Pathology of Breast Disease Flashcards
What are some benign breast conditions?
- fibrocystic change
- fibrosis, adenosis, cysts, apocrine metaplasia, ductal epithelial hyperplasia
- fibroadenoma
- intraductal papilloma
- fat necrosis
- duct ectasia- nipple dishcarge
What is fibroadenoma?
- proliferation of epithelial and stromal elements
- well-circumscribed, freely mobile, nonpainful mass
- ducts distorted, elongated -> slit like structure (intracanalicular pattern), ducts not compressed -> pericanalicular growth pattern
- most common breast tumour, in adolescent + YA, (3rd decade)
- may regress with age if left untreated
What is intraduct papilloma?
- benign tumour in milk duct of breast
- can have epithelial hyperplasia, can be atypical
- nipple discharge
- usually middle aged women
What is fat necrosis?
- dead/damaged breast tissue
- history of antecedent trauma, prior surgery
- histiocytes with foamy cytoplasms
- lipid-filled cysts
- fibrosis, calcifications, egg shell on mammography
- can simulate carcinoma clinically + on mammography
What is Phyllodes tumour?
- circumscribed, connective tissue + epithelial elements, 1-15cm
- benign, borderline malignant
- metastases are haemotogenous
- fleshy tumour, leaf like pattern, cycts on surface
- < 1% of breast tumours
What proportion of males and females are affected by breast carcinoma and how many females die from the disease?
- 1 in 870 males
- 1 in 8 females
- 1/3 of affected females die
What are the risk factors for breast carcinoma?
- gender
- age
- early menarche, late menopause
- age at first pregnancy
- radiation
- hormonal treatment
- family/personal history
- genetic factors
- obesity, lack of exercise, alcohol
What are the macroscopic and mammogram findings of breast carcinoma?
- hard lump
- fixed mass
- mastalgia
- tethering to skin
- peau d’orange dimpling of skin
- nipple discharge/changes
- changes in size/shape of breast
- lymphoedema
- soft tissue opacity
- microcalcification
- masses
What is the percentage contribution of the following genes, to hereditary breast cancer; BRCA1, BRCA2, TP53, PTEN + other genes?
- BRCA1- 20-40%
- BRCA2- 10-30%
- TP53- < 1%
- PTEN- < 1%
- other genes- 30-70%
What are the different histological classifications of breast carcinoma?
Non-invasive:
- ducatal carcinoma in situ (DCIS)
- lobular carcinoma in situ (LCIS/LISN)
Invasive:
- invasive ductal carinoma (NST) (~75%)
- invasive lobular carcinoma + its variants (5-15%)
- special types; tubular carcinoma, mucinous carcinoma, carcinoma with medullary features, metaplastic carcinoma
What is an in situ carcinoma?
- preinvasive- does not form a palpable tumour
- not clinically detected
- multicentricity and bilaterality (LCIS)
- no metastatic spread (basement membrane)
- risk of invasion depending on grade
What are the investigations for breast carcinoma?
- clinical examination
- radiology (mammogram, ultrasound, MRI)
- fine needle aspiration cytology FNA
- needle core biopsy
- wide local excision with adequate margins
What is the screening for breast cancer?
- mammogram every 3 years
- women age 50-70 years
* 30% reduction in mortality
Where does breast carcinoma spread to?
- local- skin, pectoral muscles
- lymphatic- axillary, internal mammary
- blood- bone, lungs, liver, brain
What are the 5 molecular subtypes of breast carcinoma?
- ER + luminal A (55%0
- ER +ve
- HER2 -ve
- low Ki67
- luminal B (15%)
- ER +ve
- HER2 +ve OR HER2 -ve with high Ki67
- basal (10-15%)
- ER -ve
- PR -ve
- HER2 -ve
- Her 2+ (15-20%)
- ER -ve
- PR -ve
- HER2 +ve
- normal breast-like
