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Breast & Endocrine > Pathology > Flashcards

Pathology Flashcards

1
Q

Breast involution

A
  • Gradual replacement of breast tissue w/ adipose tissue

- Occurs from age 30 in nulliparous F

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2
Q

Aberrations of involution

A
  • Breast cysts
  • Ductal ectasia
  • Sclerosis
  • Duct papillomas
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3
Q

Fat necrosis

A
  • Trauma + bruising of the breast
  • Common cause is seat-belt trauma
  • More common in obesity + postmenopausal
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4
Q

Causes of nipple d/c

A
  1. Physiological d/c - cream / green / black, multiple ducts, often bilateral
  2. Duct papilloma - persistent troublesome serous/bloody d/c
  3. Duct ectasia - asymptomatic but may cause thick, creamy d/c
  4. Galactorrhoea - bilateral d/c affecting multiple ducts, copious amounts (check meds + prolactin level)
  5. DCIS - unilateral nipple d/c
  6. Invasive Ca - rarely causes nipple d/c without palpable mass
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5
Q

Breast screening

A
  • Mammography q3y from age 50 till 70

- 10-20% over diagnosis rate

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6
Q

Fibroadenoma

A
  • Common cause of breast lump, particularly younger F
  • Develops from a whole lobule
  • Hormone dependence (lactate during pregnancy + involute post-menopause)
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7
Q

Macro appearance of fibroadenoma

A
  • Well-circumscribed, firm, smooth, mobile lumps

- Multiple or bilateral

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8
Q

Ductal ectasia

A
  • Central subareolar ducts dilate + shorten w/ age

- By 70 40% of F = dilated ducts

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9
Q

Benign neoplasms

A
  1. Duct papilloma
  2. Lipoma
  3. Cysts
  4. Hyerplasia without atypia
  5. Hyperplasia with atypia (confers risk of Ca)
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10
Q

Duct papilloma

A
  • Most commonly in the ducts below the nipple
  • Single or multiple
  • Minimal malignant potential
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11
Q

Breast infection

A
  • Lactational vs. non-lactational
  • 18-50yo, common during around time of breastfeeding
  • May form abscess requiring drainage
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12
Q

Non-lactating breast infection

A
  • Periareolar (common) is assoc. w/ young F that smoke

- Peripheral is rare + assoc. w/ immunodeficient states e.g. DM, RA, immunosuppression

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13
Q

Risk factors for breast Ca

A
  1. Age
  2. Genetics / FHx
  3. Exogenous estrogen
  4. Age at menarche / late menopause
  5. Nulliparity / age when 1st pregnant
  6. Previous benign disease
  7. Ca in contralateral breast
  8. EtOH
  9. Exposure to ionising radiation
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14
Q

Only benign disease w/ significant increased risk of breast Ca

A

= atypical hyperplasia (Dx by core Bx)

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15
Q

Genetics of breast Ca

A
  • BRCA1 / BRCA2 = increased risk of breast / ovarian

- p53

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16
Q

Types of breast Ca

A
  • In-situ vs invasive

- Lobular vs. ductal (non-special type)

17
Q

DCIS

A
  • Most common form of non-invasive Ca
  • Screen detected DCIS assoc. w/ microcalcifications on mammogram
  • Risk factors for DCIS = size, grade, margins
  • Much less likely to be bilateral compared to LCIS (only 10-20%)
18
Q

LCIS

A
  • Always an incidental Bx finding
  • Not assoc. w/ calcifications or stromal reactions (increased mammographic densities) on mammogram
  • NOT picked up by mammogram
  • Commonly bilateral (20-40%), both breasts @ risk of breast Ca
19
Q

Invasive ductal breast Ca

A
  • Found on screening or as a palpable mass (in absence of screening)
  • Are assoc. w/ axillary LNs >50% if found as palpable mass (<20% if detected via mammogram)
20
Q

Peau d’orange

A
  • Thickening of skin secondary to lymphoedema w/ tethering of the skin to ligaments of Cooper giving the appearance of an orange peel
21
Q

Thickening of skin in ductal Ca

A

Lymphatic involvement -> lymphatic occlusion -> lymphoedema + thickening of skin

22
Q

Inflamm breast Ca

A
  • Type of ductal Ca that presents w/ swollen + erythematous breast
  • Causes by extensive invasion + obstruction of dermal lymphatics by tumour cells
  • Likely metastatic @ time of Dx
23
Q

Incidence of different types of breast Ca

A
  • Ductal = 80%
  • Lobular = 10%
  • Medullary = 2%
  • Papillary = 1%
24
Q

Macro appearance of ductal breast Ca

A
  • Firm to hard w/ an irregular border

- Makes a grating sound when cut or scraped secondary to small foci of calcification

25
Q

Classification of ductal breast Ca

A
  • Luminal A = ER +ve, PR +ve, HER2/neu -ve
  • Luminal B = ER +ve, PR +ve HER2/neu +ve
  • Triple -ve
  • HER2/neu +ve
26
Q

Invasive lobular breast Ca

A
  • Palpable mass or mammographic density w/ irregular borders
  • 25% are diffusely infiltrative -> unpalatable + subtle mammographic changes
  • Increased incidence bilaterally
27
Q

Metastatic spread of invasive lobular breast Ca

A
  • Different to ductal

- Tends to metastasise to peritoneum / retroperitoneum / GIT / ovaries / uterus

28
Q

Medullary breast Ca

A
  • Most common in 60-69yo F
  • Well-circumscribed mass
  • Closely mimics a benign lesion, clinically / radiologically
  • Mets infrequently
29
Q

Macro appearance of medullary breast Ca

A
  • Soft / fleshy (like marrow = medullary)

- Well-circumscribed

30
Q

Micro appearance of medullary breast Ca

A
  • Poorly differentiated sheets of large cells
31
Q

Colloid (mucinous) breast Ca

A
  • > 70yo F
  • Slow growing
  • Soft rubbery + has consistency of blue/grey gelatine
32
Q

Papillary Ca

A
  • <1% of all breast Ca

- LNs commonly involved, poor prognosis

Breast & Endocrine (4 decks)

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