Histopathology 3: Breast pathology

Question 1

45 year old lady presents with thick, white nipple discharge and a periareolar lump. Histology shows distended lactiferous duct.

Most likely diagnosis ?

Answer 1

Mammary duct ectasia

Question 2

Breastfeeding mother presents with a red, painful, swollen breast. Histology shows neutrophils and pus.

Most likely diagnosis ?
Likely organism ?

Answer 2

Acute mastitis

S.Aureus

Question 3

60 year old women presents with a painless breast lump. She reports being in a RTA 10 years ago and wonders if the trauma from her seatbelt might have caused it.

Most likely diagnosis ?
Other causes ?

Answer 3

Fat necrosis

Radiotherapy, surgery, panniculitis

Question 4

A 20 year old lady presents with a breast lump which is well demarcated, mobile and feels rubbery. Histology shows stromal (fibrous tissue) proliferation.

Most likely diagnosis ?

Answer 4

Fibroadenoma

Question 5

Which breast tumour can originate from Fibroadenomas ?

Answer 5

Phyllodes tumour

Question 6

A 60 year old lady presents after she noticed her breast lump previously diagnosed as a fibroadenoma has started to increase in size. Histology shows: increased cellularity + Stromal overgrowth and overlapping cells.

most likely diagnosis ?

Answer 6

Phyllodes tumour (Possibly malignant)

Normally phyllodes tumours are benign

Question 7

45 year old lady presents with bloody nipple discharge. No lump is felt and no mass is seen on mammography.
Histology shows: Large dilated duck with fibrovascular core and stromal vessels.

Most likely diagnosis ?

Answer 7

Duct Papilloma

Question 8

Histology shows a stellate pattern with central sclerosis surrounded by proliferating glandular tissue.

Most likely diagnosis ?

Answer 8

Radial scar

Question 9

A 79 year old lady presents with a hard fixed lump of the breast. Paget’s disease of the breast is present and there are signs of nipple retraction.

Most likely diagnosis ?

Answer 9

Breast carcinoma

Paget’s disease of the breast is eczema affecting the nipple

Question 10

Histology: Intraductal epithelial proliferation, with pleomorphic cells in the duct and necrotic material in the central lumen.

Mammogram: Microcalcifications

Most likely diagnosis ?

Answer 10

DCIS

• Increasesd risk of progession to invasive breast carcinoma
• Screening programme is designed to catch these
• Treat = surgical excision w/ clear margins

Question 11

Young women presents with multiple small lumps in the breast.

Most likely diagnosis ?

Answer 11

Fibrocystic disease

Question 12

Histology shows linear arrangement of monomorphic cells in a distribution known as the Indian file pattern.

Most likely diagnosis ?

Answer 12

Lobular carcinoma

Question 13

List 3 receptors tested for in breast carcinoma ?

Answer 13

Oestrogen
Progesteron
HER2

Question 14

Which drug is used to treat HER2 positive breast carcinoma?

Answer 14

Herceptin

Question 15

How does the E cadherin help differentiate between invasive ductal and invasive lobular carcinoma ?

Answer 15

If E cadherin +ve = invasive ductal

if E cadherin -ve = Invasive lobular

Question 16

What is duct ectasia? Presentation? Major RF?

Answer 16

Inflammation and dilation of large breast ducts

Nipple discharge (MAIN), may cause pain, mass and nipple retraction

Smoking = MAJOR RF

However this is a benign condition

Question 17

Ix for duct ectasia?

Answer 17

Cytology of nipple discharge = proteinaceous material + inflammatory cells

Question 18

What is acute masitis? who is it commonly seen in?

Answer 18

Acute inflammation in the breast

Commonly seen in lactating women due to milk stasis and cracked skin (or breaks in skin allowing bacteria in)

Question 19

Causative organism for acute mastitis? + mx?

Answer 19

Commonly due to staphylococci (aureus) - hence mx = flucloxacillin

Continued milk expression, drainage and abx

Question 20

What is fat necrosis? cause? who is it likely in?

Answer 20

Inflammatory reaction to damaged adipose tissue

Caused by trauma, surgery or radiotherapy

Presents with a painless breast mass in obese,
middle-aged women

THIS IS BENIGN

Question 21

What is fibrocystic disease

Answer 21

Breast lumpiness due to normal responses to hormonal influences

No increased risk for breast carcinoma

Question 22

What is a fibroadenoma

Answer 22

(breast mouse)

Common, benign fibroepithelial neoplasm of the breast

Circumscribed mobile breast lump in young women aged 20-30

Question 23

What is phyllodes tumour?

Answer 23

Uncommon potentially aggressive fibroepithelial neoplasms of the breast

Enlarging masses in women >50 y/o - MAIN

May form from fibroadenomas with increased mitoses

Mostly benign but can be aggressive so are excised with local excision/mastectomy - MAIN

Question 24

What is ddx?

Bloody discharge from breast + lump

where does it come from?

Answer 24

Intraductal papilloma - arises from w/in duct system

Benign papillary tumour

Question 25

What is ddx?

Benign central scarring surrounded by proliferating glandular tissue

Answer 25

Radial Scar - Presents as a stellate mass

Question 26

What are the 4 subtypes of invasive breast carcinoma?

Answer 26

Invasive ductal -> most common -> big, pleomorphic cells that move into the stroma (MOST COMMON)

Invasive lobular -> cells in single file chains (can get lobular in situ too but lot less common than DCIS - not screened)

Tubular -> well-formed tubules with low grade nuclei

Mucinous -> lots of extracellular mucin which goes into the surrounding stroma

Question 27

Triple assessment of breast cancers? + ix and what does that meaning?

Answer 27

examination, radiology and (histology) core needle biopsy

Requires assessment for oestrogen, progesterone and HER2 receptor status

• ER/PR = good prognosis (as responds to tamoxifen)
• HER2 = poor prognosis

ER/PR +ve and HER2 -ve = BEST PROGNOSIS

Question 28

How should a patient with acute mastitis be managed?

53 y/o F with a BMI of 28 presents to her GP with a non-tender mass in her right breast. She suffered a knock to that side of her chest a few weeks ago. Most likely diagnosis?

What is the biggest risk factor for duct ectasia?

Histology shows benign central scarring surrounded by proliferating glandular tissue. Most likely diagnosis?

What stage of breast cancer does the screening programme aim to detect?

Answer 28

Continued milk expression, drainage and antibiotics

Fat necrosis

Smoking

Radial scar

DCIS

Question 29

A 32 year old breastfeeding woman presents to her GP with a sore, inflamed left breast. She reports symptoms are worsening. She feels unwell.

Her temperature is 38.5c. She is not tachycardic.

On examination there is a diffusely tender left breast with a firm, fluctuant mass located 2cm medial to the nipple. It is approximately 1cm in size. There is no nipple retraction.

What is the diagnosis?

Answer 29

Breast Abscess