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Y3 repro > pathology of breast disease > Flashcards

pathology of breast disease Flashcards

1
Q

normal structure of the breast - lobes and lobules

A

each breast has 8-10 lobes (arranged like daisy petals)
inside each lobe are smaller structures called lobules
at the end of each lobule are bulbs that can produce milk

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2
Q

changes to breasts in puberty - ducts

A

before puberty - breasts in both sexes, ducts

variable degrees of branching, lack lobules
15-25 lactiferous ducts
start at the nipple and branch until terminal ductal lobular unit
hormonally responsive

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3
Q

lymph ducts in the breast

A

drain fluid carrying WBCs fromt he breast tissue into LNs in the axilla and behind the sternum

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4
Q

lymph nodes in the breasts

A

filter harmful bacteria

play a key role in fighting off infection

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5
Q

give 5 examples of benign breast conditions

A 
fibrocystic change 
fibroadenoma 
intraduct papilloma - lactiferous ducts, nipple discharge
fat necrosis - traumatic
duct ectasia - nipple discharge
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6
Q

examples of fibrocystic change

A 
fibrosis 
adenosis 
cysts 
apocrine metaplasia 
ductal epithelial hyperplasia (usal type, atypical)
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7
Q

what is a fibroadenoma

A

well circumscribed, freely mobile, non-painful mass

proliferation of epithelial and stromal elements

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8
Q

how common are fibroadenomas

A

most common breast tumour in adolescent and young adult women

peak age - 3rd decade

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9
Q

what can happen to fibroadenomas if untreated

A

may regress with age if left untreated

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10
Q

growth pattern in fibroadenomas

A

ducts distorted and elongated –> slit like structures, intracanalicular pattern, ducts not compressed –> pericanalicular growth pattern

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11
Q

intraductal papilloma

  • who
  • key symptom
  • features
A

usually middle aged women
nipple discharge
can show epithelial hyperplasia which may be atypical

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12
Q

fat necrosis - what can it result in

A

can stimulate carcinoma - clinically and mammographically

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13
Q

what causes fat necrosis

A

hx of antecedent trauma, prior to surgical intervention

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14
Q

histological features of fat necrosis

mammography features

A

histiocytes with foamy cytoplasm
lipid-filled cysts

fibrosis, calcifications, egg shell on mammography

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15
Q

what is Phyllodes tumour

A

fleshy tumour, leaf like pattern and cysts on cut surface

circumscribed, connective tissue and epithelial elements

1-15cm

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16
Q

how common are Phyllodes tumour

A

<1% of breast tumours

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17
Q

what type of tumours are Phyllodes tumour

what about the mets

A

benign, borderline, malignant

mets are hematogenous

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18
Q

breast cancer incidence

A

2.3mln new cases 2020
incidence increasing in most countries
685 000 deaths
commonest cancer in UK (15%)

55200 new cases p/a UK, 4700 scotland

390 male breast cancer p/a UK, 31 scotland

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19
Q

risk factors for breast cancer

A 
gender
age 
menstrual hx
age at 1st pregnancy
radiation
FHx
personal hx
hormonal treatment
genetics
other: obesity, lack of physical activity, alcohol
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20
Q

causes of hereditary susceptibility to breast cancer

gene, contribution to hereditary breast cancer

A 
BRCA1 20-40%
BRCA2 10-30%
TP53 <1%
PTEN <1%
other 30-70%
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21
Q

histological classification of breast cancer

A

non-invasive

invasive

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22
Q

non-invasive breast cancers

A

ductal carcinoma in situ (DCIS)

lobular carcinoma in situ (LCIS/LISN)

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23
Q

invasive breast cancers

A 
invasive no special type (ductal) carcinoma, NST (~75%)
special types (rest) incl. invasive lobular carcinoma and variants (5-15%)
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24
Q

features of in situ carcinoma

A 
pre-invasive - no palpable tumour formed
not detected clinically - only x-ray in DCIS screening 
multi centricity and bilaterality (LCIS)
no mets - basement membrane 
risk of invasion depending on grade
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25
Q

in situ cancer - risk of progression

A

low grade DCIS - 30% in 15yrs
high grade DCIS - 50% in 8yrs
LCIS - 19% in 25yrs and bilaterality

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26
Q

histological classification - pure special types

A 
>90% of tumour showing characteristic features of a specific type: 
tubular carcinoma 
cribiform carcinoma 
mucinous carcinoma 
carcinoma w/ medullary features
metaplastic carcinoma 
others
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27
Q

histological classification - NST and mixed carcinoma

A

NST carcinoma - up to 75% of cases
invasive tumour shows none of <50% of special type features

mixed carcinoma:
heterogenous morphology
50-<90% special type morphology

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28
Q

what is shown

A

normal breast tissue

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29
Q

what is shown

A

normal breast tissue

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30
Q

what is shown

A

involution - progressive decrease in the size of an organ usually associated with a decline in function

31
Q

what cells can be seen here

A

epithelial and myoepithelial cells

32
Q

what type of change can be seen here

A

fibrocystic change

33
Q

what tumour type is shown here

A

fibroadenoma

34
Q

what tumour type is shown here

A

intraductal papilloma

35
Q

what change is shown here

A

fat necrosis

36
Q

what tumour type is shown here

A

Phyllodes tumour

37
Q

what carcinoma is shown here

A

LCIS

38
Q

what carcinoma type is shown here

A

NST carcinoma

39
Q

what grade would this carcinoma be

A

3

40
Q

what carcinoma is shown here

A

ILC

41
Q

what carcinoma is shown here

A

tubular carcinoma

42
Q

what carcinoma type is shown here

A

tubular carcinoma

43
Q

what carcinoma type is shown here

A

medullary

44
Q

what carcinoma type is shown here

A

mucinous

45
Q

what carcinoma type is shown here

A

micropapillary

46
Q

diagnostic procedures for breast cancer

A 
clinical examination
radiology - mammogram, US, MRI
FNA cytology
needle core biopsy 
diagnostic excision
47
Q

what is included in the histology report

A 
invasive vs non-invsaive 
histological type - ductal (85%) vs lobular
grade - estimate of aggressiveness under microscope
size
margins
LNs
estrogen/progesterone receptor (2/3 +ve)
HER-2/neu
48
Q

how can breast cancer spread

A

local - skin, pectoral muscles
lymphatic - axillary and internal mammary nodes
blood - bone, lungs, liver, brain

49
Q

spread of breast cancer - what is shown here

A

LVSI

Lymphovascular space invasion

50
Q

spread of breast cancer - what is shown here

A

LN mets

51
Q

determining prognosis of breast cancer

A 
patient related and tumour related
node status - best prognostic indicator 
tumour size (<2cm) 
type 
grade (1,2,3)
age 
lymphovascular space invasion 
oestrogen receptors (ER), progesterone receptors (PR)
HER-2
proliferative rate of tumour 
gene expression profiling 
NPI - tumour size, grade, nodal status
52
Q

what is the overall 5YS for breast cancer

A

64%

53
Q

molecular markers for breast cancer and clinical applications

A

ER/PR - strong predictors of response to hormonal therapies

ER/PR-ve tumours do NOT respond
HER-2: ~20-30% +ve, predicts response to trastuzumab (herceptin)

54
Q

what is shown here

A

oestrogen receptors

55
Q

what is shown here

A

HER-2

56
Q

molecular classification of cancers

A

gene expression technology
5 subtypes
biologically diverse disease
predictive gene signatures/potential to improve therapy
complement current clinicopathological features

57
Q

molecular classification - what are the 5 subtypes

A 
ER+ luminal A
lumina B 
basal 
HER 2+ 
normal breast like
58
Q

luminal A features and prevalence

A

ER +ve
HER 2 -ve
low Ki67

55%

59
Q

luminal B features and prevalence

A

ER+ve
HER2 +ve (or -ve w/ high Ki67)

15%

60
Q

triple -ve/basal like features and prevalence

A

ER -ve
PR -ve
HER2 -ve

10-15%

61
Q

HER2 type features and prevalence

A

ER -ve
PR -ve
HER2 +ve

15-20%

62
Q

what is true recurrence

A

carcinoma survives initial treatment and recurs

63
Q

what is a new 1y

A

a 2nd cancer which is biologically different from 1st cancer

64
Q

what % of breast cancer patients will develop a 2nd cancer

A

~10% of pts undergoing breast conservation for breast cancer will develop a 2nd cancer within 10yrs

<10yrs - majority are true recurrences
10 yrs - 50/50
>10yrs - majority are new 1ys

65
Q

when is the incidence of recurrence more

A

more in triple -ve breast cancer compared to ER or HER2 +ve cancers

66
Q

prognosis with true recurrence

A

poorer prognosis that new 1ys (depending on stage of new cancer)

pathological features are inaccurate in 40%

67
Q

what is Paget’s disease of the nipple

A

result of intraepithelial spread of intraductal carcinoma

68
Q

histological features of Paget’s disease of the nipple

A

large pale staining cells within the epidermis of the nipple

69
Q

clinical features of Paget’s disease of the nipple

A

limited to the nipple or can extend to the areola
pain/itching, scaling, redness - mistaken for eczema

ulceration, crusting, serous/bloody discharge

70
Q

what is shown here

A

Paget’s disease

71
Q

gynaecomastia

A

most common clinical and pathologic abnormality of the male breast

increase in subareolar tissue

in 30-40% of adult males, both breasts are affected in many cases

72
Q

what is gynaecomastia associated with

A 
hyperthyroidism 
liver cirrhosis 
chronic renal failure 
chronic pulmonary disease
hypogonadism 
use of hormones - oestrogens, androgens 
drugs - digitalis, cimetidine, spironolactone, marijuana, tricyclic antidepressants
73
Q

carcinoma of the male breast prevalence

A

uncommon

<1% of all breast cancers

Y3 repro (47 decks)

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