Pathology of Breast Disease Flashcards
What are the diagnostic procedures of breast disease?
- Clinical examination
- Radiology (mammogram, ultrasound, MRI)
- FNA cytology
- Needle core biopsy
- Wide local excision with margins
What are the mammographic indicators of breast cancer?
- Masses
- Microcalcifications (flecks of calcium in soft tissue of breast that can sometimes indicate an early cancer)
What are the common benign breast diseases?
- 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
Describe the physiology of fibrocystic change
Fibrosis occurs, followed by cyst formation. These cysts have a lining of apocrine cells.
What steps need to be taken in cases of ductal epithelial hyperplasia?
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
What are the characteristics of fibroadenomas of the breast?
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
What is the difference between intracanalicular and pericanalicular growth patterns of fibroadenomas?
Intracanalicular- ducts become distorted
Pericanalicular- ducts not compressed
What are the characteristics of tubular adenomas?
Far less common than fibroadenomas
Young women, discrete, freely movable masses
Uniform sized ducts
What are the characteristics of a lactating adenoma?
Enlarging masses during lactation or pregnancy
Prominent secretory change
What are the characteristics of intraduct papillomas?
Usually in middle aged women
Results in nipple discharge
Can show epithelial hyperplasia, which can be atypical
What are the characteristics of fat necrosis?
- 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
What are the characterisics of a Phyllodes tumour?
- 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
What is the incidence of breast carcinoma?
1:8 women lifetime risk
1:1,870 men
Incidence increasing
How does breast carcinoma present microscopically?
As a mass or microcalcification
How does breast carcinoma present macroscopically?
Hard lump
Fixed mass
Tethering to skin
Peau d’orange dimpling of skin
What are the risk factors for breast carcinoma?
- 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
How is breast carcinoma classified histologically?
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
What are the characteristics of an in-situ breast carcinoma?
- 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
What is the risk of invasion of an in-situ breast carcinoma?
- Low grade DCIS = 30% in 5 years
- High grade DCIS = 50% in 8 years
- LCIS = 19% in 25 years
How does the spread of breast cancer occur?
- Local-skin, pectoral muscles
- Lymphatic- axillary and internal mammary nodes
- Blood- bone, lungs, liver, brain
What are the factors affecting the prognosis of a breast cancer?
- 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
What is the overall 5 year survival rate for breast cancer?
64%
Which breast tumours will respond to hormonal therapy?
Oestrogen or progesterone receptor tumours will respond well to hormonal therapy. Tumours without these will not respond to hormonal therapy.
How is breast cancer managed?
- Staging
- Surgery (mastectomy, breast conserving surgery – wle) + lymph nodes
- Radiotherapy
- Antihormonal therapy
- Chemotherapy
