Breast pathology

Question 1

Green-white (+bloody) nipple discharge

Answer 1

Duct ectasia
(Duct clogs and fills with secretions that can discharge from nipple - ducts dilate + can rupture leading to blood in discharge)

Question 2

Blood-stained discharge

Answer 2

Ductal papilloma

Question 3

Mobile lump

Artichoke like appearance

Answer 3

Phylloides tumour (stroma proliferates + pushes up on ducts to produce artichoke like protrusions)

Question 4

Triple assessment

Answer 4

1. History + breast exam
2. Imaging (<35 USS, >35 mammogram)
3. Solid lump = core biopsy + histology; fluctuant lump = FNA + cytology

Question 5

Histology/cytology grading

Answer 5

B1-B5 (histology - tissue)
C1-C5 (cytology - cells)
1 - Normal breast tissue
2 - Benign
3 - Atypical
4 - ? Malignancy
5 - Malignancy (for B - a = DCIS, b = carcinoma)

Question 6

Breast-feeding
Acute inflammation, abscess
Express milk, flucloxacillin

Answer 6

Acute mastitis

Cracked nipples from breast feeding allow S aureus to enter and cause acute inflammation

Question 7

Post-trauma adipose necrosis
Firm painless lump w/ skin thickening
Obese

Answer 7

Fat necrosis

Adipocytes degenerate following trauma

Question 8

Lumpy breasts

Multiple bilateral masses

Answer 8

Fibrocystic disease (formation of multiple small cysts that burst to cause fibrosis)

Question 9

Breast mouse
Well circumscribed mobile lump
Commonest benign tumour of breast - shelling out is curative
Hormone responsive (pregnancy, menopause)

Answer 9

Fibroadenoma (benign proliferation of stroma)

Question 10

Red roughened ulcerated nipple

Answer 10

Paget’s disease (like eczema of the nipple)

Question 11

Painless breast lump
Dilatation of duct
Breast feeding

Answer 11

Galactocele (during breast feeding milk blocks duct but no infection)

Question 12

Bloody discharge without lump (hidden in duct)

3D papillary clusters

Answer 12

Duct papilloma (benign proliferation of duct cells - tumour concealed within duct)

Question 13

Incidental finding

Stellate

Answer 13

Radial scar (central core containing benign ducts)

Question 14

Multi-focal + bilateral
Pre-menopausal
Histology: no calcificiation, no necrosis, normal nuclei
Better prognosis

Answer 14

Lobular carcinoma in situ

Question 15

No invasion into BM

Answer 15

Carcinoma in situ

Question 16

Single+ unilateral
Post-menopausal
Histology: calcification, central necrosis, pleiomorphic nuclei
Worse prognosis

Answer 16

Ductal carcinoma in situ

Question 17

Is ductal or lobular carcinoma in situ best?

Answer 17

Ductal - less likely to progress to carcinoma

Question 18

Hard fixed lump
Paget’s disease
Peau d’orange
Nipple retraction

Answer 18

Invasive carcinoma`

Question 19

Most common carcinoma

Answer 19

80% ductal
15% lobular
5% tubular

Question 20

Carcinoma RF

Answer 20

Increased unopposed oestrogen

BRCA (85% lifetime risk)

Question 21

ER/PR +

Answer 21

Low grade

Tamoxifen response

Question 22

HER2+

Answer 22

High grade

Herceptin response

Question 23

4 determinants of prognosis

Answer 23

Axillary LN spread (best predictor)
Receptor status (indicates grade + chemo response)
Sub-type (ductal, lobular, tubular)
Grade (tubule formation + nuclear polymorphism + mitotic activity each scored /3 to produce score /9 - indicates how well differentiated)

Question 24

Carcinoma grading

Answer 24

Nottingham modification of Blue-Richardson criteria
Tubule formation + nuclear polymorphism + mitotic activity
Each scored /3 to produce score /9 - indicates how well differentiated + therefore prognosis

Question 25

Breast screening programme

Answer 25

Every 5y
47-73y
Mammogram

Question 26

Sheets of atypical cells w/ lymphocyte infiltrate

CK5/6/14+

Answer 26

Basal-like carcinoma