Malignant breast disease Flashcards
What is breast carcinoma in situ?
- Contained within breast ducts - have not spread to surrounding breast tissue so not invaded basement membrane eg LCIS and DCIS
- Rarely symptomatic
- Precursor to invasive breast cancer
Most common type of non-invasive breast malignancy and types
- DCIS
- Malignancy of ductal tissue
- Five major types - comedo, cribiform, micropapillary, papillary, solid types, mixed (most).
How is DCIS often detected?
Via screening - microcaclifications on mammogram
Then confirmed via biopsy
Management DCIS
- Surgical excision - breast conserving surgery (wide local excision)
- Or if multifocal - mastectomy
LCIS - what is it
- Non-invasive lesion of secretory lobules
- Contained within BM
- Rarer than DCIS but greater risk of developing invasive breast malignancy
- Usually pre-menopausal women
How is LCIS often diagnosed?
- Not associated with microcalfications
- Asymptomatic
- Usually incidental on biopsy
Management LCIS
- Depends on extent
- Low grade - monitor rather than excise
- Less associated with axillary node mets compared with DCIS
- But does increase risk of later developing invasive breast cancer in either breast
- Bilateral prophylactic mastectomy can be needed if BRCA1 or 2
Invasive carcinoma types
- Invasive ductal (70-80%)
- Invasive lobular (5-10%)
- Others - medullary, micropapillary, metaplastic
IDC appearance vs ILC on microscope
- IDC - nests and cords of tumour cells
- ILC - diffuse stromal pattern of spread, detection more difficult, can be large by diagnosis time
Nottingham prognostic index formula
(Size x 0.2) + nodal status + grade
Nodes = number of axillary nodes involved:
* 0 nodes = 1, 1-4 nodes = 2, more 4 nodes = 3
* Grade based on Bloom-Richardson classification
What influences breast cancer prognosis?
- Nodal status
- Size
- Grade
- Receptor status
What is Pagets disease of the nipple?
- Rare
- Persistent roughening, ulcerating or eczematous change to nipple
- 85-88% have underlying neoplasm either in-situ or invasive
Microscope appearance of Pagets disease of nipple
- Involvement of nipple epidermis by malignant intraepithelial adenocarcinoma cells
- Unknown pathophys but maybe malignant cells migrate from ducts to nipple surface or nipple becomes malignant
Symptoms of Pagets disease of nipple
- Itching or redness in nipple +/- areola
- Flaking and thickened skin on or around nipple
- Sensitive and painful
- Flattened nipple +/- yellow or bloody discharge can also be present
How can Pagets disease be differentiated from eczema?
- Eczema involves areola and spares nipple
- Pagets involves nipple and secondary involves areola