Pathology of breast disease (Breast lecture 3)

Question 1

How many lobes are there in a breast?

Answer 1

15-25

Question 2

What are lobules?

Answer 2

Small structures which make up lobes

Question 3

What are bulbs?

Answer 3

Tiny sacs at the end of each breast lobule that produce milk

Question 4

Which lymph nodes handle most of the lymph drainage for the breasts?

Answer 4

Lateral

• Anterior axillary
• Pectoral

Medial
-Internal thoracic

Question 5

What is fibroadenoma?

Answer 5

Proliferation of epithelial and stromal elements of breast

Question 6

What is the most common breast tumour in young women?

Answer 6

Fibroadenoma

Question 7

What are some characters of a fibroadenoma?

Answer 7

Well-circumscribed
Freely mobile
Nonpainful mass

Question 8

What is the most common kind of breast cancer?

Answer 8

Invasive ductal carcinoma

Question 9

How may intraduct papilloma present?

Answer 9

Usually middle aged
women
Nipple discharge
Can show epithelial
hyperplasia

Question 10

Which condition may mimic carcinoma clinically and mammographically?

Answer 10

Fat necrosis

Question 11

How may fat necrosis present?

Answer 11

Lipid filled cysts
Fibrosis
Calcifications
Egg shell on mammography
Histiocytes with foamy cytoplasm

Question 12

How does phyllodes tumour present?

Answer 12

Fleshy tumour
Leaf-like pattern
Cysts on cut surface
Circumscribed

Question 13

What are some macroscopic changes in breast carcinoma?

Answer 13

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

Question 14

What are the biggest genetic causes of hereditary breast cancer?

Answer 14

BRCA1
BRCA2
TP53
PTEN

Question 15

What are some non-invasive breast cancers?

Answer 15

Ductal carcinoma in situ (DCIS)

Lobular carcinoma in situ (LCIS/ LISN)

Question 16

Do in situ carcinomas form a palpable tumour?

Answer 16

No

Question 17

Is there metastatic spread with in situ carcinomas?

Answer 17

No

Question 18

What are some useful diagnostic investigations for breast cancer?

Answer 18

Clinical examination
Mammogram
USS 
MRI
Fine needle aspiration cytology
Needle core biopsy
Wide local excision with adequate margin

Question 19

Are microcalcifications normal findings?

Answer 19

Yes
Most women have one or more areas of
microcalcifications of various sizes
Majority of calcium deposits are harmless

Question 20

What are the two of the most important mammographic

indicators of breast cancer?

Answer 20

Masses

Microcalcifications

Question 21

What are some factors in the histology report?

Answer 21

Invasive or non
Ductal or lobular
Grade
Size
Margins
Lymph nodes
Estrogen/ Progeterone receptor positive or negative

Question 22

How does breast cancer usually spread lymphatically?

Answer 22

Axillary or internal mammary nodes

Question 23

What are some local targets of breast cancer spread?

Answer 23

Skin

Pectoral muscles

Question 24

What are the most common sites of breast cancers mets?

Answer 24

Bone
Lungs
Liver
Brain

Question 25

What is the NPI?

Answer 25

Nottingham Prognostic Index

Based on tumour size, grade and nodal status

Question 26

How does ER/PR affect therapy?

Answer 26

ER /PR strong predictors of response to hormonal therapies

ER/PR negative tumours do not respond

Question 27

What is a hormonal therapy indicated by ER/PR positive result?

Answer 27

Trastuzumab (Herceptin)

Question 28

What medication is given for antihormonal therapy in breast cancer?

Answer 28

Tamoxifen

Question 29

What is Paget’s disease?

Answer 29

Result of intraepithelial spread of intraductal
carcinoma
Large pale-staining cells within the epidermis of the
nipple

Question 30

How does Paget’s disease present?

Answer 30

Pain
Itching
Scaling
Redness
Sometimes mistaken for eczema
Limited to nipple or extend to areola