Pathology of the Breast Flashcards
benign breast conditions: fibrocystic change
fibrosis adenosis cysts apocrine metaplasia ductal epithelial hyperplasia
benign breast conditions: fibroadenoma
circumscribed mobile nodule in reproductive age
benign breast conditions: intraduct papilloma
lactiferous ducts
nipple discharge
benign breast conditions: fat nectrosis
traumatic
benign breast conditions: duct ectasia
nipple discharge
describe fibroadenoma
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
describe tubular adenoma
far less common than fibroadenomas
young women, discrete, freely movable masses
uniform sized ducts
describe lactating adenoma
enlarging masses during lactation or pregnancy
prominent secretory change
describe intraduct papilloma
usually middle aged women
nipple discharge
can show atypia
describe fat necrosis of the breast
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
describe phyllodes tumour
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
mammogram of breast carcinoma
soft tissue opacity
microcalcification
macroscopic features of breast ca
hard lump, fixed mass, tethering to skin, peau d’orange dimpling of skin
risk factors for breast ca
Gender Age Menstrual history Age at first pregnancy Radiation Family history Personal history Hormonal treatment Genetic factors Other factors: obesity, alcohol
histological classification of breast ca
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%)
describe DCIS
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
name 3 special types of breast ca
tubular carcinoma
mucinous carcinoma
medullary carcinoma
what are microcalcifications? in relation to breast ca
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
spread of breast ca: local
skin
pectoral muscles
spread of breast ca: lymphatic
axilllary and internal mammary nodes
spread of breast ca: blood
bone
lungs
liver
brain
molecular markers on breast ca
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 )
molecular classification of breast ca
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
managment of breast ca
Staging surgery (radical – mastectomy, breast conserving surgery – WLE) + lymph nodes radiotherapy antihormonal therapy (Tamoxifen) chemotherapy
paget’s disease of the breast
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
male gynecomastia is associated with:
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)
what % of breast ca are in men?
<1%
