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Reproductive System Brian > Pathology of Breast Disease > Flashcards

Pathology of Breast Disease Flashcards

1
Q

What are examples of benign breast conditions?

A
  • Fibrocystic change
    • Fibrosis, adenosis, cysts, apocrine metaplasia, ductal epithelial hyperplasia (usual type and atypical)
  • Fibroadenoma
    • Circumscribed mobile nodule in reproductive age
  • Other adenomas
    • Tubular adenoma and lactating adenoma
  • Intraduct papilloma
    • Lactiferous ducts, nipple discharge
  • Fat necrosis
  • Duct ectasia
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2
Q

What are examples of fibrocystic changes to the breast?

A
  • Fibrosis, adenosis, cysts, apocrine metaplasia, ductal epithelial hyperplasia (usual type and atypical)
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3
Q

What is fibroadenoma?

A

Proliferation of epithelial and stromal elements

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4
Q

What is the most common breast tumour in young adult woman?

A

Fibroadenoma

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5
Q

What are the different types of fibroadenoma?

A
  • Intracanalicular pattern
    • Ducts distorted elongated
  • Pericanalicular pattern
    • Ducts not compressed
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6
Q

What are characteristics of fibroadenoma?

A
  • Well-circumscribed, freely mobile, no painful mass
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7
Q

What is the management for fibroadenoma?

A
  • May regress with age
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8
Q

Describe the epidemiology of tubular adenoma (how common compared to fibroadenoma, young/older woman)?

A
  • Less common than fibro adenomas
  • Young woman
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9
Q

What are characteristics of tubular adenoma?

A
  • Uniform sized ducts
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10
Q

What is lactating adenoma?

A

Enlarging masses during lactation or pregnancy:

  • Prominent secretory change
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11
Q

Describe the epidemiology of intraduct papilloma (young/middle/older woman)?

A
  • Usually middle aged woman
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12
Q

What are characteristics of intraduct papilloma?

A
  • Nipple discharge, bloody
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13
Q

What is the aetiology of fat necrosis?

A
  • History of antecedent trauma, surgery
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14
Q

What is seen in the histology for fat necrosis of the breast?

A
  • Histiocytes with foamy cytoplasm
  • Lipid-filled cysts
  • Fibrosis, calcifications, egg shell on mammography
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15
Q

What is a possible complication of fat necrosis?

A
  • Can stimulate carcinoma
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16
Q

What are characteristics of phyllodes tumour?

A
  • Fleshy tumour, leaf-like pattern and cysts on cut surface
  • Circumscribed, connective tissue and epithelial elements
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17
Q

What are possible complications of phyllodes tumour?

A
  • Rapid growing so is borderline malignant
    • Metastases are haematogenous
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18
Q

What are the 5 subtypes of molecular classification for breast carcinoma?

A
  • ER and luminal A
  • Luminal B
  • Basal
  • Her2
  • Normal breast like
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19
Q

What molecular classification of breast carcinoma is most common?

A

Luminal A

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20
Q

For each molecular subtype of breast carcinoma, are they positive or negative for:

  • ER
  • PR
  • HER2
A
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21
Q

What is the aetiology for breast carcinoma?

A
  • Different breast lesions have potential to become cancer
    • Epithelial proliferation without atypia – RR 1.5-2x
    • With atypia ductal or lobular – RR 4-5x
    • LCIS – RR 8-10x
    • DCIS – RR 8-10x
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22
Q

Describe the epidemiology for breat cancer (fraction of females, fraction of all female cancers)?

A
  • 1/8 females, 22% all female cancer
23
Q

What are the different histological classifications for breast carcinoma?

A
  • Non-invasive
    • Different types
      • Ductal carcinoma in situ (DCIS)
      • Lobular carcinoma in situ (LCIS/LISN)
    • Not detected clinically (only x-ray)
    • Risk of invasion depending on grade
      • Low grade DCIS – 30% in 15 years
      • High grade DCIS – 50% in 8 years
      • LCIS - 19% in 25 years and bilaterally
  • Invasive
    • Invasive ductal carcinoma 75%
    • Invasive lobular carcinoma
    • Special types
      • Tubular carcinoma, mucinous carcinoma, carcinoma with medullary features, metaplastic carcinoma
24
Q

What are different types of non-invasive breast carcinoma?

A
  • Ductal carcinoma in situ (DCIS)
  • Lobular carcinoma in situ (LCIS/LISN)
25
What does DCIS stand for?
Ductal carcinoma in situ
26
What does LCIS stand for?
Lobular carcinoma in situ
27
Risk of invasion for non-invasive breast carcinomas depends on what?
* Risk of invasion depending on grade * Low grade DCIS – 30% in 15 years * High grade DCIS – 50% in 8 years * LCIS - 19% in 25 years and bilaterally
28
What are different kinds of invasive breast cancers?
* Invasive ductal carcinoma 75% * Invasive lobular carcinoma * Special types * Tubular carcinoma, mucinous carcinoma, carcinoma with medullary features, metaplastic carcinoma
29
What are risk factors for breast carcinoma?
* Gender * Age * Menstrual history * Age at first pregnancy * Radiation * Family history * Genetic * BRCA1 and BRCA2 * Personal history * Hormonal treatment * Oestrogen exposure * Other factors * Obesity, lack of exercise, alcohol
30
What genes have biggest impact for developing breast carcinoma?
BRCA1 and BRCA2
31
What are characteristics of breast carcinoma (mammogram and macroscopic)?
* Mammogram * Soft tissue opacity, microcalcification * Macroscopic * Hard lump, fixed mass, tethering to skin
32
How does breast cancer spread?
* Local * Skin, pectoral muscles * Lymphatic * Axillary and internal mammary nodes * Blood * Bone, lungs, liver, brain
33
What organs does breast cancer commonly spread to through the blood?
* Bone, lungs, liver, brain
34
What investigations should be done for breast carcinoma?
* Examination * Imaging * Mammogram, USS, MRI * Sensitivity of mammography reduced in younger woman due to more glandular tissue being present * Biopsy * Fine needle aspiration cytology (FNA) * Needle core biopsy * Histology report looks at invasive vs non-invasive, histological type, grade, size, margins, lymph nodes, oestrogen/progesterone receptor, HER-2 * Also do sentinel lymph node biopsy * If negative, rest of nodes are negative
35
What is the presentation of breast carcinoma?
* Asymptomatic * Symptomatic * Lump * Mastalgia – persistent unilateral pain * Nipple discharge – blood stained * Nipple changes – Paget’s disease, retraction * Change in size or shape of breast * Lymphoedema – swelling of arm * Dimpling of breast skin
36
Describe the managemnent for breast carcinoma?
* Staging * Surgery * Masectomy, breast conserving surgery with or without lymph nodes * Radiotherapy * Antihormonal therapy * Tamoxifen * Chemotherapy
37
What antihormonal therapy can be used for breast carcinoma?
* Antihormonal therapy * **Tamoxifen**
38
What does the prognosis of breast carcinoma depend on?
* Patient and tumour related, depends on * Node status, tumour size, type, grade (1, 2, 3), age, lymphovascular space invasion * Oestrogen receptors, progesterone receptors, HER-2, proliferative rate of tumour, gene expression profiling * Can use Nottingham Prognostic Index (NPI) based on tumour size, grade and nodal status * Overall 64% 5 year survival
39
What system is used to estimate prognosis of breast carcinoma?
* Can use Nottingham Prognostic Index (NPI) based on tumour size, grade and nodal status
40
What does NPI stand for?
Nottingham prognostic index
41
Is Paget's disease of the nipple benign or malignant?
Malignant
42
What is the aetiology for Paget's disease of the nipple?
* Intraepithelial spread of intraductal carcinoma
43
What is the presentation for Paget's disease of the nipple?
* Large pale-staining cells within epidermis of nipple * Limited to nipple or extend to the areola * Pain or itching, scaling and redness * Ulceration, crusting, serous or bloody discharge
44
What investigations are done for Paget's disease of the nipple?
* Same as breast carcinoma
45
How is screening for breast cancer done?
Mammogram every 3 years for woman aged 50-70 years: * 30% reduction in mortality * Indicators on mammogram * Masses * Microcalfications
46
What age group qualifies for breast cancer screening and how often do they get this?
**Mammogram every 3 years for woman aged 50-70 years:** * 30% reduction in mortality * Indicators on mammogram * Masses * Microcalfications
47
What are indicators on a mammogram of breast cancer?
* Masses * Microcalfications
48
What are examples of pathology of the male breast?
* Gynecomastia * Carcinoma of male breast
49
What is gynecomastia?
Increase in subareolar tissue
50
What is the most common pathology of the male breast?
Gynecomastia
51
What are risk factors for gynecomastia?
* Hyperthyroidism * Cirrhosis of liver * Renal failure * Chronic pulmonary disease * Hypogonadism * Use of hormones * Oestrogens, androgens
52
What hormones increase the risk of gynecomastia?
* Oestrogens, androgens
53

Reproductive System Brian (34 decks)

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