Reproductive Pathology: Female 1 Flashcards
What percentage of lesions that occur in the breast are benign?
~ 90%
What sort of shape are benign breast lumps?
Oval/ellipsoid
What is the difference in allignment between benign and malignant breast lumps?
Benign
- Wider than deep; aligned parallel to tissue planes
Malignant
- Deeper than wide
What is the difference like in the margins of malignat and benign lumps?
Benign
- Smooth/thin
- Echogenic pseudocapsule with 2-3 gentle lobulations
Malignant
- Irregular or spiculated; echogenic ‘halo’
Is lateral shadowing present in benign or malignant lumps?
- Present in benign
- Absent in malignant
What does a cyst look like on US vs a malignant tumour?
- Cyst is Hypoechoic, black
- Solid malignant lesion will give out a shadow
What are some concerning features of sample cells from breast tissue which may indicate cancer?
- Small cytoplasm
- Multiple nuclei
- Multiple and large nuclei
- Coarse chromatin
What happens to the ducts in postmenopausal women?
Terminal duct lobular units are absent. The remaining intermediate ducts and larger ducts are commonly dilated
What is a fibrocystic change (FCC)?
- Nonproliferative change that includes gross and microscopic cysts, apocrine metaplasia, mild epithelial hyperplasia, adenosis and an increase in fibrous stoma
- Typically multifocal and bilateral
What happens in apocrine metaplasia/what can be seen on histoligally?
- 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
What percentage of women have Fibrocystic change?
1/3 20-50 years old (declines after menopause
Does FCC increase the risk of breast cancer?
NO - but can make potentially cancerous lumps harder to identify
What is the increase in risk of developing carcinoma from proliferative breast disease?
- 2 fold without atypia, (5-15 years)
- 5 fold with atypia (patient requires close clinical monitoring)
Describe the changes that lead to breast cancer?
- Normal epithelium
- Proliferative disease without atypia
- Atypical hyperplasia
- DCIS
- Invasive breast cancer
What substance is used in breast magnetic resonance imaging to see vascularity better?
Gadolinium
What is gynaecomastia?
- 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
What is the most common cause of gynaecomastia?
- Secondary to drugs
- OLder patients: CV and prostate drugs
- Younger patients most likely cannabis, anabolic steroids, anti-ulcer drugs and antidepressants
What ages are physiological gynaecomastia present?
- Neonats
- Pubertal
- Senescence
What can be some pathalogical causes of gynaecomastia?
- Undiagnosed hyperprolactinaemia
- Liver failure
- Alcohol excess
- Obesity
- Malignancy (testes, lung)
What are the different types of benign breast tumours?
- Fibroadenoma
- Duct papilloma
- Adenoma
- Connective tissue tumours
What do fibroadenomas look like?
- Well circumscribed and highly mobile
What do fibroadenomas arise from?
breast lobules and are composed of fibrous epithelial tissue
WHat are fibroadenomas clinically hard to differentiate from?
Phyllodes tumours (distinct pathology, malignant)
What are the differences between fibroadenomas and phyllodes tumour?
- 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
What does fat necrosis usually present like?
- 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
What is the lifetime risk for women of breast cancer?
1 in 9
What factors are very likely increase the risk of breast cancer?
- Alcoholic beverages
- Diethylstilbestrol
- Oestrogen-progestogen contraceptives
- Oestrogen-progesterone menopausal therapy
- X radiation and gamma radiation
- Body fatness (pos-menopause)
- Adult attained height (post-menopause)
What factors are thought to probably increase the chances of breast cancer?
- Digoxi
- Oestrogen menopausal therapy (HRT)
- Ethylene oxide
- Shiftwork involving circadian disruption
- Tobacco smoking
- Greater birth weight
- Abdominal fatness
- Adult weight gain
- Total dietary fat
What decreases the risk of breast cancer?
- Breastfeeding
- Body fatness thought to possibly decrease chances of pre-menopausal BC
- Physical activity thought to decrease risk
What is Diethylstilbestrol?
- 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
What are the 2 forms of non-invasive precursors of breast cancer?
Ductal carcinoma in situ
- Often unilateral
Lobular carcinoma in situ
- Often bilateral, can be multifocal
What do micro-calcifications which show up on X-ray indicate?
Ductal carcinoma
What percentage of carcinomas of the breast are thought to be ‘no special type’ or ‘ductal’?
75 - 90%
What percentage of carcinomas are thought to be infiltrating lobular carcinomas? (may be multifocal)
10%
What is Paget’s disease of the nipple?
- Apparent eczema of nipple (unilateral)
- Associated with underlying in situ or invasive carcinoma
How can breast cancer spread?
- Direct
- Lymphatics
- Bloodstream
- Transcoelomic
What will a sentinel node biopsy show?
- What nodes (axillary) has the cancer spread to
What factors affect the prognosis of breast cancers?
- Tumour type
- Tumour grade
- Tumour grade (size, metastases)
- Oestrogen receptor
- HER-2 amplification (~20%)
What is the prognosis for breast cancer like now?
- 80% - 5 year
- 75% - 10 years
- 66% - 20 year survival rate
How many women have cancer found in screening?
- 4 out of 100 are called back for further investigation
- Overall, cancer is found in 8 out of every 1000 women
How often are women screened in the NHS breast screening programme?
Women between 50 and 70 are screened every 3 years
WHat percentage of breast cancer patients are thought to be affected by breast cancer genes?
5%
Yearly MRI scans are given to what women?
- TP53 mutation from aged 20
- BRCA1 and BRCA2 mutation from age 30
When should women be referred urgently?
- 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
What is the main aetiological factor for cervical squamous neoplasia?
Human papillomavirus
What are the cervical changes which lead to cervical cacncer?
- Normal
- LSIL
- HSIL (these 2 classes divided by Bethesda classification)
- Cervical cancer
What 2 main factors increase risk of cervical squamous neoplasia?
- Smoking
- Immunosuppresion (HIV)
How is the pre-invasive disease detected for cervical sq neoplasia?
Cervical cytology
Where does cervical cancer take place usually?
- Transformation zone (squamo-columnar junction)
What leads to reverse cell hyperplasia?
Low pH of vaginal mucous (causes everted squamous cells to turn to columnar)
- Reverse cell hyperplasia then leads to sq metaplasia
Whata re 2 types of cervical biopsy?
- Punch biopsy
- Cone biopsy (more invasive)
What is a Large loop excision (of the transformation zone) procedure (LEEP or LLETZ)?
Burning off of superficial layer of cells in transitional zone and can be done in outpatient clinic used to prevent Cervical cancer
What is cryo therapy?
A lot like burning off a veruca or wart, destruction of transitional zone
What is the classic symptom of invasive cervical cancer?
Post coital bleeding, mainly asymptomatic in early stages
What are a minority of invasive cervical cancers?
Adenocarcinomas
- Precursor lesion cervical glandular intraepithelial neoplasia (CGIN)
What is the treatment for squamous cell carcinoma of the cervix?
Radical hysterectomy for localise tumour
- Tumours larger than 4 cm or spread beyond cervix - radiotherapy eith concurrent platinum based chemotherapy
What how many strains does the HPV vaccine include?
Quadrivalent
What strains of HPV are most carcinogenic?
16 and 18
What percentage of sq intraepithelial lesions become invasive cancer?
less than 1% (6% progress to HSIL)
What is the mean age at which women develop sq intraepithelial lesions or cervical intraepithelial neoplasia?
25 - 30 years
