Pathology of the breast Flashcards
Epithelial components of the breast
ducts and lobules
Mesencymal components of the breast
fat and fibrous tissue
How many lobes does each breast have? how do lobes connect up to produce bulbs?
8-10
by forming lobules
Before puberty are there ducts in both sexes?
yes : 15-25
Before puberty are there lobules in both sexes?
no
Explain the branching in the breast following puberty
starts in nipple and branch into the terminal ductal lobular unit
Function of lymph ducts
drain fluid that carries WBC from the breast –> axillary/parasternal LN
LN function
filter bacteria (harmful) and play a key role in fighting infection
5 benign breast conditions
fibrocystic change fibroadenoma intraduct papilloma fat necrosis duct ectasia
Who are fibroadenomas common in?
adolescent and young adult female
Pathology of fibroadenoma
proliferation of epithelial and stromal elements
symptoms and signs of fibroadenoma
well circumscribed, freely moveable, non painful - may regress
Ducts in fibroadenomas
elongated - intracanicular
not compressed - pericanicular
2 other adenomas
tubular and lactating
Intraduct papilloma
- middle aged women
- nipple discharge
- epithelial hyperplasia
How can fat necrosis simulate carcinoma?
clinically and mammographically
IMPORTANT history in fat necrosis
history of trauma
appearance of fat necrosis histologically
histiocytes with foamy macrophages and lipid filled cysts
mammography appearance of fat necrosis
fibrosis, calcifications, egg shell
Appearance of phyllodes tumour
fleshy, leaf like pattern and cysts on cut surface
circumscribed, 1-15cm
types of phyllodes tumour
benign, borderline and malignant
metastatic spread of phyllodes tumour
hematogenous
How many women does breast cancer affect?
1 in 8
How may men does breast cancer affect?
1 in 870
Mammogram appearance of breast ca
soft tissue opacity and microcalcification
Macroscopic appearance of breast ca
hard lump, fixed mass, tethering to the skin, peau d’orange dimpling of skin
Risk factors for breast cancer
genetic hormonal treatment personal history family history radiation age at 1st pregnancy menstrual history gender other eg obesity, alcohol
Breast lesion and risk of ca
- Epithelial proliferation without atypia
- with atypia ductal or lobular
- LCIS/DCIS
1.5-2x
4-5x
8-10x
What % of breast cancer attributed to hereditary factors?
5-10
4 genes implicated in breast cancer
BRCA1, BRCA2, TP53, PTEN,
Non invasive carcinoma
LCIS,DCIS
invasive carcinoma types
IDC - 75%
ILC
special types = rest
In situ carcinoma characteristics
preinvasive - non palpable
not detected clinically
LCIS is bilateral and multicentral
no met spread
Risk of invasion of in situ carcinoma depends on?
grade
Risk of progression
- LGDCIS
- HGDCIS
- LCIS
30% in 15 years
50% in 8 years
19% in 25 years
special types
- tubular carcinoma
- mucinous carcinoma
- carcinoma with medullary features
- metaplastic carcinoma
Diagnostic procedures
mammogram/USS/MRI clinical exam FNAC core biopsy wide local excision with adequate margins
screening for breast cancer
30% reduction in mortality
mammogram every 3 years for 50-70 year olds
Microcalcifications - what do they mean?
most harmless but can be a precancerous/cancerous indicator
2 of the most important mammography indicators of breast cancer
masses
microcalcifications
Histology report info
invasive or non invasive tumour size grade nodal status histological type margins ER/PR receptor HER-2/neu
3 spread of breast cancer
local eg skin, pectoral muscle
lymphatic - axillary and internal mammary
blood - bone, brain, lung, liver
Prognosis of breast cancer
patient and tumour related node status tumour size type grade age LVSI ER/PR/HER-2 gene expression profiling proliferative rate of tumour NPI
Nottingham prognostic index
tumour size, grade, nodes
5YS breast ca
64%
ER/PR - useful for?
predictors of response to hormonal treatment
HER-2 - what does it predict?
response to trastuzumab - Herceptin
5 subtypes of molecular classification
ER + luminal A Luminal B basal Her 2+ normal breast like
Management for breast ca
staging surgery - mastectomy, breast conserving +/- nodes radiotherapy chemo anti-hormonal eg tamoxifen
pagets disease of nipple
intraepithelial spread of intraductal carcinoma
large pale staining cells in epidermis of nipple
gynaecomastia associated with…
hyperthyroidism - cirrhosis - Chronic renal failure - hypogonadism - hormone use
