histology?
Tufts of cells
How does mucinous breast adenocarcinoma appear on histology?
Pools of extracellular mucin
What features do we need to consider when grading a breast cancer?
Tubule formation
Nuclear pleomorphism
Mitotic count
What stagin system is used for breast cancer?
TNM
How does breast cancer spread?
Lymphatic vessels to local lymph nodes (Axillary)
Blood vessels to distant sites
What causes dimpling around the nipple?
Lymphatic invasion
How do clinicans identify sentinel lymph nodes to excise if the cancer has spread?
Injection radioactive dye into the tumour
Use Geiger counter to identify
What type of breast cancer easily metastasises?
Lobular
What are the managements of breast cancer?
Surgery (mastectomy)
Chemotherapy
Radiotherapy
Drugs
What are the 2 main drugs to treat breast cancer?
Tamoxifen
Herceptin
How does tamoxifen work to treat breast cancer?
Its a selective oestrogen receptor modulator
If cancer produces too much oestrogen driving proliferation, tamoxifen given to block the oestrogen receptors
How does herceptin work to treat breast cancer?
Overproduction of human epidermal growth facotr drives proliferation
Drug blocks HER2 receptors
What is a triple negative breast cancer?
Is oestrogen receptor, HER2 receptor and progesterone receptor negative
Have very poor prognosis (BRCA tumours)
What mutations are responsible for hereditary breast cancer?
BRCA1/BRCA2
What prophylactic measures is done if BRCA1/BRCA2 is identified?
Prophylactic mastectomy
