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Pathology by week > W13 - Breast pathology > Flashcards

W13 - Breast pathology Flashcards

1
Q

What breast samples (2) undergo cytology?

Aspirates of breast lumps are coded C1-5 => what does each indicate?

A

Breast samples: (1) nipple discharge, (2) palpable lumps

—C1 = inadequate

—C2 = benign

—C3 = atypia, probably benign

—C4 = suspicious of malignancy

—C5 = malignant

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2
Q

5 different breast FNA cytology - what does each show?

A

Top right = healthy, benign aspirate = flat sheet of cells of epithelial cells, no overlapping, lots of cytoplasm

Top left = lots of debris, red are RBC, neutrophils = you can’t see the monolayer so inadequate

Bottom left = fat cells = large empty-looking cells with nuclei on outer esges

Bottom right = healthy, benign benign = lots of glandular tissue, monolayer sheet (common in young girls)

Bottom = more structured unit = as compared to top right, this patient has got glandular proliferation and forming branches and staghorn clefts = may have an underlying benign tumour

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4
Q

Name 2 pros and 1 con of cytopathology of breast samples

A

Pros:

  1. Good cellular detail
  2. Quick to prepare

Cons:

  1. No architectural info
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5
Q

Name 1 pros and 2 cons of histopathology of breast samples.

A

Pros: 1. Architectural and cellular detail

Cons: 1. Takes longer (24h) to process

  1. Core biopsies requiring surgical excisions
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6
Q

Name 3 inflammatory breast diseases

A
  1. Duct ectasia
  2. Acute mastitis
  3. Fat necrosis
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7
Q

What does this breast histological slide show?

A

This duct is enlarged (maybe x12)

lots of proteinaceous excretion in the lumen

duct ectasia!

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8
Q
  1. What is duct ectasia?
  2. How does it present?
  3. What does FNA cytology show?
  4. Risk of cancer?
A
  1. inflammation and dilation of large breast ducts
  2. nipple discharge +/- breast pain, breast mass, nipple retraction
  3. FNA = proteinaceous material + inflammatory cells
  4. no increased risk of malignancy
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10
Q

What does this breast cytology show?

A
  1. Oval cells are histiocytes
  2. Empty spaces are FAT
  3. Multinucleated cells are giant cells

= fat necrosis

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11
Q
  1. What is acute mastitis?
  2. How does it present?
  3. Causative organism?
  4. What does FNA cytology show?
  5. Complications
  6. Treatment
A
  1. acute inflammation in the breast
  2. often in lactating women (due to cracked skin + milk stasis) => painful red breast
  3. staphylococci (usually)
  4. abundant polymorphonuclear cells, macrophages, lots of debris.
  5. breast abscess (1), duct ectasia (2)
  6. Warm compression, milk expression, analgesia, increased fluid intake, sometimes abx (dicloxacillin) and sometimes drainage
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12
Q

What does this breast histology image show?

A

normal lobule on left

large calcified cysts on right

fibrocystic disease

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13
Q
  1. What is fat necrosis?
  2. Aetiology?
  3. How does it present?
  4. What does FNA cytology show?
  5. Is it benign?
A
  1. Inflammatory reaction to damaged adipose tissue
  2. Caused by trauma (1), surgery (2), radiotherapy (3)
  3. A breast mass
  4. histiocytes (1), multinucleated giant cells (2) and degenerating adipocytes (3)
  5. Benign condition
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14
Q

What do these cytology and histology slides show?

A

histology = monolaye sheet, lots of honeycomb cells, staghorn like arrangement

histology = well circumscribed edge, lots of tissue proliferation = glands compressed

= fibroadenoma

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16
Q

What do these cytology and histology show?

A

cytology = DENSE = lots of CELLS, large nuclei (not like firboadenoma where it’s a monolayer)

histology = lots of stroma, phyllodes = leaf-like moprhology

= phyllodes tumour

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17
Q
  1. What is fibrocystic disease?
  2. How does it present?
  3. What does histology show?
  4. Is it benign?
A
  1. a group of alterations int he breast which reflect NORMAL, albeit exaggerated, responses to hormonal influences
  2. breast lumpiness
  3. normal lobules, hypercalcified cysts
  4. Completely
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18
Q

What do these cytology and histology images show?

A

cytology => finger-like projections

histology => enlarged, dilated ducts

= intraductal papilloma

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20
Q

What does this histology show?

A

Central fibrous scar with radiating lobules and ductules = radial scar (also known as complex sclerosing lesion if lesion >1cm)

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21
Q
  1. What is a fibroadenoma?
  2. How does it present?
  3. What does histology show? What does cytology show?
  4. Is it benign?
  5. Treatment
A
  1. A benign fibroepithelial neoplasm of the breast
  2. Mobile, circumscribed breast lump in young women 20-30s
  3. histology = well-circumscribed edge, compressed glands due to high proliferation of tissue

cytology = monolayer sheets, honeycomb sheets, lots of staghorn and antler-like cells

  1. yes, very low chance of becoming cancerous
  2. Shelling out is curative
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23
Q
  1. What is a phyllodes tumour?
  2. How does it present?
  3. What does histology show? What does cytology show?
  4. Is it benign?
A
  1. A group of potentially aggressive fibroepithelial neoplasms of the breast
  2. enlarging breast lump in women >50y
  3. cytology = DENSE = lots of CELLS, large nuclei (not like firboadenoma where it’s a monolayer)

histology = lots of stroma, phyllodes = leaf-like moprhology

  1. Vast majority behave benignly, but small proportion could be aggressive!
24
Q

What does this histology slide of the breast show? Risk of cancer?

A

Multilayering of the epithelium; but nothing has spread outside the duct = epithelial hyperplasia (type of proliferative breast disease)

RR 1.5-2x for subsequent invasive carcinoma

25
Q

What does this histology slide of the breast show? Risk of cancer?

A

Flat epithelial atypia around the ducts, ducts are dilated and glands are more “blue”, frequent secretions and calcifications within dilated glands = FEA (flat epithelial atypia/atypical ductal carcinoma ; type of proliferative breast disease)

RR 4x of developing cancer

27
Q
  1. What is an intrudcutal papilloma?
  2. How does it present?
  3. What does histology show? What does cytology show?
  4. Is it benign?
A
  1. —A benign papillary tumour arising within the duct system of the breast, usually in women 40-60 y.o.
  2. IF arising from small terminal ductules (peripheral papilloma) => remain silent if small

IF arising from larger lactiferous ducts (central papilloma) => occlusion of ductal system => nipple discharge/blood

  1. cytology => finger-like structures

histology => large, dilated ducts

  1. could be in situ tumours that become invasive later = warrants excision
28
Q

What does each histology slide of the breast show?

A

Left = Atypical ductal hyperplasia, Punched out lesions, calcified, nuclei similar size ro adjacent RBC = low grade DCIS

Right = as above + lots of central necrosis and calcifications = high grade DCIS

30
Q
  1. What is a radial scar?
  2. How does it present?
  3. What does histology show?
  4. Is it benign?
A
  1. A benign sclerosing lesion characterised by a central zone of scarring surrounded by a radiating zone of proliferating glandular tissue
  2. usually present as stellate masses on screening mammograms which may closely resemble a carcinoma. Ig lstge lesion then pt may present with mass
  3. central scar that is fibrous with radiating ducts and lobules
  4. can harbour atypical cells = warrants excision
32
Q

A benign breast lesion that most commonly mimicks breast cancer on radiology?

A

Radial scars

Fat necrosis

33
Q

What do these cytology and histology slides of breast sample show?

A

Cytology = very large, irregular nuclei with very litle cytoplasm

Histology = very irregular cells invading the fat spaces

= invasive ductal carcinoma

34
Q

What does this histology of the breast show?

A

Lobular carcinoma, but you see they also traverse through the stroma in this single-layer trabeculae fashion = invasive lobular carcinoma

35
Q

What do each of these histology slides of breast tissues show?

A

Left = open tubules with dispersed cells = these are associated with radial scars = inasive tubular carcinoma

Right = nests of tumour cells submerged in mucin (can’t see), usually have a glassy-appearance = invacine mucinous carcinoma

36
Q

What are proliferative breast diseases?

Name 3 types

A

A diverse group of intraductal proliferative lesions of the breast associated with an increased risk, of greatly different magnitudes, for subsequent development of invasive breast carcinoma

1. Epithelial hyperplasia

2. Flat epithelial atypia/atypical ductal carcinoma

3. In situ lobular neoplasia

37
Q

What do these histology slides of breast tissue show? What do they have a propensity for?

A

Very dark cells, little cytoplasm, brown stain on bottom is for basal markers and hence, these arise from basal cells (pick up CK5 and CK14 = basal-like carcinoma

Propensity to vascular invasion and distant metastatic spread

38
Q

What are the symptoms of proliferative breast diseases?

A

Microscopic lesions = usually produce NO symptoms.

41
Q

What is DCIS?

A

Ductal carcinoma in situ (DCIS) = A neoplastic intraductal epithelial proliferation in the breast with a risk of progression to invasive breast carcinoma. depending on the grade DCIS could either spread or stay in situ.

85% identified on mammograms as microcalcifications

42
Q

How does DCIS present?

A
  • 85% are detected on mammography as areas of microcalcification.
  • 10% produce clinical findings such as a lump, nipple discharge, or eczematous change of the nipple (Paget’s disease of the nipple).
  • 5% are diagnosed incidentally in breast specimens removed for other reasons.
43
Q

Is there a risk of malignancy with gynaecomastia?

A

No - it is fully benign and is epithelial hyperplasia with typical finger-like projections extending into the duct lumen. Periductal stroaml is often CELLULAR and OEDEMATOUS

45
Q

What is the treatment for DCIS?

A
  • Surgical excision = complete excision with clear margins is curative. Recurrence more likely with extensive disease + high grade DCIS
46
Q

What are invasive breast carcinomas? Lifetime risk in women?

A

Invasive breast carcinomas are a group of malignant epithelial tumours which infiltrate within the breast and have the capacity to spread to distant sites.

lifetime risk of 1 in 8.

47
Q

RFs (7) for invasive breast carcinoma

A
  1. Early menarche
  2. Late menopause
  3. Increased wieght
  4. High alcohol consumption
  5. OCP
  6. Family history
  7. BRCA mutation = 85% lifetime risk of developing invasive breast carcinoma
48
Q

How does invasive breast carcinoma usually present?

A
  • Most cases with a breast lump
52
Q

What is the most common malignant breast tumour?

A

Invasive ductal carcinoma (IDC)

54
Q

What 3 parameters are used to histologically grade invasive breast cancers? How many scores is each given? Total score?

A
  1. Tubule formation
  2. Nuclear pleomorphism
  3. Mitotic activity

each parameter is scores from 1-3. Total scores from 3-9.

3-5 = grade 1 (well differentiated), 6-7 = grade 2 (moderately differentiated), 8-9 = grade 3 (poorly differentiated)

55
Q

How are invasive breast carcinomas treated?

Describe properties of low-grade, high-grade tumours, and basal-like carcinomas related to treatment

A
  1. All are assesed for oestrogen receptor (ER), progesterone receptor (PR), and Her2 status

Low grade tumours tend to be ER/PR + and Her2 -

High grade tumours tend to be ER/PR - and Her2 +

Basal-like carcinomas are often ER/PR/Her2 - (triple negative)

56
Q

The single most important prognostic factor for invasive breast carcinomas is ___________?

Name some other prognostic factors (3)

A

Infiltration into axillary LNs

  1. Tumour size
  2. Histological type
  3. Histological grade
57
Q

Describe the aim of the NHS Breast Screening Programme

Who is included?

A
  • pick up DCIS or early invasive carcinomas
  • women aged 47-73 are invited for screening every 3 years
  • mammogram looking for abnormal areas of calcification or a mass within the breast
58
Q

What % of women have an abnormal mammogram?

They are then invited for further testing, such as having a core biopsy taken. These are scored by B1 => B5. Describe each

A

5%

B1 = normal breast tissue.

B2 = benign abnormality.

B3 = lesion of uncertain malignant potential.

B4 = suspicious of malignancy.

B5 = malignant (B5a = DCIS, B5b = invasive carcinoma).

Pathology by week (70 decks)

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