Pathology of the Breast

Question 1

benign breast conditions: fibrocystic change

Answer 1

fibrosis
adenosis
cysts
apocrine metaplasia
ductal epithelial hyperplasia

Question 2

benign breast conditions: fibroadenoma

Answer 2

circumscribed mobile nodule in reproductive age

Question 3

benign breast conditions: intraduct papilloma

Answer 3

lactiferous ducts

nipple discharge

Question 4

benign breast conditions: fat nectrosis

Answer 4

traumatic

Question 5

benign breast conditions: duct ectasia

Answer 5

nipple discharge

Question 6

describe fibroadenoma

Answer 6

proliferation of epithelial and stromal elements
most common breast tumor in adolescent and young adult women (peak age = third decade)
well-circumscribed, freely mobile, nonpainful mass
may regress with age if left untreated
ducts distorted elongated –> slit-like structures intracanalicular pattern, ducts not compressed –> pericanalicular growth pattern

Question 7

describe tubular adenoma

Answer 7

far less common than fibroadenomas
young women, discrete, freely movable masses
uniform sized ducts

Question 8

describe lactating adenoma

Answer 8

enlarging masses during lactation or pregnancy

prominent secretory change

Question 9

describe intraduct papilloma

Answer 9

usually middle aged women
nipple discharge
can show atypia

Question 10

describe fat necrosis of the breast

Answer 10

can simulate carcinoma clinically and mammographically
 history of antecedent trauma, prior surgical intervention
 histiocytes with foamy cytoplasm
 lipid–filled cysts
 fibrosis, calcifications, egg shell on mammography

Question 11

describe phyllodes tumour

Answer 11

Fleshy tumor, leaf-like pattern and cysts on cut surface
 circumscribed, connective tissue and epithelial elements, 1-15 cm
 less than 1 % of breast tumors
 benign, borderline, malignant
 metastases are hematogenous

Question 12

mammogram of breast carcinoma

Answer 12

soft tissue opacity

microcalcification

Question 13

macroscopic features of breast ca

Answer 13

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

Question 14

risk factors for breast ca

Answer 14

Gender
Age
Menstrual history
Age at first pregnancy
Radiation
Family history
Personal history
Hormonal treatment
Genetic factors
Other factors: obesity, alcohol

Question 15

histological classification of breast ca

Answer 15

Non-invasive
Ductal carcinoma in situ (DCIS)
Lobular carcinoma in situ (LCIS/ LISN)
Invasive
Invasive ductal carcinoma, NST (85%)
Invasive lobular carcinoma (10%)
Special type (5%)

Question 16

describe DCIS

Answer 16

preinvasive - does not form a palpable tumor
 not detected clinically (only X-ray in DCIS– screening)
 multicentricity and bilaterality (LCIS)
 no metastatic spread (basement membrane)
 risk of invasion depending on grade

Question 17

name 3 special types of breast ca

Answer 17

tubular carcinoma
mucinous carcinoma
medullary carcinoma

Question 18

what are microcalcifications? in relation to breast ca

Answer 18

Tiny deposits of calcium can appear anywhere in the breast and often show up on a mammogram
Most women have one or more areas of microcalcifications of various sizes
Majority of calcium deposits are harmless
A small percentage may be in precancerous or cancerous tissue

Question 19

spread of breast ca: local

Answer 19

skin

pectoral muscles

Question 20

spread of breast ca: lymphatic

Answer 20

axilllary and internal mammary nodes

Question 21

spread of breast ca: blood

Answer 21

bone
lungs
liver
brain

Question 22

molecular markers on breast ca

Answer 22

ER /PR strong predictors of response to hormonal therapies
ER/PR negative tumours do not respond
HER-2 : about 20-30% positive- predicts response to trastuzumab ( Herceptin )

Question 23

molecular classification of breast ca

Answer 23

Gene expression technology
5 subtypes : ER + luminal A, luminal B, Basal, Her 2+ and normal breast-like
Biologically diverse disease
Predictive gene signatures/ potential to improve therapy
Complement current clinicopathological features

Question 24

managment of breast ca

Answer 24

Staging
surgery (radical – mastectomy, breast conserving surgery – WLE) + lymph nodes
 radiotherapy
 antihormonal therapy (Tamoxifen)
 chemotherapy

Question 25

paget’s disease of the breast

Answer 25

result of intraepithelial spread of intraductal carcinoma
 large pale-staining cells within the epidermis of the nipple
 limited to the nipple or extend to the areola
 pain or itching, scaling and redness, mistaken for eczema
 ulceration, crusting, and serous or bloody discharge

Question 26

male gynecomastia is associated with:

Answer 26

hyperthyroidism, cirrhosis of the liver, chronic renal failure, chronic pulmonary disease, and hypogonadism, use of hormones - oestrogens, androgens, and other drugs (digitalis, cimetidine, spironolactone, marihuana, and tricyclic antidepressants)

Question 27

what % of breast ca are in men?

Answer 27

<1%