(48) Breast pathology Flashcards
(59 cards)
The majority of malignancies in the breast arise from which tissue type?
Epithelial cells = CARCINOMAS
Malignant tumours from connective tissue cells rarely occur. What are these called?
Sarcomas
Many tumours have more fibrous tissue which has what characteristics?
Fibrous tissue makes things lumpy/harder and more radio-opaque. (fat is soft and radiolucent)
What are the 3 principal components of the anatomy of the breast?
- fat
- fibrous connective tissue
- epithelial tissue
lobes - ducts - nipple
How is younger breast tissue different?
More glandular and therefore fibrous - more lumpy, even when benign and radio-dense
Why are mammograms less effective in younger people?
As young breast tissue is more lumpy anyway as it is more glandular - USS is better for detecting tumours
What factors increase the risk of breast cancer?
- alcohol
- oestrogen-progesterone contraceptives/menopausal therapy
- x-ray/gamma radiation
- body fat
What factors decrease the risk of breast cancer?
- breastfeeding
- (physical activity)
Who does the NHS breast screening programme target?
- all women aged 50 and over
- free breast screening every 3 years
- for some areas, screening is extended to cover ages 47-73
Has the NHS breast screening programme been effective?
- lowered mortality rates from breast cancer in the 55-69 age group
- benefits of mammographic screening is greater than harm in terms of over diagnosis
- 2-2.5 lives saved for every overdiagnosed case
Is fibrocystic change in the breast always pathological?
So common as to be almost physiological - can mimic cancer both clinically and pathologically
How does breast disease present?
- lumps
- puckered skin/indrawn nipple
- pain
- inflammation/infection
- nipple discharge
- abnormal/sore nipple
- radiology/screening
What is the “triple assessment” of breast abnormality?
- all breast lumps should be considered in 3 parameters
1. clinical (examination and palpation)
2. radiological (look for calcifications)
3. pathological (cytology or histopathology) - the results of all these need to be triangulated at an MDT meeting
If suspicious calcifications or a mass is found, what needs to be done?
It will need to be biopsied to permit the pathologist to make a diagnosis
How can normal breast tissue be described histologically?
Very organised
lots of “little villages” connected by roads
How can invasive breast tumours be described histologically?
Irregular disorganised margins of invasive tumours, high grade tumours might get rounded edge due to fast growth
uncontained, untidy
“urban sprawl”
What procedure should happen in any breast lump?
Triple assessment
What type of genes are BRCA genes?
Tumour suppressor genes - mutation causes lack of function
Biopsies are graded using the “B” grading system. What is this?
B1 = unsatisfactory B2 = benign lesion B3 = atypical probably benign B4 = atypical probably malignant B5a = malignant, in-situ B5b = malignant, invasive
What are fibroadenomas?
Fibroepithelial neoplasms in which there is coordinated growth of the glandular and connective tissue (stromal) element “breast mice” - benign
How do fibroadenomas present?
They are common and present as mobile lumps or radiological masses
- painless
- firm
- solitary
- mobile
- slowly-growing
Are fibroadenomas are cause for concern?
Should be biopsied but if confirmed to be fibroadenoma by biopsy then can be left alone as they are benign
What are phyllodes tumours?
Rare fibroepithelial neoplasm which forms a spectrum of lesions - at one end are lesions very similar to fibroadenomas, other end very aggressive and malignant
What do the more aggressive phyllodes tumours show?
Overgrowth of the stromal element, which in some cases might be frankly sarcomatous
