Pathology Flashcards
Breast involution
- Gradual replacement of breast tissue w/ adipose tissue
- Occurs from age 30 in nulliparous F
Aberrations of involution
- Breast cysts
- Ductal ectasia
- Sclerosis
- Duct papillomas
Fat necrosis
- Trauma + bruising of the breast
- Common cause is seat-belt trauma
- More common in obesity + postmenopausal
Causes of nipple d/c
- Physiological d/c - cream / green / black, multiple ducts, often bilateral
- Duct papilloma - persistent troublesome serous/bloody d/c
- Duct ectasia - asymptomatic but may cause thick, creamy d/c
- Galactorrhoea - bilateral d/c affecting multiple ducts, copious amounts (check meds + prolactin level)
- DCIS - unilateral nipple d/c
- Invasive Ca - rarely causes nipple d/c without palpable mass
Breast screening
- Mammography q3y from age 50 till 70
- 10-20% over diagnosis rate
Fibroadenoma
- Common cause of breast lump, particularly younger F
- Develops from a whole lobule
- Hormone dependence (lactate during pregnancy + involute post-menopause)
Macro appearance of fibroadenoma
- Well-circumscribed, firm, smooth, mobile lumps
- Multiple or bilateral
Ductal ectasia
- Central subareolar ducts dilate + shorten w/ age
- By 70 40% of F = dilated ducts
Benign neoplasms
- Duct papilloma
- Lipoma
- Cysts
- Hyerplasia without atypia
- Hyperplasia with atypia (confers risk of Ca)
Duct papilloma
- Most commonly in the ducts below the nipple
- Single or multiple
- Minimal malignant potential
Breast infection
- Lactational vs. non-lactational
- 18-50yo, common during around time of breastfeeding
- May form abscess requiring drainage
Non-lactating breast infection
- Periareolar (common) is assoc. w/ young F that smoke
- Peripheral is rare + assoc. w/ immunodeficient states e.g. DM, RA, immunosuppression
Risk factors for breast Ca
- Age
- Genetics / FHx
- Exogenous estrogen
- Age at menarche / late menopause
- Nulliparity / age when 1st pregnant
- Previous benign disease
- Ca in contralateral breast
- EtOH
- Exposure to ionising radiation
Only benign disease w/ significant increased risk of breast Ca
= atypical hyperplasia (Dx by core Bx)
Genetics of breast Ca
- BRCA1 / BRCA2 = increased risk of breast / ovarian
- p53
Types of breast Ca
- In-situ vs invasive
- Lobular vs. ductal (non-special type)
DCIS
- 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%)
LCIS
- 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
Invasive ductal breast Ca
- 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)
Peau d’orange
- Thickening of skin secondary to lymphoedema w/ tethering of the skin to ligaments of Cooper giving the appearance of an orange peel
Thickening of skin in ductal Ca
Lymphatic involvement -> lymphatic occlusion -> lymphoedema + thickening of skin
Inflamm breast Ca
- 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
Incidence of different types of breast Ca
- Ductal = 80%
- Lobular = 10%
- Medullary = 2%
- Papillary = 1%
Macro appearance of ductal breast Ca
- Firm to hard w/ an irregular border
- Makes a grating sound when cut or scraped secondary to small foci of calcification
