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MD3002 Pathology > Reproductive Pathology: Female 1 > Flashcards

Reproductive Pathology: Female 1 Flashcards

1
Q

What percentage of lesions that occur in the breast are benign?

A

~ 90%

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2
Q

What sort of shape are benign breast lumps?

A

Oval/ellipsoid

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3
Q

What is the difference in allignment between benign and malignant breast lumps?

A

Benign
- Wider than deep; aligned parallel to tissue planes
Malignant
- Deeper than wide

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4
Q

What is the difference like in the margins of malignat and benign lumps?

A

Benign
- Smooth/thin
- Echogenic pseudocapsule with 2-3 gentle lobulations
Malignant
- Irregular or spiculated; echogenic ‘halo’

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5
Q

Is lateral shadowing present in benign or malignant lumps?

A
  • Present in benign

- Absent in malignant

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6
Q

What does a cyst look like on US vs a malignant tumour?

A
  • Cyst is Hypoechoic, black

- Solid malignant lesion will give out a shadow

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7
Q

What are some concerning features of sample cells from breast tissue which may indicate cancer?

A
  • Small cytoplasm
  • Multiple nuclei
  • Multiple and large nuclei
  • Coarse chromatin
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8
Q

What happens to the ducts in postmenopausal women?

A

Terminal duct lobular units are absent. The remaining intermediate ducts and larger ducts are commonly dilated

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9
Q

What is a fibrocystic change (FCC)?

A
  • Nonproliferative change that includes gross and microscopic cysts, apocrine metaplasia, mild epithelial hyperplasia, adenosis and an increase in fibrous stoma
  • Typically multifocal and bilateral
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10
Q

What happens in apocrine metaplasia/what can be seen on histoligally?

A
  • MAture cell type replaced by another cell type

- Normal 2 cell lining of the ducts and lobules replaced by esinophil granules which resemble apocrine sweat glands

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11
Q

What percentage of women have Fibrocystic change?

A

1/3 20-50 years old (declines after menopause

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12
Q

Does FCC increase the risk of breast cancer?

A

NO - but can make potentially cancerous lumps harder to identify

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13
Q

What is the increase in risk of developing carcinoma from proliferative breast disease?

A
  • 2 fold without atypia, (5-15 years)

- 5 fold with atypia (patient requires close clinical monitoring)

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14
Q

Describe the changes that lead to breast cancer?

A
  • Normal epithelium
  • Proliferative disease without atypia
  • Atypical hyperplasia
  • DCIS
  • Invasive breast cancer
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15
Q

What substance is used in breast magnetic resonance imaging to see vascularity better?

A

Gadolinium

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16
Q

What is gynaecomastia?

A
  • Hyperplasia of the male breast stromal and ductal tissue

- Usually caused by a relative increase in the estrogen to androgen ratio in the circulation or breast tissue

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17
Q

What is the most common cause of gynaecomastia?

A
  • Secondary to drugs
  • OLder patients: CV and prostate drugs
  • Younger patients most likely cannabis, anabolic steroids, anti-ulcer drugs and antidepressants
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18
Q

What ages are physiological gynaecomastia present?

A
  • Neonats
  • Pubertal
  • Senescence
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19
Q

What can be some pathalogical causes of gynaecomastia?

A
  • Undiagnosed hyperprolactinaemia
  • Liver failure
  • Alcohol excess
  • Obesity
  • Malignancy (testes, lung)
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20
Q

What are the different types of benign breast tumours?

A
  • Fibroadenoma
  • Duct papilloma
  • Adenoma
  • Connective tissue tumours
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21
Q

What do fibroadenomas look like?

A
  • Well circumscribed and highly mobile
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22
Q

What do fibroadenomas arise from?

A

breast lobules and are composed of fibrous epithelial tissue

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23
Q

WHat are fibroadenomas clinically hard to differentiate from?

A

Phyllodes tumours (distinct pathology, malignant)

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24
Q

What are the differences between fibroadenomas and phyllodes tumour?

A
  • Phyllodes tumours are sarcomas which rapidly enlarge and have variable degress of malignant potential
  • They are larger than fibroadenomas and tend to occur in an older age grouop
  • Fibroadenomas appear as well-defined, smooth, oval-shaped lump, distinctly mobile and easily identified on US
  • Young patients (less than 25yrs) with clearly benign clinical and imaging findings are usually spared a core biopsy
  • In older patients we have to rule out occult malignany / Phyllodes tumour
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25
Q

What does fat necrosis usually present like?

A
  • Soft, indistinct lump that develops a few weeks after a traumatic incident, often in older women with fatty brreasts
  • Often hard to distinguish on imaging from breast cacncer, core biopsy often indicated
26
Q

What is the lifetime risk for women of breast cancer?

A

1 in 9

27
Q

What factors are very likely increase the risk of breast cancer?

A
  • Alcoholic beverages
  • Diethylstilbestrol
  • Oestrogen-progestogen contraceptives
  • Oestrogen-progesterone menopausal therapy
  • X radiation and gamma radiation
  • Body fatness (pos-menopause)
  • Adult attained height (post-menopause)
28
Q

What factors are thought to probably increase the chances of breast cancer?

A
  • Digoxi
  • Oestrogen menopausal therapy (HRT)
  • Ethylene oxide
  • Shiftwork involving circadian disruption
  • Tobacco smoking
  • Greater birth weight
  • Abdominal fatness
  • Adult weight gain
  • Total dietary fat
29
Q

What decreases the risk of breast cancer?

A
  • Breastfeeding
  • Body fatness thought to possibly decrease chances of pre-menopausal BC
  • Physical activity thought to decrease risk
30
Q

What is Diethylstilbestrol?

A
  • Drug prescribed to mothers, thought to prevent miscarriage and pregnancy complications from 1940 - 71 (it didn’t)
  • Synthetic estrogen
  • Increases chances of breast, uterine and vaginal cancer in mother and fetus
31
Q

What are the 2 forms of non-invasive precursors of breast cancer?

A

Ductal carcinoma in situ
- Often unilateral
Lobular carcinoma in situ
- Often bilateral, can be multifocal

32
Q

What do micro-calcifications which show up on X-ray indicate?

A

Ductal carcinoma

33
Q

What percentage of carcinomas of the breast are thought to be ‘no special type’ or ‘ductal’?

A

75 - 90%

34
Q

What percentage of carcinomas are thought to be infiltrating lobular carcinomas? (may be multifocal)

A

10%

35
Q

What is Paget’s disease of the nipple?

A
  • Apparent eczema of nipple (unilateral)

- Associated with underlying in situ or invasive carcinoma

36
Q

How can breast cancer spread?

A
  • Direct
  • Lymphatics
  • Bloodstream
  • Transcoelomic
37
Q

What will a sentinel node biopsy show?

A
  • What nodes (axillary) has the cancer spread to
38
Q

What factors affect the prognosis of breast cancers?

A
  • Tumour type
  • Tumour grade
  • Tumour grade (size, metastases)
  • Oestrogen receptor
  • HER-2 amplification (~20%)
39
Q

What is the prognosis for breast cancer like now?

A
  • 80% - 5 year
  • 75% - 10 years
  • 66% - 20 year survival rate
40
Q

How many women have cancer found in screening?

A
  • 4 out of 100 are called back for further investigation

- Overall, cancer is found in 8 out of every 1000 women

41
Q

How often are women screened in the NHS breast screening programme?

A

Women between 50 and 70 are screened every 3 years

42
Q

WHat percentage of breast cancer patients are thought to be affected by breast cancer genes?

A

5%

43
Q

Yearly MRI scans are given to what women?

A
  • TP53 mutation from aged 20

- BRCA1 and BRCA2 mutation from age 30

44
Q

When should women be referred urgently?

A
  • Aged 30 or over and have unexplained breast lump with or w/o pain
  • Aged 30 or over with unexplained lump in axilla
  • Skin changes suggestive of breast cancer
  • Aged 50 and over with any of the following symptoms in one nipple only: discharge, retraction or other changes of concern
45
Q

What is the main aetiological factor for cervical squamous neoplasia?

A

Human papillomavirus

46
Q

What are the cervical changes which lead to cervical cacncer?

A
  • Normal
  • LSIL
  • HSIL (these 2 classes divided by Bethesda classification)
  • Cervical cancer
47
Q

What 2 main factors increase risk of cervical squamous neoplasia?

A
  • Smoking

- Immunosuppresion (HIV)

48
Q

How is the pre-invasive disease detected for cervical sq neoplasia?

A

Cervical cytology

49
Q

Where does cervical cancer take place usually?

A
  • Transformation zone (squamo-columnar junction)
50
Q

What leads to reverse cell hyperplasia?

A

Low pH of vaginal mucous (causes everted squamous cells to turn to columnar)
- Reverse cell hyperplasia then leads to sq metaplasia

51
Q

Whata re 2 types of cervical biopsy?

A
  • Punch biopsy

- Cone biopsy (more invasive)

52
Q

What is a Large loop excision (of the transformation zone) procedure (LEEP or LLETZ)?

A

Burning off of superficial layer of cells in transitional zone and can be done in outpatient clinic used to prevent Cervical cancer

53
Q

What is cryo therapy?

A

A lot like burning off a veruca or wart, destruction of transitional zone

54
Q

What is the classic symptom of invasive cervical cancer?

A

Post coital bleeding, mainly asymptomatic in early stages

55
Q

What are a minority of invasive cervical cancers?

A

Adenocarcinomas

- Precursor lesion cervical glandular intraepithelial neoplasia (CGIN)

56
Q

What is the treatment for squamous cell carcinoma of the cervix?

A

Radical hysterectomy for localise tumour

- Tumours larger than 4 cm or spread beyond cervix - radiotherapy eith concurrent platinum based chemotherapy

57
Q

What how many strains does the HPV vaccine include?

A

Quadrivalent

58
Q

What strains of HPV are most carcinogenic?

A

16 and 18

59
Q

What percentage of sq intraepithelial lesions become invasive cancer?

A

less than 1% (6% progress to HSIL)

60
Q

What is the mean age at which women develop sq intraepithelial lesions or cervical intraepithelial neoplasia?

A

25 - 30 years

MD3002 Pathology (19 decks)

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