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Integration for Clinical Application > Breast Disease > Flashcards

Breast Disease Flashcards

(49 cards)

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1
Q

What are the normal histological features of normal breast tissue?

A
  • Ducts and acini arranged into lobules
  • Dual layer of epithelium
    • Inner layer cuboidal
    • Outer layer of myoepthilium to allow contraction
  • Surrounded by adipose tissue
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2
Q

What physiologial changes are seen in breast tissue throughout a womans life?

A

Pre-puberty: few lobules (identical to male)

Menarche: increased number of lobules, increased volume of interlobular stroma

Menstrual cycle: follicular lobules develop to prepare for pregnancy, after ovulation see proliferation and stromal oedema, with menstruation a decrease in lobule size

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3
Q

What does breast tissue look like in pregnancy?

A
  • Less fibromuscular stroma
  • Lobules contain colostrum - white + fluffy
  • Will go back to normal afterwards
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4
Q

What physiological changes are seen in breast tissue with increasing age?

A
  • Decrease in number and size of terminal duct lobular units
  • Interlobular stroma is replaced by adipose tissue - fattier breast compared with younger woman
    • makes examining breasts easier if older
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5
Q

How can breast conditions present?

A
  • Pain
  • Palpable mass
  • Nipple dicharge
  • Skin changes
  • Lumpiness
  • Mammographic abnormalities (picked up on screening)
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6
Q

What does cyclical and diffuse breast pain suggest?

A

Often phsycological or linked to periods, can’t do much to treat the pain

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7
Q

What does non-cyclical and focal breast pain suggest?

A

could be:

  • ruptured cysts
  • injury
  • inflammation
  • only occasionally would cancer cause pain
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8
Q

What breast conditions can cause a palpable mass?

A
  • Normal nodularity
  • Invasive carcinoma
  • Fibroadenomas
  • Cysts

Most worrying if hard, craggy and fixed

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9
Q

What would densities on a mammmogram suggest?

A
  • Invasive carcinoma
  • Fibroadenoma
  • Cysts
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10
Q

What would calcification on a mammogram suggest?

A
  • Ductal carcinoma in situ (DCIS)
  • May be benign
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11
Q

Briefly explain the principles of the breast screening programme (UK)

A

Mammogram performed on wome aged 47-73 invited every 3 years

Increases detection of small invasive tumours and in situ carcinomas

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12
Q

What is the most common type of benign breast tumour?

A

Fibroadenoma

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13
Q

What age group do breast fibroadenomas most commonly appear in?

A

<30 years

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14
Q

What is a phyllodes tumour?

A

A very rare breast neoplasm

Although very similar to a fibroadenoma, the stromal component is hypercellular with increased pleomorphism and mitotic activity

Presents mostly in women in 6th decade

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15
Q

What is acute mastitis?

A
  • Usually a Staphylococcus aureus infection from cracked nipples from breastfeeding
  • Breast is erythematous and often pyrexic
  • May produce abscesses
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16
Q

How is acute mastitis treated?

A

Expressing milk and antibiotics

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17
Q

What occurs in breast fat necrosis?

A
  • Destruction of fatty tissue surrounded by macrophages and inflammatory cells
  • Often have a history of trauma or surgery
  • Can mimic carcinoma clinically and on mammograms
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18
Q

What is the most common type of breast lesion?

A

Fibrocystic change

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19
Q

What changes are seen in benign epithelial fibrocystic breast disease?

A
  • May present as a mass or on mammogram
  • Often dissapears after fine needle aspiration
    • but can come back as cyst refills
  • Histology - see cysts, fibrosis and apocrine metaplasia (pink cells) and large dilated ducts
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20
Q

What are breast fibroadenomas? a.k.a breast mouse

Study These Flashcards
A
  • Present as a mass, usually mobile or mammographic abnormality
  • Can be multiple and bilateral
  • Can grow very large and replace msot of the breast
21
Q

How do fibroadenomas appear macroscopically?

Study These Flashcards
A

Well circumscribed, rubbery, greyish/white

Can easily be scooped out in surgery without removing surrounding tissue

22
Q

What do brest fibroadenomas look like histologically?

Study These Flashcards
A

A mix of stromal and epithelial elements

23
Q

What is gynaecomastia?

Study These Flashcards
A
  • Enlargement of male breast
  • Unilateral or bilateral
  • Often seen at puberty and the elderly
  • Caused by relative decrease in androgen effect or increase in oestrogen
  • Can mimic male breast cancer if unilateral
  • No increased risk of cancer
24
Q

Why does gynaecomastia occur in most neonates?

Study These Flashcards
A

Due to circulating maternal and placental oestrogens and progresterone

25
What are some of the causes of gynaecomastia?
* **Transiet gynaecomastia**: affects more than 1/2 boys in puberty as oesterogen production peaks earlier than testosterone * **Klinefelter's syndrome: XXY** chromosome * **Oestrogen excess:** if patient has liver cirrohosis oestrogen cannot be effectively metabolised * **Gonadotrophin excess:** functioning testicular tumour e.g. Leydig and Sertoli tumours, germ cell tumours * **Drug related:** spironolacton,e chlorpromazine, digitalise, cimetidine, alcohol, marijuana, heroin, anabolic steroids
26
What is the most common type of breast cancer?
Adenocarcinoma
27
In what location do approximately 50% of breast cancers occur?
Upper outer qudrant
28
List some risk factors for developing breast cancer
* Female * Uninterrupted menses * Early menarche (\<11 yrs) * Late menopause * Reproduction - parity and age of 1st full term pregnancy \>30 years higher risk * Breast feeding though to be **protective** * Obesity and high fat diet * Exogenous oestrogens (HRT, long term OCP use) * Breast density - harder to detect if more fibrous * Geography - high incidence in US and Europe * Previous breast cancer or atypical change * Radiation
29
Which genes are associated with 25% of familiar breast cancers? Explain how they can cause cancer?
BRCA1 and BRCA2 Both are **tumour suppressor genes** - repair damaged DNA therefore mutation in gene allows proliferation of tumour
30
What gene is mutated in Li-Fraumeni syndrome?
**p53** | (The guardian of the genome)
31
What is an **in situ** carcinoma?
A neoplastic population of cells limited to **ducts** and **lobules** by the basement membrane Does **not invade** into surrounding vessels, so cannot metastasise or kill the patient
32
What is ductal carcinoma in situ a problem if it doesn't have ability to metastasise?
* Non obligate precursor of invasive carcinoma * Presents as mammographic calcifications or a mass * Can spread through **ducts** and **lobules** extensively (without invading other tissues) * Shows **central necrosis** with calclification (comedo)
33
What is Paget's disease?
* Unilateral red and crusing nipple * Atypical and malignant cells can grow up the epidermis extending to the nipple * Suggests malignanc elsewhere in breast * Eczematous or inflammatory conditions of nipple need biopsy to exclude Paget's
34
How does invasive carcinoma differ from DCIS?
Neoplastic cells have extended **beyond** the basement membrane into the **stroma**, can **invade** into vessels and metastasise to lymph nodes and other sites
35
What is peau d'orange?
A symptom of malignant tumour causing the skin of the breast to pull in Suggests involvement of lymphatic drainage of skin
36
What are the classifications of invasive breast carcinoma?
**​Invasive _Ductal_ Carcinoma:** * 70-80% * Well differentiated - tubules lined by atypical cells * Poorly differentated type - sheets of pleomorphic cells * 25-50% survival 10 years **Invasive _Lobular_ Carcinoma:** * 5-15% * Inflitrating cells in single file, lack cohesion Other types: tubular, mucinous
37
What does invasive ductal carcinoma look like histologically?
No organisation Lots of tubules and glands in stroma
38
What does invasive lobular carcinoma look like histologically?
* Single banded line * Can be hard to spot * Doesn't create much change to the stroma
39
What does a mucinous carcinoma look like histologically?
Lots of island cells floating in mucin
40
How can breast cancer spread?
* **Lymphatics** to lymph nodes, usually the **ipsilateral axilla** * **Blood vessels** spread causes **distant** metastases * Invasive lobular carcinoma can spread to: peritoneaum, retroperitoneum, leptomeninges, GI tract, ovaries, uterus
41
What are the most frequent sites for breast cancer to metastasise to?
* Bones * Lungs * Liver * Brain
42
What factors determine prognosis in breast disease?
* In situ or invasive * Tumour Stage (TNM) * Tumour Grade * Histological subtype (Invasive ductal poorer prognosis) * Molecular classifcation and gene expression profile
43
Explain the molecular classifications of breast cancer
Either Oestrogen receptor +/- or HER2 +/-
44
What is the triple approach to investigating and diagnosis breast cancer?
1. **Clinical:** history, family history, examination 2. **Radiographic imaging:** mammogram and ultrasound 3. **Pathology:** core biopsy and fine needle aspiration cytology
45
What is sentinel lymph node biopsy?
* Reduced risk of post-op morbidity * Intra-operative mapping of lymph nodes with dye to identify sentinal node (most likely to contain metastases) * If sentinel node is negative, axillary dissection can be avoided
46
Which receptor does tamoxifen target?
Oestreogen receptor if patient is ER +
47
What receptor does Herceptin target?
HER2 (a tyrosine kinase receptor) Herceptin = trastuzumab = humanised antibodies against the HER2 protein
48
What is mammary duct ectasia?
* Dilation of the major ducts, filled with creamy secretion and inflammation * May be asymptomatic or symptoms * nipple discharge * retracted nipple * acute inflammation * recurrent chronic inflammation/ abscess
49
What symtpoms can suggest breast cancer?
* Lump * Nipple retraction * Dimples * Weight loss * Axillary node enlargement * Discharge

Integration for Clinical Application (8 decks)

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