Pathology of breast disease (Breast lecture 3) Flashcards
How many lobes are there in a breast?
15-25
What are lobules?
Small structures which make up lobes
What are bulbs?
Tiny sacs at the end of each breast lobule that produce milk
Which lymph nodes handle most of the lymph drainage for the breasts?
Lateral
- Anterior axillary
- Pectoral
Medial
-Internal thoracic
What is fibroadenoma?
Proliferation of epithelial and stromal elements of breast
What is the most common breast tumour in young women?
Fibroadenoma
What are some characters of a fibroadenoma?
Well-circumscribed
Freely mobile
Nonpainful mass
What is the most common kind of breast cancer?
Invasive ductal carcinoma
How may intraduct papilloma present?
Usually middle aged women Nipple discharge Can show epithelial hyperplasia
Which condition may mimic carcinoma clinically and mammographically?
Fat necrosis
How may fat necrosis present?
Lipid filled cysts Fibrosis Calcifications Egg shell on mammography Histiocytes with foamy cytoplasm
How does phyllodes tumour present?
Fleshy tumour
Leaf-like pattern
Cysts on cut surface
Circumscribed
What are some macroscopic changes in breast carcinoma?
Hard lump
Fixed mass
Tethering to skin
Peau d’orange dimpling
What are the biggest genetic causes of hereditary breast cancer?
BRCA1
BRCA2
TP53
PTEN
What are some non-invasive breast cancers?
Ductal carcinoma in situ (DCIS)
Lobular carcinoma in situ (LCIS/ LISN)
Do in situ carcinomas form a palpable tumour?
No
Is there metastatic spread with in situ carcinomas?
No
What are some useful diagnostic investigations for breast cancer?
Clinical examination Mammogram USS MRI Fine needle aspiration cytology Needle core biopsy Wide local excision with adequate margin
Are microcalcifications normal findings?
Yes
Most women have one or more areas of
microcalcifications of various sizes
Majority of calcium deposits are harmless
What are the two of the most important mammographic
indicators of breast cancer?
Masses
Microcalcifications
What are some factors in the histology report?
Invasive or non Ductal or lobular Grade Size Margins Lymph nodes Estrogen/ Progeterone receptor positive or negative
How does breast cancer usually spread lymphatically?
Axillary or internal mammary nodes
What are some local targets of breast cancer spread?
Skin
Pectoral muscles
What are the most common sites of breast cancers mets?
Bone
Lungs
Liver
Brain
What is the NPI?
Nottingham Prognostic Index
Based on tumour size, grade and nodal status
How does ER/PR affect therapy?
ER /PR strong predictors of response to hormonal therapies
ER/PR negative tumours do not respond
What is a hormonal therapy indicated by ER/PR positive result?
Trastuzumab (Herceptin)
What medication is given for antihormonal therapy in breast cancer?
Tamoxifen
What is Paget’s disease?
Result of intraepithelial spread of intraductal
carcinoma
Large pale-staining cells within the epidermis of the
nipple
How does Paget’s disease present?
Pain Itching Scaling Redness Sometimes mistaken for eczema Limited to nipple or extend to areola
