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Reproductive System > Pathology of Breast Disease > Flashcards

Pathology of Breast Disease Flashcards

1
Q

What are the diagnostic procedures of breast disease?

A
  • Clinical examination
  • Radiology (mammogram, ultrasound, MRI)
  • FNA cytology
  • Needle core biopsy
  • Wide local excision with margins
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2
Q

What are the mammographic indicators of breast cancer?

A
  • Masses

- Microcalcifications (flecks of calcium in soft tissue of breast that can sometimes indicate an early cancer)

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3
Q

What are the common benign breast diseases?

A
  • Fibrocystic change - fibrosis , adenosis, cysts , apocrine metaplasia, ductal epithelial hyperplasia
  • Fibroadenoma -circumscribed mobile nodule in reproductive age
  • Intraduct papilloma- lactiferous ducts, nipple discharge.
  • Fat necrosis - traumatic
  • Duct ectasia – nipple discharge
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4
Q

Describe the physiology of fibrocystic change

A

Fibrosis occurs, followed by cyst formation. These cysts have a lining of apocrine cells.

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5
Q

What steps need to be taken in cases of ductal epithelial hyperplasia?

A

Regular type ductal epithelial hyperplasia is completely benign
Atypical ductal epithelial hyperplasia carries a very low risk of progression to cancer and so patients are put onto regular screening

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6
Q

What are the characteristics of fibroadenomas of the breast?

A

Occurs due to proliferation of epithelial and stromal elements
Most common breast cancer in young women and adolescents
Peak incidence in third decade
Mass is benign with well-circumscribed, freely mobile, painless mass
Can regress with age without treatment

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7
Q

What is the difference between intracanalicular and pericanalicular growth patterns of fibroadenomas?

A

Intracanalicular- ducts become distorted

Pericanalicular- ducts not compressed

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8
Q

What are the characteristics of tubular adenomas?

A

Far less common than fibroadenomas
Young women, discrete, freely movable masses
Uniform sized ducts

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9
Q

What are the characteristics of a lactating adenoma?

A

Enlarging masses during lactation or pregnancy

Prominent secretory change

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10
Q

What are the characteristics of intraduct papillomas?

A

Usually in middle aged women
Results in nipple discharge
Can show epithelial hyperplasia, which can be atypical

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11
Q

What are the characteristics of fat necrosis?

A
  • Can simulate carcinoma clinically and mammographically
  • History of preceding trauma or prior surgical intervention
  • Histiocytes with foamy cytoplasm
  • Lipid–filled cysts
  • Fibrosis, calcifications, egg shell on mammography
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12
Q

What are the characterisics of a Phyllodes tumour?

A
  • Fleshy tumor, leaf-like pattern and cysts on cut surface
  • Circumscribed, connective tissue and epithelial elements, 1-15 cm
  • Less than 1 % of breast tumors
  • Benign, borderline, malignant
  • Metastases are hematogenous
  • Can be benign or malignant
  • Usually presents as quite a large tumour
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13
Q

What is the incidence of breast carcinoma?

A

1:8 women lifetime risk
1:1,870 men
Incidence increasing

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14
Q

How does breast carcinoma present microscopically?

A

As a mass or microcalcification

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15
Q

How does breast carcinoma present macroscopically?

A

Hard lump
Fixed mass
Tethering to skin
Peau d’orange dimpling of skin

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16
Q

What are the risk factors for breast carcinoma?

A
  • Gender
  • Age >50
  • Menstrual history- early menarche
  • Age at first pregnancy
  • Radiation
  • Family history (1st degree relatives most significant)
  • Personal history
  • Hormonal treatment (HRT, some contraceptives)
  • Genetic factors
  • Other factors: obesity, lack of physical activity, alcohol
17
Q

How is breast carcinoma classified histologically?

A

Non-invasive- can be ductal carcinoma in situ or lobular carcinoma in situ
Invasive- can be invasive ductal carcinoma (~75%), invasive lobular carcinoma (plus variants) and special types

18
Q

What are the characteristics of an in-situ breast carcinoma?

A
  • Preinvasive - does not form a palpable tumor
  • Not detected clinically (only x-ray in DCIS– screening)
  • Multicentricity and bilaterality (LCIS)
  • No metastatic spread
  • Risk of invasion depending on grade
19
Q

What is the risk of invasion of an in-situ breast carcinoma?

A
  • Low grade DCIS = 30% in 5 years
  • High grade DCIS = 50% in 8 years
  • LCIS = 19% in 25 years
20
Q

How does the spread of breast cancer occur?

A
  • Local-skin, pectoral muscles
  • Lymphatic- axillary and internal mammary nodes
  • Blood- bone, lungs, liver, brain
21
Q

What are the factors affecting the prognosis of a breast cancer?

A
  • Patient related (young age, comorbidities)
  • Node status (best prognostic indicator)
  • Tumour size (>2cm = T2)
  • Type
  • Grade
  • Lymphovascular space invasion (poor prognostic sign)
  • Oestrogen receptors
  • Progesterone receptors
  • HER-2 (+ve more aggressive)
  • Proliferative rate of tumour
  • Gene expression profiling
22
Q

What is the overall 5 year survival rate for breast cancer?

A

64%

23
Q

Which breast tumours will respond to hormonal therapy?

A

Oestrogen or progesterone receptor tumours will respond well to hormonal therapy. Tumours without these will not respond to hormonal therapy.

24
Q

How is breast cancer managed?

A
  • Staging
  • Surgery (mastectomy, breast conserving surgery – wle) + lymph nodes
  • Radiotherapy
  • Antihormonal therapy
  • Chemotherapy
25
Q

What are the characteristics of Paget’s disease of the nipple?

A
  • Result of intraepithelial spread of intraductal carcinoma
  • Large pale-staining cells within the epidermis of the nipple
  • Limited to the nipple or extend to the areola
  • Pain or itching, scaling and redness, mistaken for eczema
  • Ulceration, crusting, and serous or bloody discharge
26
Q

How does male breast cancer present?

A

Usually presents later than female but otherwise similarly to female

27
Q

What are the molecular characteristics of luminal A type tumours?

A

Oestrogen receptor positive

HER2 negative

28
Q

What are the molecular characteristics of luminal B type tumours?

A

Oestrogen receptor positive

HER2 positive

29
Q

What are the molecular characteristics of triple negative tumours?

A

Oestrogen receptor negative
Progesterone receptor negative
HER2 negative

30
Q

What are the molecular characteristics of HER2 type tumours?

A

Oestrogen receptor negative
Progesterone receptor negative
HER2 positive

Reproductive System (30 decks)

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