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Reproduction Pathology > Pathology of the Breast > Flashcards

Pathology of the Breast Flashcards

1
Q

What is inside the lobe of the breast?

A

Smaller structures called lobules

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2
Q

What is at the end of each lobule of the breast?

A

Tiny sacs (bulbs) that can produce milk

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3
Q

Definition of fibroadenoma

A

Circumcised mobile nodule in reproductive age

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4
Q

Fibrocystic changes of the breast involves

A 
Fibrosis
Adenosis
Cysts
Apocrine metaplasia
Ductal epithelial hyperplasia (normal or atypical)
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5
Q

Intraduct papilloma involves….

A

Lactiferous ducts

Nipple discharge

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6
Q

Duct ectasia presentation

A

Nipple discharge

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7
Q

Peak age for fibroadenomas

A

3rd decade

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8
Q

What may happen to a fibroadenoma if left untreated?

A

It may regress with age

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9
Q

Presentation of a fibroadenoma

A

A mass that is

  • well circumcised
  • freely mobile
  • non-painful
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10
Q

What age is intraduct papillomas usually seen in?

A

middle aged women

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11
Q

Pathology of fibroadenomas

A
  1. ductus distorted elongated
  2. Slit like structures intracanalicular pattern, ducts not compressed
  3. Peri canalicular growth pattern
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12
Q

What can fat necrosis stimulate?

A

Carcinoma, clinically and mammographically

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13
Q

Fat necrosis will have an associated history of…..

A

Antecedent trauma

Prior surgical intervention

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14
Q

Pathology of intraduct papilloma

A

Histiocytes with foamy cytoplasm
Lipid filled cysts
Fibrosis, calcifications, egg shell on mammography

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15
Q

Definition of Phyllodes tumour

A

A fleshy, circumscribed tumour with connective tissue and epithelial elements with cysts on cut surface and a leaf like pattern

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16
Q

Malignancy status of phyllodes tumour

A

Epithelial component is benign

Stroma component is malignant

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17
Q

Metastases of a phyllodes tumour is by…

A

Haematogenous spread

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18
Q

What does breast carcinoma show on a mammogram?

A

Soft tissue opacity

Microcalfication

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19
Q

Presentation of breast carcinoma

A

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

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20
Q

Risk factors for breast carcinoma

A 
Gender
Increased age 
Early menarche / late menopause 
Delayed age of 1st pregnancy (>30 y/o)
Radiation 
Family history 
Previous cancer 
Hormonal treatment (HRT, COCP)
Genetic factors
Obesity 
Lack of physical activity 
Alcohol
P53 gene mutation
Previous surgery for benign breast disease (scar hides mass etc)
Non breastfeeding 
Nulliparity
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21
Q

Breast lesions that require surveillance due to the risks include…

A

Epithelial proliferation without atypia - 1.5-2x
With atypical ductal or lobar - 4-5x
Lobular carcinoma in situ (LCIS) - 8-10x
Ductal carcinoma in situ (DCIS) - 8-10x

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22
Q

What percentage of breast cancers can be attributed to inherited factors?

A

5-10%

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23
Q

What are the inherited genes that contribute to breast cancer?

A 
BRCA1 - 20-40%
BRCA2 - 10-30%
TP53 - <1%
PTEN - <1%
other genes - 30-70%
24
Q

Non-invasive carcinomas

A

Ductal carcinoma in situ (DCIS)

Lobular carcinoma in situ (LCIS)

25
Q

Investigations for breast carcinoma

A 
Clinical exam 
Mammogram 
USS
MRI 
FNAC
Needle core biopsy
26
Q

Who is screened for breast cancer?

A

Women aged 50-70 years

27
Q

How often is breast cancer screening carried out?

A

every 3 years

28
Q

What scanning is carried out for breast cancer screening?

A

Mammogram

29
Q

Screening for breast cancer reduces mortality by…

A

30%

30
Q

The two most important mammographic indications of breast cancer

A
  1. Masses

2. Macrocalcifications

31
Q

What can microcalfications on mammogram indicate?

A

Possibly an early cancer

32
Q

What does breast cancer spread to?

A 
Local 
- skin 
- pectoral muscles
Lymphatic
- axillary nodes
- internal mammary nodes
Blood
- bone
- lungs
- liver
- brain
33
Q

5 year survival prognosis for breast cancer

A

64%

34
Q

What is looked at to predict the prognosis in the breast cancer?

A 
Patient related and tumour related
Node status (breast prognostic indicator)
Tumour size <2cm 
Type
Grade (1,2,3)
Age
Co-morbidities 
Lymphovascular space invasion 
Oestrogen receptors (OR)
Progesterone receptors (PR)
HER-2
Proliferative rate of tumour
Gene expression profiling
Nottingham prognostic index (NPI)
35
Q

What does the Nottingham prognostic index (NPI) base their prognosis on?

A

Tumour size
Grade
Nodal status

36
Q

What molecular markers are strong predictors to responses to hormonal therapies in breast cancer?

A

ER/PR

37
Q

What molecular marker in breast cancer predicts the response to trastuzumab (Herceptin)?

A

HER-2

38
Q

Treatment of breast carcinoma

A 
Surgery 
- mastectomy
- breast conserving surgery (WLE)
- +/- lymph nodes
Radiotherapy
Antihormonal therapy (tamoxifen)
Chemotherapy
39
Q

What is pagets disease of the nipple pathologically a result of?

A

Intraepithelial spread of intraductal carcinoma

40
Q

Presentation of pagets disease of the nipple

A 
Large pale staining ells within the epidermis of the nipple
limited to the nipple or extend to the areola
Pain 
itching
scaling or redness
mistaken for eczema 
ulceration 
crusting 
serous or bloody discharge
41
Q

Gynaecomastia is associated with

A 
hyperthyroidism 
Cirrhosis of the liver
Chronic renal failure
Chronic pulmonary disease 
Hypogonadism 
Use of hormones (oestrogen, androgrens, spironolactone, marihuana, tricyclic antidepressants)
42
Q

Who does a galactocele typically occur in?

A

In women who recently stopped breast feeding

43
Q

Pathology of galactocele

A

Occlusion of a lactiferous duct

The build up of milk creates a cystic lesion in the breast

44
Q

What is lactation mastitis?

A

A common inflammatory condition of the breast which may be either infectious or non infectious in origin. The main cause is milk status, due to overproduction or insufficient removal.

45
Q

Most common organism for infectious lactation mastitis

A

Staph Auerus

46
Q

Presentation of lactation mastitis

A

Breast pain (most commonly unilateral)
Erythematous, warm, tender area
Fever
Flu like symptoms

47
Q

Treatment of lactation mastitis

A

Analgesia
Encourage removal of milk (continue breastfeeding or expressing) from the affected side in order to prevent further milk status
If symptoms dont improve after 12 - 24 hours of conservative management
- oral flucloxacillin 500mg 4x a day for 14 days
- erythromycin if penicillin allergic
- (second line choice co amoxiclav)

48
Q

Frequent breastfeeding prpblems

A

Nipple pain
Blocked duct causing nipple pain when breastfeeding
Nipple candiadis

49
Q

Can oral flucloxacillin be prescribed during breastfeeding?

A

Yes

50
Q

If mastitis is left untreated what can it progress to?

A

A breast abscess

51
Q

Presentation of raynauds disease of the nipple

A

Pain intermittent
Pain during and immediately after feeding
Blanching of the nipple followed by erythema and/or cyanosis

52
Q

Management of raynauds disease of the nipple

A

Minimize exposure to the cold
Use of heat packs following a breastfeed
Avoid caffeiene
Stop smoking
If symptoms persist consider oral nifedipine (off license)

53
Q

If you have breast cancer which is HER-2 positive, what can be used to treat it? What kind of therapy is this?

A

Herceptin

Biologic therapy

54
Q

Hormonal treatment of breast cancer in pre and peri menopausal women who are ER +ve

A

Tamoxifen

55
Q

Hormonal treatment of post menopausal ER +ve cancer

A

Aromatase inhibitors (anastrole)

Reproduction Pathology (28 decks)

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