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Y3 Reproduction > Pathology - Breast > Flashcards

Pathology - Breast Flashcards

1
Q

what three elements are involved in assessing a patient with breast disease?

A

clinical exam
imaging
pathology

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2
Q

what imaging can be done for breast disease?

A

mammography
USS
MRI

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3
Q

what two types of pathology can be done for breast disease?

A

cytopathology - cells, rarely done

histopathology - tissue, main component

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4
Q

what samples can be used for breast cytopathology?

A

FNA sample
fluids
nipple discharge
nipple scrape

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5
Q

what are the possible results for breast cytopathology?

A 
C1 = unsatisfactory 
C2 = benign 
C3 = atypia, probably benign 
C4 = suspicious of malignancy 
C5 = malignant
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6
Q

what are the two components of breast histopathology?

A

diagnostic

therapeutic

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7
Q

what are the options for diagnostic breast histopathology?

A

needle core biopsy
vacuum assisted/large volume biopsy
skin biopsy
incisional biopsy of mass

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8
Q

what are the options for therapeutic breast histopathology?

A

vacuum assisted excision
excisional biopsy of mass
resection of cancer

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9
Q

what are the possible results for a needle core biopsy?

A 
B1 = unsatisfactory 
B2 = benign 
B3 = atypia, probably benign 
B4 = suspicious of malignancy 
B5 = malignant
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10
Q

what do B5a and B5b mean as results in needle core biopsy?

A 
B5a = carcinoma in situ 
B5b = invasive carcinoma
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11
Q

what is gynaecomastia?

A

breast development in males

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12
Q

what growth occurs in gynaecomastia?

A

ductal growth without lobular development

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13
Q

name some causes of gynaecomastia

A

hormones
cannabis use
prescribed drugs
liver disease

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14
Q

who is most commonly affected by fibrocystic change?

A

women aged 20-50

most are 40-50

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15
Q

what menstrual abnormalities can be associated with fibrocystic changes?

A

early menarche

late menopause

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16
Q

when can fibrocystic changes resolve themselves?

A

often after the menopause

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17
Q

how do fibrocystic changes present?

A

smooth discrete lumps
sudden or cyclical pain
lumpiness

often incidental finding or found at screening

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18
Q

what is the gross pathology of fibrocystic changes?

A

cysts with intervening fibrosis

cysts are blue domed with pale fluid and are usually multiple

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19
Q

what lines the cysts seen in fibrocystic changes?

A

apocrine epithelium

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20
Q

how are fibrocystic changes managed?

A

exclude malignancy
reassure the patient
excise if needed

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21
Q

what is a hamartoma?

A

circumscribed lesion composed of cells types normal to the breast but in an abnormal proportion/distribution

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22
Q

which group of women are more commonly affected by fibroadenoma?

A

african ethnicity

peak incidence in 20’s

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23
Q

how do fibroadenomas present?

A

painless, firm, discrete and mobile masses

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24
Q

how are fibroadenomas diagnosed?

A

often found on screening

solid on USS

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25
Q

what are the two types of sclerosing lesions?

A

sclerosing adenosis

complex sclerosing lesions

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26
Q

what is another name for a complex sclerosing lesion?

A

radial scar

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27
Q

what are sclerosing lesions?

A

benign, disorderly proliferations of acini and stroma

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28
Q

how does sclerosing adenosis present?

A

pain
tenderness
lumpiness
can be asymptomatic

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29
Q

what is the risk of subsequent carcinoma with sclerosing adenosis?

A

negligible - these are benign lesions

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30
Q

what is the difference between a radial scar and complex sclerosing lesions?

A 
RS = 1-9mm 
CSL = >10mm
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31
Q

what do radial scars mimic radiologically?

A

carcinoma

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32
Q

what can occur within a radial scar?

A

in situ or invasive carcinoma

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33
Q

how is a radial scar managed?

A

excise or sample extensively via vacuum biopsy

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34
Q

what causes fat necrosis?

A

local trauma

warfarin therapy

35
Q

what is the pathophysiology of fat necrosis?

A

damage to adipocytes causes fat leakage = acute inflammatory response

this causes subsequent fibrosis and scarring

36
Q

what ducts are affected by duct ectasia?

A

sub areolar ducts

37
Q

how does duct ectasia present?

A

pain
bloody and/or purulent discharge
fistulation
nipple retraction and distortion

38
Q

what is a key risk factor for duct ectasia?

A

smoking

39
Q

how is duct ectasia managed?

A

treat any infections
exclude malignancy
stop smoking
excise involved ducts

40
Q

what are the two main causes of acute mastitis?

A

duct ectasia

lactation

41
Q

what organisms are associated with mastitis due to duct ectasia?

A

mixed organisms

anaerobes

42
Q

what organisms are associated with mastitis due to lactation?

A

staph aureus

strep pyogenes

43
Q

what age group are most commonly affected by phyllodes tumour?

A

40-50

44
Q

describe the presentation of phyllodes tumour

A

a slow growing unilateral breast mass

45
Q

what is another name for phyllodes tumour?

A

cystosarcoma phyllodes

46
Q

what pathological feature dominates in phyllodes tumour?

A

stromal overgrowth

determines the behaviour of the tumour (benign, borderline or malignant)

47
Q

what is a possible complication of phyllodes tumour?

A

local recurrence if not adequately excised

rarely metastasise

48
Q

what age group are most commonly affected by intraduct papilloma?

A

35-60

49
Q

how does intraduct papilloma present?

A

nipple discharge +/- blood

asymptomatic at screening

50
Q

what ducts are affected by intraduct papilloma?

A

sub-areolar ducts

51
Q

what proliferative activity can the epithelium show in intraduct papilloma?

A

none
usual type hyperplasia
atypical ductal hyperplasia
ductal carcinoma in situ

52
Q

what is breast carcinoma?

A

a malignant tumour of breast epithelial cells

53
Q

where does breast carcinoma arise?

A

glandular epithelium of the terminal duct lobular unit (TDLU)

54
Q

what type of cancer is breast carcinoma?

A

adenocarcinoma

55
Q

what are the two classes of precursor lesions for breast carcinoma?

A

ductal

lobular

56
Q

what are the ductal precursors of breast carcinoma?

A

epithelial hyperplasia
columnar cell change
atypical duct hyperplasia (ADH)
ductal carcinoma in situ (DCIS)

57
Q

what are the lobular precursor lesions for breast carcinoma?

A

atypical lobular hyperplasia (ALH)

lobular carcinoma in situ (LCIS)

58
Q

what is an in situ breast carcinoma?

A

one that is confined within the basement membrane of the acini and ducts

cytologically malignant but non-invasive

59
Q

how is atypical lobular hyperplasia (ALH) defined?

A

less than 50% of the lobule is involved

60
Q

how is lobular carcinoma in situ (LCIS) defined?

A

> 50% of the lobule is involved

61
Q

when does incidence of LCIS decrease?

A

after the menopause

62
Q

how can LCIS be found?

A

not palpable/visible grossly, can be seen on mammography

usually an incidental finding

63
Q

how is LCIS managed if found on a core biopsy?

A

proceed to excision/vacuum biopsy

64
Q

what is there a risk of with DCIS?

A

progression to an invasive carcinoma

65
Q

where does DCIS arise?

A

the TDLU

66
Q

how many duct systems are involved in DCIS?

A

a single duct system - termed unicentric

may also involve lobules and nipple skin

67
Q

what is it called when DCIS involves nipple skin?

A

paget’s disease of the nipple

68
Q

what is the classification of DCIS based on?

A

grade
histology
presence of necrosis

69
Q

what are the management options for DCIS?

A

surgery
adjuvant radiotherapy
chemoprevention or endocrine therapy

70
Q

what is paget’s disease of the nipple?

A

high grade DCIS extending along ducts to reach the epidermis of the nipple

still a non invasive disease

71
Q

what is microinvasive carcinoma of the breast?

A

DCIS with invasion of <1mm

72
Q

what three things are considered and assigned a score of 1-3 when defining the grade of breast cancer?

A

tubular differentiation
nuclear pleomorphism
mitotic activity

73
Q

what grade is a breast cancer with a score of 3-5?

A

grade 1

74
Q

what grade is a breast cancer with a score of 6-7?

A

grade 2

75
Q

what grade is a breast cancer with a score of 8-9?

A

grade 3

76
Q

what are the three hormone receptors that a breast cancer can express?

A 
oestrogen receptor (ER)
progesterone receptor (PR)
HER2
77
Q

what specific therapies can ER+ breast cancers respond to?

A

anti-oestrogen therapies

78
Q

name four possible anti-oestrogens therapies

A

oophorectomy
tamoxifen
aromatase inhibitors
GnRH antagonists

79
Q

name an aromatase inhibitor

A

letrozole

80
Q

name a GnRH antagonist

A

goserilin

aka zoladex

81
Q

what drug can HER2+ breast cancers respond to?

A

trastuzamab aka Herceptin

82
Q

how is breast cancer staged?

A

TNM staging

83
Q

name a prognostic index that can be used for breast cancer

A

nottingham prognostic index

Y3 Reproduction (49 decks)

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