11.2 Breast Disease

Question 1

What is the breast made up of made up of?

Answer 1

15-24 lobulated masses
Lobules are stroma with many acini. The acini are made up of cuboidal cells surrounded by myoepithelium which can contract.

Question 2

How does the breast change at puberty?

Answer 2

Increased number of lobules

Increased stroma

Question 3

How does the breast change within a menstrual cycle?

Answer 3

Follicular phase- lobules inactive
After ovulation- cell proliferation and stromal oedema
Menstruation- decreased size of lobules

Question 4

How does the breast change in pregnancy?

Answer 4

Increased size
Increased number of lobules
Decrease in stroma
Secretory changes

Question 5

How does the breast change postmenopause?

Answer 5

Decreased size
Decreased number of lobules
Intralobular stroma replaced with adipose tissue

Question 6

What type of mass is worrying to find in the breast?

Answer 6

Craggy, fixed, hard

Question 7

What may milky breast discharge be a symptom of?

Answer 7

Endocrine disorder

Side effect of medication

Question 8

What may bloody breast discharge be a symptom of?

Answer 8

Benign lesions

Duct ectasia

Question 9

What is a worrying mammogram finding?

Answer 9

Calcifications

Densities

Question 10

What is the most common benign breast tumour?

Answer 10

Fibroadenoma

Question 11

What is polythelia?

Answer 11

More than 2 nipples

Can appear anywhere in milk line

Question 12

What is acute mastitis?

Answer 12

Occurs during lactation

Usually S. aureus infection from nipple cracks

Question 13

How does acute mastitis present?

Answer 13

Painful breast
Pyrexia
Breast abscesses

Question 14

Who is at risk of fat necrosis presenting in the breast?

Answer 14

Recent trauma or surgery

Question 15

How does a benign epithelial lesion present?

Answer 15

Presents as a mass or mammographic abnormality

Question 16

How does a fibroadenoma present?

Answer 16

Mobile, elusive mass (breast mouse)

Question 17

What does a fibroadenoma look like macroscopically?

Answer 17

Rubbery, greyish-white, well-circumcised

Question 18

What does a phyllodes tumour look like?

Answer 18

Nodule of proliferating stroma covered by epithelium

Question 19

What is gynaecomastia?

Answer 19

Enlargement of male breast

Question 20

What causes gynaecomastia?

Answer 20

Puberty- oestrogen levels peak before testosterone
Oestrogen excess- liver cirrhosis
Gonadotrophin excess- testicular tumour
Drug-related- spironolactone, alcohol
Klinefelter syndrome- XXY not enough testosterone

Question 21

What are some risk factors of breast cancer?

Answer 21

Female
Long oestrogen exposure
Exogenous oestrogen 
Previous breast cancer
Geography

Question 22

What is an in situ carcinoma?

Answer 22

Neoplastic population of cells limited to ducts and lobules by the basement membrane.
Myoepithelial cells of acini are maintained.
Vessels not invaded.
No metastases

Question 23

How does DCIS present?

Answer 23

Mammographic calcifications or a mass

Question 24

What does DCIS look like histologically?

Answer 24

Central necrosis with calcification

Question 25

How does Paget's disease present?

Answer 25

Neoplastic cells spread to nipple skin without crossing basement membrane. Presents with unilateral red and crusting nipple.

Question 26

What is an invasive carcinoma?

Answer 26

Neoplastic cells invade beyond basement membrane and into stroma. Can invade vessels Metastasise to other sites

Question 27

What is peau d'orange?

Answer 27

Lymphatic drainage of the skin of the breast is compromised so hairs retract and skin turns orange colour

Question 28

How does invasive ductal carcinoma present histologically?

Answer 28

Atypical cells lining tubules | Poorly-differentiated

Question 29

Where does invasive lobular carcinoma spread to?

Answer 29

``` Peritoneum Retroperitoneum GI Tract Ovaries Uterus ```

Question 30

Where do breast cancers often spread to?

Answer 30

``` Lymph nodes Bones Liver Lungs Brain ```

Question 31

What are the aims of mammographic screening?

Answer 31

Detect small impalpable tumours and pre-invasive cancers | Looks for densities, calcifications and parenchymal abnormalities

Question 32

Who is eligible for mammographcic screening?

Answer 32

Women aged 47-73 | Done every 3 years

Question 33

What surgery can be done to eliminate breast cancer?

Answer 33

Massectomy Breast-conserving surgery Axillary dissection Sentinel lymph node biopsy

Question 34

What is Herceptin?

Answer 34

Drug containing antibodies against the Her2 protein

Question 35

How can survival rates of breast cancer be improved?

Answer 35

``` Early detection Neoadjuvent chemotherapy New therapies- herceptin Gene expression profiling Prevent familial cases ```