Breast Histopathology

Question 1

Give the 3 most common presenting symptoms for breast pathology

Answer 1

Mastalgia/mastodynia (seem like the same thing)
Palpable masses
Nipple discharge

Question 2

Name the 4 inflammatory breast conditions

Answer 2

Acute mastitis,
Periductal mastitis,
Mammary duct ectasia,
Fat necrosis

Question 3

Give 3 general symptoms/signs of acute mastitis

Answer 3

Mastalgia, red breast, fever

Question 4

What is the most common mechanism for acute mastitis

Answer 4

Almost all cases occur during lactation/breast feeding due to a staph aureus infection via nipple cracks.

Question 5

What would you see on histology of acute mastitis

Answer 5

Necrotic breast tissue and neutrophil infiltrates

Question 6

What is the treatment of acute mastistis?

Answer 6

continued milk expression, antibiotics, +/- surgical drainage.

Question 7

What group of people does periductal mastitis most often occur in? Is it associated with lactation?

Answer 7

Usually smokers, NOT associated with lactation

Question 8

What would you see on histology for periductal mastitis

Answer 8

keratinizing squamous epithelium extending deep into nipple duct orifices

Question 9

What group of people does mammary duct ectasia most often occur in? What kind of discharge is it associated with?

Answer 9

Mainly multiparous 40-60yo women.

Thick white secretions from the nips

Question 10

What kind of mass is there in mammary duct ectasia?

Answer 10

Poorly defined palpable periareolar mass

Question 11

What is the cause of mammary duct ectasia

Answer 11

granulomatous inflammation and dilation of large breast ducts

Question 12

What are the findings on cytology for mammary duct ectasia?

Answer 12

proteinaceous material, inflammatory cells

Question 13

What do mammographical findings for mammary duct ectasia look similar to?

Answer 13

CANCER.

Question 14

What is the pathophysiology of fat necrosis?

Answer 14

inflammatory response to damaged adipose tissue

Question 15

How does fat necrosis present?

Answer 15

Often painless, sometimes tender breast mass/lesion

Question 16

What are 3 causes of fat necrosis?

Answer 16

trauma, radiotherapy, surgery

Question 17

Name the 2 main groups of benign proliferative breast conditions

Answer 17

Fibrocystic/fibroadenosis

Gynaecomastia

Question 18

What are the 3 types of changes in fibrocystic/fibroadenosis and describe them

Answer 18

1. cystic change- small cysts form by dilation of lobules. contain fluid. often calcified
2. fibrosis- inflammation and fibrosis secondary to cyst rupture
3. adenosis- increased number of acini per lobule (normally seen in pregnancy)

Question 19

Describe gynaecomastia including:

definition, causes, and histology

Answer 19

1. unilateral or bitlateral enlargement of the main titties
2. indicator of hyper-oestrinism (AFLD, cirrhosis, age, obesity, functioning gonadal tumour
3. histology- epithelial hyperplasia, finger like projections into ducts

Question 20

what are the 3 main groups of benign neoplastic conditions

Answer 20

Fibroadenoma (‘breast mouse’)
Duct papilloma
Radial scar

Question 21

Describe a fibroadenoma

group affected, tissue of origin, hormone responsiveness, calcification

Answer 21

Occurs between menarche and menopause, usually at 20-30. Most common benign tumour, arises from stroma. Overgrowth of collagenous mesenchyme. Hormone responsive, increases in size during pregnancy and calcifies after menopause. ‘shelling out’ is curative.

Question 22

Describe fibroadenoma

location, shape and consistency

Answer 22

Often multiple lesions and bilateral. Spherical, freely mobile, variable size and rubbery.

Question 23

Describe features of a duct papilloma

Answer 23

Can be within small terminal ductules (peripheral papillomas) or larger lactiferous ducts (central papillomas). Causes a bloody discharge, no lump. Not seen on mammogram, need to conduct galactogram

Question 24

Describe a radial scar

Answer 24

Benign schlerosing lesion- central scarring surrounded by proliferating glandular tissue in a stellate pattern. Resembles carcinoma on mammogram

Question 25

What are the key feature of a phyllodes tumour

Answer 25

can be benign, pre-malignant or malignant. grow in a 'leaf like' pattern. more common in women with fibroadenomas.

Question 26

What is the lifetime risk of breast cancer for women

Answer 26

1/8, most common cancer in women. | Most commonly at 75-80yo (younger in black people)

Question 27

Give 8 risk factors for breast cancer

Answer 27

Genetic mutations, estrogen exposure, increased age, family history, obesity, tobacco, alcohol

Question 28

Describe the susceptibility genes for breast cancer. what other cancers can they predispose to?

Answer 28

BRCA1/BRCA2 cause an increased lifetime risk of up to 85%. Both are tumor suppressor genes. also increase the risk of prostate, ovarian and pancreatic malignancy.

Question 29

Give 4 ways in which breast cancer most commonly presents

Answer 29

hard fixed lump, paget's disease, peau d'orange, nipple retraction

Question 30

Describe the NHS breast cancer screening programme

Answer 30

screening: 47-73 yo women invited for mammography (looks for abnormal calcification or a mass)

Question 31

Define carcinoma in situ (for the breast)

Answer 31

epithelial proliferation limited to ducts/lobules by the basement membrane (30%)

Question 32

Describe investigation findings of LCIS

Answer 32

ALWAYS incidental finding on biopsy (no microcalcifications or stromal reactions). 20-40% bilateral.

Question 33

Describe histological features of LCIS

Answer 33

cells lack adhesion protein E-cadherin. risk factor for subsequent invasive breast carcinoma. 'Signet cells' under microscopy.

Question 34

Describe investigation findings of DCIS

Answer 34

Appears as areas of microcalcification. 10% have clinical symptoms at presentation. Much higher risk of becoming invasive than LCIS.

Question 35

Define invasive breast carcinoma

Answer 35

malignant epithelial tumours which infiltrate within breast with the capacity to spread to distant sites (80%)

Question 36

What are the 4 subcategories of invasive breast carcinoma

Answer 36

Histologically categorise into: | ductal, lobular, tubular, mucinous

Question 37

What is the most common invasive breast cancer

Answer 37

invasive ductal carcinoma. cannot be subclassified.

Question 38

what are the histological findings for invasive lobular carcinomas?

Answer 38

cells are aligned in single file chains/strands

Question 39

What are the histological findings for invasive tubular carcinomas?

Answer 39

well formed tubules with low grade nuclei. rarely palpable as they are usually

Question 40

What is the triple assessment after taking the history

Answer 40

examination, imaging (mmgraphy/USS/MRI), FNA and cytology

Question 41

Why do neoplastic lesions undergo core needle biopsy?

Answer 41

to confirm histological subtype AND grading. assessment of nuclear pleomorphism (/3), tubule formation (/3) and mitotic activity (/3) is performed to determine cell differentiation.(/9). higher scoer=poorer differentiation.

Question 42

ER/PR/HER2 receptor status is assessed to determine treatment and prognosis. which ones have better/worse prognosis?

Answer 42

ER/PR+ means the tumour is hormone responsive and is associated with a better prognosis. HER2+ is associated with a bad prognosis

Question 43

What is basal-like carcinoma and what does it stain positively for?

Answer 43

Sheets of atypical cells with lymphocytic infiltrates. Stains positively for CK/6/14

Question 44

Where does phyllodes tumour originate from and how does it present?

Answer 44

Interlobular stroma (like fibroadenomas, can also arise from pre-existing fibroadenomas). Presents as a palpable mass, usually age>50yo

Question 45

Are phyllodes tumors aggressive?

Answer 45

Usually benign, but can be aggressive. Excised with wide local excision.mastectomy to limit local recurrence. mets are very rare.