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Year 5 Path Charis > Histopathology - Breast > Flashcards

Histopathology - Breast Flashcards

1
Q

Breast cytopathology

C1
C2
C3
C4
C5
A 
	C1 = inadequate 
	C2 = benign
	C3 = atypia, probably benign
	C4 = atypia, probably malignant
	C5 = malignant
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2
Q

Gold standard for the dx of breast cancer

A

Histopathology

Shows the architectural and cellular detail

H nuclei purple
E cytoplasm pink

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3
Q

Normal breast histology

A

Ductal lobular system lined by inner glandular epithelium

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4
Q

Mammary duct ectasia buzzwords

A

Smoking

Multiparous 40-60

Inflammation + dilation of large breast ducts

Benign

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5
Q

Mammary duct ectasia presentation

A

o Brown/green secretion
o periductal mastitis/ abscess/ fistula formation
o Mass beneath areola
o May cause slit like nipple retraction

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6
Q

Mammary duct ectasia

Histology

Cytology of nipple discharge

A

Histology
o Duct distension with proteinaceous material in it
o Foamy macrophages

Cytology
o Proteinaceous material
o Foamy macrophages

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7
Q

Acute mastitis cytology

A

Foamy macrophages

Abundance of neutrophils

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8
Q

Fat necrosis

presentation
cyotlogy

A

painless mass
skin tethering/ nipple retraction

fat cells surrounded by macrophages, lymphocytes, empty spaces, histocytes, giant cells

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9
Q

What is fibroadenoma and what happens to it during pregnancy and after menopause

A

Arise from interlobular stroma
Proliferation of glands and fibrous tissue

Increases in size during pregnancy
calcifies after menopause

Young women
20-30

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10
Q

What are phyllodes tumours + histology

A

Group of potentially aggressive fibroepithelial neoplasms
can be benign, borderline or malignant
arise from interlobular stroma

enlarging mass in >50

Histology - overlapping cells, cellularity

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11
Q

Peripheral vs central intraductal papilloma

A

 Small terminal ductules  peripheral papilloma  clinically silent

 Large lactiferous ductules  central papilloma  bloody nipple discharge, occlusion of the duct system, erosion

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12
Q

Intraductal papilloma

cytology
histology

A

cytology
clusters of cells
polyp/finger like projections

Histology
Dilated ducts
papillary mass within dilated duct lined by epithelium 
fibrovascular core
blood vessels within the stroma
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13
Q

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

A

Radial scar

also, mammary duct ectasia can mimic cancer on mammgrams

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14
Q

Which benign lesion cannot be seen on mammogram?

A

Intraductal papilloma

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15
Q

What is a radial scar?

A

Benign sclerosing lesion with a

central zone of scarring surrounded by a radiating zone of proliferating glandular tissue in stellate pattern

caused by exaggerated reparative phenomenon in response to areas of tissue damage within the breast

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16
Q

Symptoms of proliferative breast disease

A

Produce no symptoms

17
Q

Is usual epithelial hyperplasia pre-malignant?

A

o Not a true pre-malignant change

o Not considered a precursor lesion

18
Q

Which is the first pre-malignant change?

A

Flat epithelial atypia/ atypical ductal carcinoma

may represent a precursor to low grade DCIS

19
Q

Which proliferating breast diseases are pre-malignant?

A

flat epithelia atypia/ atypical ductal carcinoma < in situ lobar neoplasia

20
Q

flat epithelia atypia/ atypical ductal carcinoma vs in situ lobar neoplasia

A

flat epithelia atypia/ atypical ductal carcinoma
o multiple layers of epithelial cells
o irregular lumens with punched out areas

in situ lobar neoplasia
o higher risk of invasive carcinoma
o occurs within acinar unit of breast
o cell proliferation with small residual areas where you can still see the lumen

21
Q

How does early pregnancy protect from breast cancer?

A

(pregnancy – terminal differentiation of milk-producing luminal cells, removing these from the pool of potential cancer precursors)

22
Q

breast cancer screening programme in the UK

A

43-73

every 3 years

23
Q

Most common malignant breast tumour

A

Invasive ductal carcinoma

24
Q
  • E-cadherin +ve vs

* E-cadherin -ve

A
  • E-cadherin +ve  invasive ductal carcinoma

* E-cadherin -ve  invasive lobular carcinoma

25
Q

invasive ductal carcinoma vs invasive lobular carcinoma

A

Invasive ductal carcinoma

  • most common malignant breast tumour + much higher risk of progressing to invasive cancer
  • E-cadherin +ve
  • Microcalcification, can be seen on mammogram
  • Only 10% present with clinical sx

invasive lobular carcinoma

  • E-cadherin -ve
  • No microcalcifications - cannot be seen on mammograms, incidental finding
  • 20-40% are bilateral
26
Q

Low grade vs high grade DCIS histology

A

Low

  • cribiriform/ punched out DCIS
  • Lumens compact/ regular
  • size of nucleus similar to size of RBC

High grade

  • few lumens
  • central lumen necrotic material
27
Q

Invasive ductal carcinoma vs invasive lobular carcinoma vs invasive tubular carcinoma vs invasive mucinous carcinoma histology

A

Invasive ductal carcinoma

  • Cells form groups, nests, cysts
  • Tumour invades into fat spaces + stroma

Invasive lobular carcinoma - - Cells aligned in single file chains/ strands (Indian File pattern)

Invasive tubular carcinoma
- Elongated tubules invading the stroma

Invasive mucinous carcinoma
- Produce abundant quantities of extracellular mucin which dissects into surrounding stroma

28
Q

Which type of breast cancer is unlikely to be treated with chem?

A

Carcinoma in situ

29
Q

Which type of breast cancer is likely to be treated with chem?

A

Basal like carcinoma

30
Q

Basal like carcinoma histology + immunochemistry

A

Sheets of atypical cells
Central necrosis
Lymphocytic infiltrate

stains positive for basal cytokeratins CK5/6/14

31
Q

Which parameters are included in the histological grading of a breast tumour?

A 
Tubule formation (/3) (the more tubules, the better)
Mitotic activity (/3)
Nuclear pleomorphism (/3)

 3-5 = grade 1 = well differentiated
 6-7 = grade 2 = moderately differentiated
 8-9 = grade 3 = poorly differentiated

32
Q

Receptor status

All invasive cancers are screened for

A

ER
RP
Her2

33
Q

Receptor status

Low grade
High grade
Basal like carcinomas

A

 Low grade
• ER/PR positive – response to tamoxifen, good prognosis
• Her2 negative

 High grade
• ER/PR negative
• Her2 positive – bad prognosis

 Basal-like Carcinomas
• ER/PR/Her2 negative  triple negative (hard to treat)

34
Q

Breast cancer - most important prognostic factor

A

Status of axillary lymph nodes

35
Q

Biopsy coding

A

o B1 = normal breast tissue

o B2 = benign abnormality

o B3 = lesion of uncertain malignant potential (e.g. intraductal papilloma, radial scars)

o B4 = suspicious of malignancy

o B5 = malignant
 B5a = DCIS
 B5b = invasive carcinoma

36
Q

Risk of breast cancer in carriers of BRCA

A

Risk BRCA2 > BRCA1

37
Q

Histology of gynaecomastia

A

Hallmark - concentric fibrous thickening around ducts

epithelial hyperplasia of ducts with finger like projections extending into the duct lumen

periductal stroma fibrous + oedematous [similar to fibroadenoma]

Year 5 Path Charis (44 decks)

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