Breast Disease

Question 1

what are breast lobules made up of?

Answer 1

acini and interlobular stroma

Question 2

normal histological breast tissue

Answer 2

slide 3 7.1

Question 3

physiological changes to breast tissue during menarche

Answer 3

more lobules, bigger interlobular stroma volume

Question 4

physiological changes to breast tissue during menstrual cycle

Answer 4

after ovulation: cell proliferation, stromal oedema
menstraution: smaller lobules

Question 5

physiological changes to breast tissue during pregnancy and breastfeeding

Answer 5

increase size and number of lobules, less stroma

filled with colostrum, breast milk

Question 6

how do breasts change as we age? effect of this?

Answer 6

interlobular stroma replaced by adipose

so mammograms become easier to interpret as adipose is less dense

Question 7

commonest benign breast tumour

Answer 7

fibroadenoma

Question 8

benefits of mammograms

Answer 8

increased detection of small invasive and in situ carcinomas

Question 9

presentation of breast conditions

Answer 9

pain (advanced)
palpable mass
nipple discharge
skin changes
lumpiness

mammogram abnormalities

Question 10

breast screening programme

Answer 10

47-73 women
3 yearly

Question 11

what’s looked for on mammograms?

Answer 11

• asymmetric densities e.g. carcinomas, cyst
• parenchymal deformities
• calcifications e.g. DCIS

Question 12

how to assess abnormalities found on mammogram?

Answer 12

core biopsy, FNAC, more imaging

Question 13

which breast conditions cause densities on mammogram? what do they look like?

Answer 13

invasive carcinoma- regular, speculated
fibroadenoma- smooth
cyst- central hole of cystic fluid

Question 14

which breast conditions cause calcifications on mammogram?

Answer 14

ductal carcinoma in situ
bengin changes

Question 15

phyllodes tumour

Answer 15

malignant stromal tumour, common in 6th decade of life

Question 16

better imaging for young women breasts?

Answer 16

USS

Question 17

common age for fibroadenoma

Answer 17

<30, reproductive age

Question 18

acute mastitis
-when it happens
-organism
-symtpoms
-treatment

Answer 18

-lactation usually
-s. aureus
-erythematous, painful, pyrexia
-express milk, ABx

Question 19

fat necrosis
-when it happens
-symptoms
-confirmation

Answer 19

-trauma, surgery (fat cells breakdown, macrophages and inflammatory cells surround)
-mass, skin changes, mammogram abnormality
-biopsy

Question 20

fibrocystic change COMMONEST BREAST LESION
-presentation
-treatment
-histology

Answer 20

-mass, mammogram abnormality
-fine needle aspiration
-apocrine metaplasia, cyst, fibrosis

Question 21

list some stromal tumours

Answer 21

fibroadenoma
phyllodes tumour
lipoma
leiomyoma
hamartoma

Question 22

fibroadenoma
-presentation
-macroscopic
-histology

Answer 22

-mobile mass, mammogram abnormality
-well circumscribed, rubbery, grey/white
-stromal/epithelial mix

Question 23

is fibroadenoma true neoplasm?

Answer 23

no, localised hyperplasia

Question 24

hormonal causes of gynaecomastia

Answer 24

decreased androgen effect
increased oestrogen effect

Question 25

causes of gynaecomastia

Answer 25

-klinefelters (XX male, infertility, small testicles) -oestrogen excess e.g. cirrhosis -prostate cancer oestrogen treatment -neonates -puberty (oestrogen peaks earlier)

Question 26

most common type of breast cancer

Answer 26

adenocarcinoma

Question 27

most common location of breast cancer

Answer 27

upper outer quadrant

Question 28

risk factors for breast cancer

Answer 28

-female -older age -early menarche -late menopause -nulliparity -obesity -exogenous oestrogen -bigger breast density -radiation -family history BRCA1/2

Question 29

genes involved in breast cancer

Answer 29

BRCA1/2- tumour suppressor genes p53

Question 30

define in situ carcinoma

Answer 30

neoplastic population of cells limited to ducts and lobules by basement membrane, myoepithelial cells preserved doesn't invade vessels so cant metastasise

Question 31

why is DCIS a problem?

Answer 31

-precursor to invasive carcinoma -spread through ducts/lobules to be extensive

Question 32

histology of DCIS

Answer 32

central (comedo) necrosis calcification

Question 33

sentinel lymph nodes for breast cancer

Answer 33

axillary

Question 34

peau d'orange

Answer 34

shows involvement of lymphatic skin drainage

Question 35

Paget's disease

Answer 35

unilateral red, crusting, scaling, bleeding nipple as cells extend to nipple skin without crossing BM associated with DCIS/invasive carcinoma

Question 36

triple approach to diagnosing breast cancer

Answer 36

1. clinical: FH, exam 2. imaging: mammogram, USS 3. pathology: core biopsy, fine needle aspiration cytology

Question 37

classify breast carcinoma, and histological appearance of the main ones

Answer 37

invasive ductal carcinoma 70-80% -well differentiated: tubules lined by atypical cells -poor differentiated: sheets of atypical pleomorphic cells invasive lobular carcinoma -infiltrating cells in single file, lack cohesion tubular, mucinous

Question 38

why's the spread of invasive lobular carcinoma different?

Answer 38

can spread to weird places e.g. peritoneum, leptomeninges, GI tract, ovaries

Question 39

molecular classifications of breast cancer

Answer 39

-HER2 positive or negative -oestrogen receptor positive or negative

Question 40

surgeries available for breast cancer

Answer 40

-total mastectomy -wide local excision -axillary dissection surgery

Question 41

hormonal treatment of breast cancer

Answer 41

oestrogen receptor positive: tamoxifen HER2 receptor positive: Herceptin (trastuzumab)

Question 42

staining if oestrogen receptor positive

Answer 42

nuclear

Question 43

staining if HER2 receptor positive

Answer 43

cytoplasmic, around malignant cells

Question 44

how to improve breast cancer survival

Answer 44

-early detection -neoadjuvant chemo -hormal treatment -gene expression profiles -genetic screening, prophylactic mastectomy

Question 45

breast cancer staging

Answer 45

TNM

Question 46

intraductal papilloma -symtpoms -why

Answer 46

-sponenous discharge from one nipple -benign growth in single milk duct