Repro 11.2 pathology of the breast Flashcards
What symptoms may signify breast pathology?
tenderness
nipple changes (inversion, dimpling, secretions)
palpable mass
skin changes (dimples, darkening)
lumpiness
Other than symptoms, how else might breast pathology be suspected?
By use of mammography
With regards to breast pain, what features are more likely to mean the cause is benign?
- cyclical
- diffuse
Eg due to menstruation. (higher progesterone levels cause changes to the ductular-lobuar system which can cause pain)
With regards to a palpable mass, what features mean it is more likely to be due to a malignant cause?
- hard
- craggy
- fixed
Give some features of the different kinds of nipple discharge.
- milky, white (eg due to endocrine disorders)
- bilateral/unilateral (unilateral is more worrying)
- bloody
- serous
When is mammography used to screen women, and why at this time?
Ages 47-73.
Before this age you cant really see anything, there is lots of stroma and tissue. AS you get older, more stroma is replaced by adipose tissue which makes screening easier.
What may be picked up by mammography?
- densities (eg fibroadenomas, invasive carcinomas, cysts)
- calcifications (DCIS or benign changes)
How can breast pathology by classified?
- inflammatory
- benign epithelial lesions
- stomal tumours
- male breast conditions
- breast carcinomas
Give examples of some inflammatory conditions causing breast pathology.
- mastitis
- Duct ectasia
- fat necrosis
Discuss features of acute mastitis.
almost always occurs when lactating
often caused by S. Aureus,
Can cause breast abscess
What is duct ectasia?
dilation or chronic inflammation of the ducts, can cause peri-areolar masses or nipple discharge.
What might cause fat necrosis in the breast?
Why is it worrying?
Commonly by trauma, or due to breast surgery.
Mimics carcinomas clinically and on mammography.
Give some examples of benign epithelial lesions.
- fibrocystic change
- papilloma
- epithelial hyperplasia
What is meant by fibrocystic change?
- common in increasing age
- present as a mass or on mammography
- the mass can be aspirated and will often disappear
- histologically shows cyst formation, fibrosis and apocrine metaplasia.
Give examples of stromal tumours of the breast.
- fibroadenomas
- phyllodes tumour
What is a fibroadenoma?
- a mobile mass which may be picked up on mammography
- ‘breast mouse’ because freely moving and elusive
- common in younger women, often present before 30.
- can grow large to take over whole breast
Macroscopically, what does a fibroadenoma look like?
White/grey,
well circumscribed
rubbery
Histologically, what does a fibroadenoma look like?
- stromal components
- compressed epithelia
When does a phyllodes tumour often present?
After 50.
What is special about the presentation of the phyllodes tumours?
They can present on a spectrum, some being benign (most). and some being malignant, then some inbetween.
Give some features of the phyllodes tumour.
- spectrum of severity
- firm palpable mass
- grows quickly
- proliferated stroma coverred by epithelium
- need excision via a wide margin
Give the main male breast condition.
Gynecomastia
What is meant by gynecomastia?
When is it most common?
Excessive male breast tissue.
-puberty and the elderly.
Give some causes of gynecomastia.
- cirrhosis of the liver (Excess oestrogne circulating as it cannot be metabolised)
- excessive fat (converts androgens to oestrogen)
- testicular tumour (produces hormones in excess)
What are some risk factors associated with development of breast cancers.
- age
- gender
- excessive oestrogen exposure (Eg early puberty, late menopause, no pregnancy)
- obesity
- breast feeding
- HRT
- Genetics
- geographical influence
What proportion of breast cancers are thought to be hereditary?
3%
What genes are associated with familial breast cancer?
BRCA1, BRCA2.
Thought to be responsible for 25% of cases.
For carriers of a familial breast cancer, what is the lifetime risk of getting it?
85%
How can breast adenocarcinomas be categorised?
- in situ or invasive
- ductal or lobular
What is DCIS?
Ductal carcinoma in situ
The malignant cells are confined by the basement membrane and myoepithelial cells are preserved
This condition alone cannot cause death
How does DCIS often present?
- mammographic calcifications
- mass
What does DCIS look like histologically?
Central necrosis with calcification is present
How do invasive carcinomas often present?
- A hard craggy fixed mass.
- Calcifications on mammography
What sized cancer is palpable?
What is the consequence of this?
> 2cm.
By this time, an invasive adenocarcinoma of the breast will have spread to the axillary lymph nodes
What are the 2 types of invasive carcinoma of the breast?
- invasive ductal carcinoma no special type (IDC NST)
- Invasive lobular carcinoma
What are some features of IDC NST?
- most common type of invasive carcinoma (70-780%)
- various levels of grading
What are some features of invasive lobular carcinoma?
The cells lack E cadherin, so lack adhesion and are seen in single file when infiltrating.
How do breast cancers spread?
Commonly to ipsilateral axillary lymph nodes
Can via haematogenous spread (BONE, brain, liver, lung)
What does prognosis of breast carcinoma depend on?
- type
- grade
- stage
- spread
How is breast cancer investigation carried out?
Triple approach
- clinical (history, family history, examination)
- imaging (Mammography, USS)
- pathology (core biopsy, fine needle aspiration)
What treatments are there for breast cancer?
local- breast surery, local excision or mastectomy, post operative radiotherapy
systemic- chemotherapy, HRT
What does HRT for breast cancer depend on?
-the type of receptors present,
Eg if oestrogen receptors are present you can use tamoxifen to block them.
If HER2 receptors are present you can use herceptin treatment to block them.
