Week 7 part 1 Flashcards
In the basic structure of the non-lactating breast what is secretory tissue made up from?
15-25 lobules each consisting of a compound tubulo-acinar gland which drains via a series of ducts leading to nipple
What structure system of the mammary gland is described: terminal ductules lead into an intralobular collecting duct which leads into the lactiferous duct for that lobe. The lactiferous duct leads to the nipple, passing through an expanded duct region near the nipple termed the lactiferous sinus?
Duct system
What cells in the mammary gland stain brown for actin and have contractile filaments
Myoepithelial cells
What covers the nipple?
Highly pigmented keratinised stratified squamous epithelium
What is in the nipple core?
Dense irregular connective tissue mixed with bundles of smooth muscle - severeal lactiferous sinuses can be seen
What lines the lactierous duct?
As it approaches surface - stratified squamous epithelium
deeper - lined with stratified cuboidal epithelium
During the luiteal phase of menstrual cycle what happens to epithelial cells and ducts in breast?
Epithelial cells increase in height, lumina of ducts becomes enlarged and small amounts of secretion appear in ducts
What trimester of pregnancy has these breast changes: glandular tissue continues to develop with differentiation of secretory alveoli. Also, plasma cells and lymphocytes infiltrate the nearby connective tissue.
Second
What trimester in pregnancy has these changes in breast: there is elongation and branching of the smaller ducts, combined with proliferation of the epithelial cells of the glands and the myoepithelial cells.
First
What trimester has these changes: secretory alveoli continue to mature, with development of extensive rER.
Third
In pregnancy oestrogen and progesterone stimulate proliferation of what tissue?
Secretory. Fibrofatty becomes sparse
What four components make up human milk?
- 88% water
- 1.5% protein
- 7% Carbohydrate
- 3.5% lipid
With small quantities of ions, vitamins and IgA
How are lipid droplets in human milk secreted?
Apocrine secretion - bud off carrying small amount of cytoplasm with it
How are proteins in milk secreted?
Merocrine secretion - secreted in vesicles which merge with apical membrane to release onkly their contents into duct sustem
following menopause what happens to the secretory cells of the terminal ductal lobule unit?
Degenerate leaving only ducts
Four methods of breast cytopathology?
- FNA
- Fluid
- Nipple discharge
- Nipple scrape
In breast FNA cytology - what is atypia, probably benign?
C3
In breast FNA cytology what is maligannt?
C5
In needle core biopsy, what is benign?
B2
In needle core biopsy, what is suspicious of malignmancy
B4
In needle core biopsy, what is B5?
mAlignant - B5b invasice, a is carcinoma in situ
What is the term for ductal growth without lobular development in males?
Gynaecomastia - caused by liver disease, cannabis, drugs and steroids
What benign breast condition affects women 20-50, very common, has menstrual abnormaltiies, early menarche, late menopause and often resolves after menopause?
Fibrocystic change
What benign breast condition: smooth discrete lumps, sudden pain, cyclical pain, lumpiness, incidental finding on screening?
Fibrocystic change
What gross pathology does fibrocystic change show?
Cysts blue domed with pale fluid
microscopically lined by apocrine epithelium
Circumscribed lesion composed of cell types normal to the breast but present in an abnormal proportion or distribution
Hamartoma
What woen is fibroademoma commoner in?
Africans
What benign breast lesions has peak incidence 3rd decade, painless, firm, discrete, mobile mass which is solid on ultrasound?
Fibroadenoma
Breast mouse
Fibroadenoma - rubbery, grey-white colour, biphasic tumour
Age 20-70, asymptomatic, pain, tenderness or lumpiness/thickening?
Sclerosing adenosis
Stellate architecture, central puckering, radiating fibrosis?
Radial scar
On histology what is seen with a radial scar?
Fibroelastotic core
Radiating fibrosis containing distorted ductules
Fibrocystic change
Epithelial proliferation
What can cause fat necrosis?
Local trauma - seat belt injury
Warfarin therapy
Damage and disruption of adipocytes, infiltration by acute inflammatory cells, “foamy” macrophages, subseuent fibrosis and scarring?
Fat necrosis of breast
Affects sub-areolar ducts Pain Acute episodic inflammatory changes Bloody and/or purulent discharge Fistulation Nipple retraction and distortion
Duct ectasia
What is duct ectasia associated with?
Smoking
In acute mastitis/abscess what are the two causes related to duct ectasia?
Mixed organisms
Anaerobes
In acute mastitis/abscess what are the two causes related to lactqtion?
Staph auresus
Strep pyogenes
40-50 years
Slow growing unilateral breast mass?
Phyllodes tumour
Age 35-60 Nipple discharge +/- blood Asymptomatic at screening Nodules calcification Papillary fronds containing a fibrovascular core covered by myoepithelium and epithelium Epithelium may show proliferative activity
Intraduct papilloma
What miscellaneous malignant breast tumour comes post radiotherapy?
Angiosarcoma
Name three carcinomas that metastasise to breast?
Bronchial
Ovarian serous carcinoma
Clear cell carcinoma of kidney
What is the definition of breats carcinoma?
A malignant tumour of breast epithelial cells
Where does a breast carcinoma arise?
In the glandular epithelium of the terminal duct lobular unit
In relation to breast pathology what are precursor lesions?
Epithelial proliferations
Intra-lobular proliferation of characteristic cells.
Small-intermediate sized nuclei
Solid proliferation
Intra-cytoplasmic lumens/vacuoles
ER positive
E-cadherin negative (deletion & mutation of CDH1 gene on Chr 16q22.1)
Lobular in situ neoplasia
15-20% of breast malignancies are DCIS (formerly 5%)
Arises in TDLU
Characteristically unicentric (single duct system)
Ductal carcinoma in situ
What might involve nipple skin (Pagets disease?
Ductal carcinoma in situ
High grade DCIS extending along ducts to reach the epidermis of the nipple
Still in situ carcinoma (ie non-invasive)
Pagets disease of the nipple
What is an invasive breast carcinoma?
Malignant epithelial cells that have breached the basement membrane
What are the risk factors for breast cancer?
Age
Age of menarche, use of OCP, parity, breast feeding, menopause, HRT
Diet, smoking, BMI, alcohol
Genetics
What is the commonest female cancer?
Invasive breast cancer
1 in 8 will develop it
Classification of Invasive Breast Carcinoma: most common types/
Ductal
Lobular
What are the predictive and prognostic factors for invasive carcinoma?
ER (PgR) - estrogen receptor
HER 2
Symptoms of breast cancer?
- Dimled or depressed nipple
- Visible lump
- Nipple change ex. inversion
- Bloody discharge
- Texture change
- Colour change
What is the most common benign neoplasm of the breast?
Fibroadenoma
When are fibroadenimas usually diagnosed?
Early reproductive years- usually with ultrasound core biopsy
rubbery to firm, mobile, smooth with distinct borders, and is usually nontender.
Fibroadenoma
What resembles a fibroadenoma?
Phyllodes tumour - often larger 3-6cm, 35-45 y/o
When do breast cysts occur?
Late reproductive years
When are breast cysts most tender?
before menstruation
How do you diagnose and treat a cyst?
FNA
wHAT Can sometimes occur within a cyst and is often associated with bloody cyst fluid?
A benign intracystic papillary proliferation called a papilloma
How is normal nipple discharge described?
Clear, yellow and watery
What can present as an erythematous weeping lesion on the surface of the nipple and aerola?
Pagets disease of nipple
What can present as a flocculent sometimes bulging mass in central area of mastitis?
Breast abscess
If there is a breast mass under 40 years old what imaging is done?
Ultrasound
If there is a breast mass over 40 years old what imaging is done?
Mammography and ultrasound
On mammography: what is the best single view?
Mediolateral oblique
In relation to malignant calcification features: what is the distribution like to hint suspicious?
Cluster or segmental
If scattered or diffuse most likely benign
In relation to malignant calcification features on mammogram: what form of cluster shape is suspicous?
Rhomboid forms
Common in women under the age of 30 years
Often described as ‘breast mice’ due as they are discrete, non-tender, highly mobile lumps
fibroadenoma
More common in obese women with large breasts
May follow trivial or unnoticed trauma
Initial inflammatory response, the lesion is typical firm and round but may develop into a hard, irregular breast lump
Rare and may mimic breast cancer so further investigation is always warranted
fat necrosis
Stimulates breast development (both initially and further hyperplasia during pregnancy)
Stimulates milk productio
It decreases GnRH pulsatility at the hypothalamic level and to a lesser extent, blocks the action of LH on the ovary or testis.
prolactin
Stimulates the lactiferous duct system to grow at puberty
oestrogen
Stimulates the mammary glands to produce milk
prolactin
The most common histological type of breast cancer is,
invasie ductal cancer
extensive microcalcifications in the inner quadrant of her left breast.
ductal carcinoma in situ
