Week 3 - Female Pathology

Question 1

The nipple is formed by evagination of the _____ pit

Answer 1

Mammary Pit

Question 2

Name some hormones that play a part in breast development?

Answer 2

Cyclical Estrogen and Progesterone, GH, Glucocorticoids,Insulin

Question 3

What hormones stimulate Lobuloalveolar differentiation?

Answer 3

Insulin, Progesterone and Growth Hormone

Question 4

Breast development decreased in _____ phase of the menstrual cycle

Answer 4

Follicular

Question 5

What processes constitute the triple assessment of breast lumps

Answer 5

1) Clinical history and Examination
2) imaging
3) Needle biopsy

Question 6

Name some disadvantages of FNA

Answer 6

Requires qualified cytologist. No architecture, in situ and invasive. There are chances of False - and False +

Question 7

Same some advantages of Core biopsy

Answer 7

Few False + and False -, Gives diagnosis with tissue architecture, can correlate with mammogram, allows diagnosis of borderline lesions, visulaizes calcifications. In situ.

Question 8

Fibroadenoma

Answer 8

Age: 20-30, Well defined rounded opacity, Scale C2 (B2 or B3 in FNA), Lesion of stroma and epithelium. DIscrete ‘mobile’ lump

Question 9

Phyllodes

Answer 9

Has mitotic activity. Pleomorphic features (cells with nuclei of variable shape and size). Has a margin. Stromal overgrowth. Treat as sarcoma

Question 10

Fibrocystic Lesion

Answer 10

30-40y/o. Fibrosis. Cysts. Apocrine change. Epithelial hyperplasia and Columnar cell change.

Question 11

Radial Scar

Answer 11

Parenchymal distortion or complex sclerosing lesion of the breast. Can radiologically mimic carcinoma. Core biopsy to exclude carcinoma followed by excision biopsy.

Question 12

How can one differentiate between Radial scar and Tubular carcinoma?

Answer 12

Tubule shape, Pattern, Myoeptihelial cells, CK5, SMA, P53,

Question 13

Duct Ectasia

Answer 13

Nipple discharge / inverted nipple. Pain. Linked to smok. Squamous metaplasia of Lactiferous duct. Mammary duct fistula. Microdilated ducts with inflammatory changes.

Question 14

Papillary Lesion

Answer 14

Nipple discharge with blood stained epithelial cells. Microcalcifications. Core biopsy can show Papilloma, FIbrovascular cores, Epithelial and myoepithelial cells, Hyperplasia, single or multiple. Often a central mass is present

Question 15

Pesudoangiomatous Stromal Hyperplasia (PASH)

Answer 15

Hard palpable lump. Well defined mass on imaging. Gross well circumscribed pseudoencapsulated mass. Dense stroma with “anatomising channels” lined by “myofibroblasts”. Rapid englarging mass with skin changes.

Question 16

Granulomaous Mastitis

Answer 16

~33years. Distinct Hard mass. Granulomatous inflammation with abscess formation on Lobules. DDx - TB, Sarcoidosis. Causes - Fungal, atypical mycobacterial, cat scratch disease, vasculitis, Carcinoma associated granulomatous. Core biopsy, NSAIDs, avoid open biopsy if poss.

Question 17

Diabetic Mastopathy

Answer 17

Ill defined hard mass. Perilobular and vascular lymphocytes. Dense “keloid like stroma”. <30y/o. Column cell changes: Hyperplasia, Atypia, Atypical Hyperplasia.

Question 18

In-situ Carcinoma

Answer 18

Malignant Proliferation of Epithelial cells contained within BM. No extension into breast stroma. No communication with BV or Lymphatics. No possibility of Metastases.

Question 19

Ductal In-situ Carcinoma

Answer 19

Lump, Nipple discharge, Pagets d. If untreated - 30% will develop invasive carcinoma in 15 years. Excellent prognosis with surgery. I.e. complete excision, Mastectomy, or local excision with radiotherapy

Question 20

Lobular In-situ Carcinoma

Answer 20

By chance finding on breast biospy. No clinical or mammogrpahic features. Usually multifocal and Bilateral

Question 21

Invasive Ductal Carcinoma

Answer 21

Infiltrating cells in sheets, cords and tubules. Most common type of Breast Cancer

Question 22

What 3 morphological features does “Bloom and richardson grading” indicate?

Answer 22

Tubules, Pleomorphism, Mitoses

Question 23

Lobular Carcinoma

Answer 23

10% of al invasive breast carcinomas, “Signet ring cells” & diffusely infiltrative. Often multicentric and bilateral. Usually grade 2 and ER pos.

Question 24

Tubular Carcinoma

Answer 24

Well differentiated breast carcinoma with 95% 5 yr survival.

Question 25

Mucinous Carcinma

Answer 25

75+ y/o. Well circumscribed tumour with lakes of mucin.

Question 26

Name some pathological prognostic features of a tumour?

Answer 26

Tumour size, Type of Tumour, Grade of Tumour. Node status. 1 Node = 80% 5 yr survival, 4 nodes + = 50% 5yr surv.

Question 27

How are hormone receptor scores organised? (e.g. ER, PR)

Answer 27

0-2 = Negative, 3-5 = Low possib, 5-8 = high possib

Question 28

a) NPI less than 3.4 = ?; b) 3.4 < NPI < 5.4 = ?; c) NPI > 5.4 = ?

Answer 28

a) good, b) intermediate c) poor prognosis