Pathology of the breast

Question 1

Epithelial components of the breast

Answer 1

ducts and lobules

Question 2

Mesencymal components of the breast

Answer 2

fat and fibrous tissue

Question 3

How many lobes does each breast have? how do lobes connect up to produce bulbs?

Answer 3

8-10

by forming lobules

Question 4

Before puberty are there ducts in both sexes?

Answer 4

yes : 15-25

Question 5

Before puberty are there lobules in both sexes?

Answer 5

no

Question 6

Explain the branching in the breast following puberty

Answer 6

starts in nipple and branch into the terminal ductal lobular unit

Question 7

Function of lymph ducts

Answer 7

drain fluid that carries WBC from the breast –> axillary/parasternal LN

Question 8

LN function

Answer 8

filter bacteria (harmful) and play a key role in fighting infection

Question 9

5 benign breast conditions

Answer 9

fibrocystic change 
fibroadenoma 
intraduct papilloma 
fat necrosis 
duct ectasia

Question 10

Who are fibroadenomas common in?

Answer 10

adolescent and young adult female

Question 11

Pathology of fibroadenoma

Answer 11

proliferation of epithelial and stromal elements

Question 12

symptoms and signs of fibroadenoma

Answer 12

well circumscribed, freely moveable, non painful - may regress

Question 13

Ducts in fibroadenomas

Answer 13

elongated - intracanicular

not compressed - pericanicular

Question 14

2 other adenomas

Answer 14

tubular and lactating

Question 15

Intraduct papilloma

Answer 15

• middle aged women
• nipple discharge
• epithelial hyperplasia

Question 16

How can fat necrosis simulate carcinoma?

Answer 16

clinically and mammographically

Question 17

IMPORTANT history in fat necrosis

Answer 17

history of trauma

Question 18

appearance of fat necrosis histologically

Answer 18

histiocytes with foamy macrophages and lipid filled cysts

Question 19

mammography appearance of fat necrosis

Answer 19

fibrosis, calcifications, egg shell

Question 20

Appearance of phyllodes tumour

Answer 20

fleshy, leaf like pattern and cysts on cut surface

circumscribed, 1-15cm

Question 21

types of phyllodes tumour

Answer 21

benign, borderline and malignant

Question 22

metastatic spread of phyllodes tumour

Answer 22

hematogenous

Question 23

How many women does breast cancer affect?

Answer 23

1 in 8

Question 24

How may men does breast cancer affect?

Answer 24

1 in 870

Question 25

Mammogram appearance of breast ca

Answer 25

soft tissue opacity and microcalcification

Question 26

Macroscopic appearance of breast ca

Answer 26

hard lump, fixed mass, tethering to the skin, peau d'orange dimpling of skin

Question 27

Risk factors for breast cancer

Answer 27

``` genetic hormonal treatment personal history family history radiation age at 1st pregnancy menstrual history gender other eg obesity, alcohol ```

Question 28

Breast lesion and risk of ca 1. Epithelial proliferation without atypia 2. with atypia ductal or lobular 3. LCIS/DCIS

Answer 28

1.5-2x 4-5x 8-10x

Question 29

What % of breast cancer attributed to hereditary factors?

Answer 29

5-10

Question 30

4 genes implicated in breast cancer

Answer 30

BRCA1, BRCA2, TP53, PTEN,

Question 31

Non invasive carcinoma

Answer 31

LCIS,DCIS

Question 32

invasive carcinoma types

Answer 32

IDC - 75% ILC special types = rest

Question 33

In situ carcinoma characteristics

Answer 33

preinvasive - non palpable not detected clinically LCIS is bilateral and multicentral no met spread

Question 34

Risk of invasion of in situ carcinoma depends on?

Answer 34

grade

Question 35

Risk of progression 1. LGDCIS 2. HGDCIS 3. LCIS

Answer 35

30% in 15 years 50% in 8 years 19% in 25 years

Question 36

special types

Answer 36

1. tubular carcinoma 2. mucinous carcinoma 3. carcinoma with medullary features 4. metaplastic carcinoma

Question 37

Diagnostic procedures

Answer 37

``` mammogram/USS/MRI clinical exam FNAC core biopsy wide local excision with adequate margins ```

Question 38

screening for breast cancer

Answer 38

30% reduction in mortality | mammogram every 3 years for 50-70 year olds

Question 39

Microcalcifications - what do they mean?

Answer 39

most harmless but can be a precancerous/cancerous indicator

Question 40

2 of the most important mammography indicators of breast cancer

Answer 40

masses | microcalcifications

Question 41

Histology report info

Answer 41

``` invasive or non invasive tumour size grade nodal status histological type margins ER/PR receptor HER-2/neu ```

Question 42

3 spread of breast cancer

Answer 42

local eg skin, pectoral muscle lymphatic - axillary and internal mammary blood - bone, brain, lung, liver

Question 43

Prognosis of breast cancer

Answer 43

``` patient and tumour related node status tumour size type grade age LVSI ER/PR/HER-2 gene expression profiling proliferative rate of tumour NPI ```

Question 44

Nottingham prognostic index

Answer 44

tumour size, grade, nodes

Question 45

5YS breast ca

Answer 45

64%

Question 46

ER/PR - useful for?

Answer 46

predictors of response to hormonal treatment

Question 47

HER-2 - what does it predict?

Answer 47

response to trastuzumab - Herceptin

Question 48

5 subtypes of molecular classification

Answer 48

``` ER + luminal A Luminal B basal Her 2+ normal breast like ```

Question 49

Management for breast ca

Answer 49

``` staging surgery - mastectomy, breast conserving +/- nodes radiotherapy chemo anti-hormonal eg tamoxifen ```

Question 50

pagets disease of nipple

Answer 50

intraepithelial spread of intraductal carcinoma | large pale staining cells in epidermis of nipple

Question 51

gynaecomastia associated with...

Answer 51

hyperthyroidism - cirrhosis - Chronic renal failure - hypogonadism - hormone use