pathology of the breast

Question 1

what are examples of benign breast conditions ?

Answer 1

fibrocystic change - fibrosis, adenosis, cysts
fibroadenoma - circumscribed small nodule at reproductive age
intraduct papilloma - lactiferous ducts, nipple discharge
fat necrosis - traumatic
duct ectasia - nipple discharge

Question 2

what is the most common breast tumour in young women ?

Answer 2

fibroadenoma

proliferation of epithelial and stroll elements
well circumscribed, freely mobile, non painful mass

Question 3

what are examples of other adenomas ?

Answer 3

tubular adenoma - less common, freely movable

lactating adenoma - enlarging during lactation/pregnancy, prominent secretory change

Question 4

what are features of intraduct papilloma ?

Answer 4

usually middle aged women
nipple discharge

epithelial hyperplasia

Question 5

what are features of fat necrosis ?

Answer 5

simulate carcinoma
history of trauma, prior surgery
histiocytes with foamy cytoplasm
lipid-filled cysts
fibrosis, calcifications, egg shell on mammography

Question 6

what is Phyllodes tumour ?

Answer 6

fleshy tumour, leaf like pattern and cysts on cut surface
circumscribed, connective tissue and epithelial elements
less than 1% of breast tumours
can be benign or malignant
heamatogenous metastases

Question 7

what does a mammogram of a breast carcinoma look like ?

Answer 7

soft tissue opacity

microcalcification

Question 8

what is macroscopically seen with breast carcinoma ?

Answer 8

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

Question 9

what are risk factors for breast carcinoma ?

Answer 9

gender
age
menstrual history 
age at first pregnancy
radiation
FHx
personal history
HRT
genetics
obesity, lack of activity, alcohol

Question 10

what genes are attributed to breast cancer ?

Answer 10

BRCA1 20-40%
BRCA2 10-30%
TP53 <1%
PTEN <1%
other

Question 11

what are the different histological classifications of breast carcinoma ?

Answer 11

non-invasive;
ductal carcinoma in situ
lobular carcinoma in situ

invasive;
invasive ductal carcinoma
invasive lobular carcinoma

Question 12

what is an in situ carcinoma ?

Answer 12

preinvasive - no palpable tumour
not detected clinically - only Xray
multicenticity and bilaterality LCIS
no metastatic spread
risk of invasion dependent on grade

Question 13

what is the risk of progression in situ carcinoma ?

Answer 13

low grade DCIS - 30% in 15 years
high grade DCIS - 50% in 8 years
LCIS - 19% in 25 years

Question 14

what are special types of histological classification ?

Answer 14

tubular carcinoma
mucinous carcinoma
carcinoma with medullary features
metaplastic carcinoma

Question 15

how do you diagnose breast carcinoma ?

Answer 15

clinical examination
mammogram
USS
MRI
FNA cytology
needle core biopsy
wide local excision with adequate margins

Question 16

how does the breast screening programme work ?

Answer 16

women aged 50-70
mammogram every 3 years

30% mortality reduction

Question 17

what are microcalcifications ?

Answer 17

tiny deposits of calcium can show up anywhere in breast
most women have one or more areas and majority are harmless
small percentage may be precancerous/cancerous

Question 18

what information is included in histology report of an excised tumour ?

Answer 18

invasive vs noninvasive
histological type
size
margins
lymph nodes
estrogen/progesterone receptors
HER-2

Question 19

where does breast cancer spread ?

Answer 19

local - skin, pectoral muscle
lymphatic - axillary, internal mammary nodes
blood - bones, lungs, liver, brain

Question 20

how do you manage breast cancer ?

Answer 20

staging
surgery 
radiotherapy
antihormonal therapy - tamoxifen
chemotherapy

Question 21

what is Paget’s disease of the nipple ?

Answer 21

result of intraepithelial spread of intraductal carcinoma

large pale-staining cells within the epidermis of the nipple

Question 22

what are symptoms/signs of Paget’s disease of the nipple ?

Answer 22

pain or itching
scaling and redness
looks like eczema

ulceration, crusting, serous or bloody discharge