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Patho - Breast > Neoplasms > Flashcards

Neoplasms Flashcards

1
Q

Breast Neoplasms

A

Benign epithelial tumours

  • from lining of terminal ducts/lobules
    1. Epithelial
  • Papilloma
    2. Fibroepithelial
  • Fibroadenoma
  • Phyllodes tumour

Malignant epithelial tumours

  1. Non-invasive (in-situ) carcinomas
    - Ductal CIS
    - Lobular CIS
  2. Invasive carcinomas
    - Ductal, NOS
    - Special - mucinous, tubular, medullary, micropapillary, metaplastic
    - Lobular
  3. Paget’s Disease
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2
Q

Diagnostic triad for the breast

A

Triple test

  1. Clinical examination
  2. Radiology - US, mammogram, MRI
  3. Pathology - FNA, core biopsy, excision biopsy
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3
Q

Features of papilloma of the breast

A
  • finger like projections into luminal/cystic space
  • intraduct papilloma
  • bloody nipple discharge - tips of papillary pores (vascular rich) undergo necrosis
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4
Q

Features of fibroadenoma of the breast

A
  • common benign lesion
  • highest prevalence in young women, peak ~25y
  • firm, well defined mobile lump, may be multiple & bilateral
  • can recur, occasionally regress spontaneously
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5
Q

Histology of fibroadenoma of the breast

A
  • circumscribed, uniform, does not adhere to surface - can be surgically removed
  • proliferation of glandular & stromal elements - pericanalicular pattern, intracanalicular pattern
  • risk of malignancy based on degree of epithelial hyperplasia
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6
Q

Features of phyllodes tumour

A
  • fibroepithelial tumour arising from interlobular stroma of breast
  • frond/leaf like architecture
  • stroma: cytological atypia, high mitotic count, necrosis
  • benign, borderline, malignant
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7
Q

Etiological factors of breast carcinoma

A
  1. Genetic - BRCA1, BRCA2
  2. Hormonal - gender, age of menarche/menopause, breast feeding (protective), exogenous hormones
  3. Viral
  4. Environmental
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8
Q

Risk factors for breast carcinoma

A
  • Race - Caucasian, Jew, Parsi
  • Age - perimenopausal
  • Socio-economic status - high
  • Weight - obese
  • Previous breast diseases
  • Positive family history
  • Ovarian activity - early menarche/late menopause
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9
Q

Clinical presentation of breast carcinoma

A
  1. Palpable mass
  2. Nipple discharge - serous, bloody
  3. Mammographic density & calcifications
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10
Q

Prognostic factors of breast carcinoma (6)

A
  1. Stage - TNM
  2. Grade
  3. Histological type - ductal is worse
  4. CerbB2 amplication (CerbB2 +ve: Herceptin)
  5. Vascular invasion
  6. ER/PR (Tamoxifen blocks tumours ability to use estrogen, AIs decrease estrogen amt in body, ER +ve can treat w estrogen antag, but less likely to respond to chemo)
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11
Q

Gross morphology of breast carcinomas

A
  • Sites: upp outer > subareolar > other sites
  • growth pattern: comedo, circumscribed, infiltrating
  • consistency: scirrhous, encephaloid, mucinous (colloid)
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12
Q

Features of DCIS - comedo

A
  • solid sheets of pleomorphic cells
  • areas of central necrosis
  • dilates the duct but no infiltration
  • whitish spots
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13
Q

Features of DCIS - cribiform

A
  • intraepithelial spaces evenly distributed & regular in shape/cookie cutter
  • lumen filled w calcifying secretory material
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14
Q

Features of LCIS

A
  • associated with E-cadherin mutation (also in invasive lobular carcinoma & signet-ring cell gastric adenoCA)
  • dyscohesive cells w round nuclei & small nucleoli
  • may have signet ring cells
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15
Q

Features of Paget’s disease

A
  • unilateral, exfoliation/ulceration of nipple, erythematous eruption with a scale crust
  • extension of DCIS along ducts within the epithelial layer to the area under the skin over the nipple
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16
Q

Features of invasive ductal carcinoma, NOS

A
  • hard firm mass, irrgular border

- can be well to poorly differentiated

17
Q

Features of invasive lobular carcinoma

A
  • associated with E-cadherin mutations
  • mass w irregular border
  • dyscohesive infiltrative tumour cells often arranged in a single file/loose clusters/sheets
  • no tubule formation
  • minimal/no desmoplasia
  • may have signet ring cells
  • tubular, mucinous, medullary
18
Q

Features of invasive lobular carcinoma - tubular

A
  • small irregular masses

- well formed tubules but without myoepithelial cell layer

19
Q

Features of invasive lobular carcinoma - mucinous

A
  • well circumscribed
  • soft rubbery pale grey-blue
  • tumour cells arranged in clusters & small islands within large lakes of mucin
20
Q

Features of invasive lobular carcinoma - medullary

A
  • well circumscribed
  • soft fleshy
  • little desmoplasia
  • solid syncytium-like sheets of large cells w vesicular pleomorphic nuclei & prominent nucloeli
  • frequent mitotic figures, lymphocytic infiltrate, pushing non-infiltrative borders
  • poorly differentiated

Patho - Breast (4 decks)

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