Pathology Flashcards
Which hormone drives endometrial growth during the first 14 days of the menstrual cycle?
Oestrogen
Secretory changes, resulting from ovulation is under the influence of which hormone?
Progesterone
What is the dominant follicle also known as?
The graafian follicle.
This contains the secondary oocyte and granulosa cells.
What do granulosa cells produce?
Hormones
What is menorrhagia?
Prolonged and increased menstrual flow.
What thickness of endometrium in post-menopausal women indicates that an endometrial biopsy should be carried out?
> 4mm
What is disordered uterine bleeding?
Irregular uterine bleeding owing to disruption of the normal cyclic hormonal pattern.
What is the most common cause of DUB?
Anovulatory cycles.
Seen at the start and end of reproductive life.
What causes luteal phase deficiencies?
Poor response/Insufficient progesterone.
May be due to abnormal follicular development or a poor corpus luteum.
What is endometritis?
Inflammation of the endometrium.
Can be caused by infection, an IUD or occur following pregnancy.
What is molar pregnancy?
Abnormal pregnancy in which a non-viable egg implants. No chance of progression.
Sperm combines with egg that has lost its DNA.
What cancer is increased risk in molar pregnancy?
Choriocarcinoma
What is adenomyosis?
The presence of endometrial glands and stroma within the myometrium.
Can cause long, heavy, painful periods.
What is leiomyoma?
A very common benign tumour of smooth muscle found within the uterus.
This is the pathological name for a fibroid.
What is leiomyoma growth dependent on?
Oestrogen
What is the triple assessment carried out in breast disease?
Clinical (history and examination)
Imaging (can be mammography, USS or MRI)
Histopathology/Cytopathology
What does cytopathology involve?
FNA
Fluid and nipple testing
Why is histopathology preferred to cytopathology?
Cytopathology disrupts context of sample, therefore cannot determine if any invasion has occurred.
As histopathology involves biopsy, the context is preserved, allowing a clear diagnosis.
What is wide local excision?
A method used to remove a lesion of interest, with a margin.
What is gynaecomastia?
Breast development in males.
Results from ductal growth, without lobular development.
What can cause gynaecomastia?
Exogenous/Endogenous hormones
Cannabis
Prescription drugs
Liver disease
What is fibrocystic change?
Development of fluid-filled cysts in the breasts. Accompanied by intervening fibrosis.
Most cases are perimenopausal/in their 40s.
How do fibrocystic changes present?
Can be asymptomatic and often an incidental finding.
Some may have sudden/cyclical pain with ill-defined breast lumpiness.
What is metaplasia?
A change of one fully differentiated cell type to another.
Should fibrocystic change be investigated?
Yes, in order to rule out malignancy.
How does fibroadenoma present?
A benign solitary lump which is a painless, firm and mobile mass.
Will appear solid on USS.
Should fibroadenoma be removed?
Only on patient request - reassurance may be sufficient.
What are the 2 types of sclerosing lesions?
Sclerosing adenosis
Radial scar
What are sclerosing lesions?
Benign, disorderly, proliferations of acini and stroma. Can cause mass or calcification.
How does sclerosing adenosis present?
Can be asymptomatic or painful, with a tenderness and/or lumpiness.
Often seen alongside other breast changes.
There is a risk of progression to carcinoma.
How often is a radial scar seen?
Very common. Often multiple are seen at the same time. These can be bilateral.
Should a radial scar be treated?
Yes, as risk of in-situ or invasive carcinoma existing within this lesion.
Treat with excision/vacuum biopsy.
What causes fat necrosis?
Local trauma
Warfarin therapy
What occurs in fat necrosis?
Disruption of adipocytes, causing leakage. Results in an inflammatory response and subsequent scarring.
What is seen histologically in the case of fat necrosis?
Foamy macrophages
What is affected in duct ectasia?
The subareolar ducts.
What symptoms are seen in duct ectasia?
Pain
Episodic inflammation
Bloody/Purulent discharge
What can duct ectasia lead to?
Fistulation
Nipple retraction
Distortion
What is associated with duct ectasia?
Smoking
What causes acute mastitis/abscess?
Duct ectasia
Lactation
How is acute mastitis/abscess treated?
Antibiotic or drainage (if needed).
Treat underlying cause.
What is seen in Phyllodes tumour?
Stromal overgrowth
Is Phyllodes tumour benign?
Not necessarily.
It depends on the stromal features.
It can be benign, borderline or malignant.
Does Phyllodes tumour metastasize?
Rarely
How can intraduct papilloma present?
Nipple discharge (may be bloody)
Nodules
Calcification
Can be asymptomatic in some cases - therefore identified through screening.
Is metastasis to the breast common?
No
What is commonly the cause of angiosarcoma of the breast?
Breast radiotherapy
Where does metastasis to the breast originate from?
Bronchial Ovarian (serous) Clear cell carcinoma of the kidney Malignant melanoma Soft tissue tumours
What cells does a breast carcinoma originate within?
Glandular epithelium of the TDLU.
This is a form of adenocarcinoma.
What are the 2 forms of carcinoma-in-situ seen in breast pathology?
Lobular
Ductal
What is Paget’s disease of the nipple?
A high grade DCIS which extends along ducts, reaching the epidermis of the nipple.
Is Paget’s disease of the nipple invasive?
No, as it only occupies the existing structures.
How is DCIS treated?
Surgery and adjuvant radiotherapy.
What is microinvasive carcinoma?
DCIS with invasion of less than 1mm.
When malignant epithelial cells have breached the basement membrane, what is it referred to as?
Invasive breast carcinoma
Which ethnicity is most likely to suffer breast cancer?
White
What plays a key role in breast cancer development?
Hormones
What genetic conditions predispose to breast cancer?
BRCA1/BRCA2
p53 mutation
Peutz-Jeghers syndrome
What is the most common form of breast cancer?
Ductal carcinoma
What % of breast cancers are oestrogen receptor positive?
80%
What does the presence of oestrogen receptors indicate about a breast cancer?
That it would be sensitive to anti-oestrogen therapy.
What are examples of anti-oestrogen therapies?
Oophorectomy
Tamoxifen
Aromatase inhibitors
GnRH antagonists
What drug is advised in those with HER2 receptor overexpression?
Trastuzumab
What are common sites of breast cancer spread?
Bone Liver Brain Lungs Abdominal viscera Female genital tract
