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Flashcards in Breast Histopathology Deck (45):

Give the 3 most common presenting symptoms for breast pathology

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


Name the 4 inflammatory breast conditions

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


Give 3 general symptoms/signs of acute mastitis

Mastalgia, red breast, fever


What is the most common mechanism for acute mastitis

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


What would you see on histology of acute mastitis

Necrotic breast tissue and neutrophil infiltrates


What is the treatment of acute mastistis?

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


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

Usually smokers, NOT associated with lactation


What would you see on histology for periductal mastitis

keratinizing squamous epithelium extending deep into nipple duct orifices


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

Mainly multiparous 40-60yo women.
Thick white secretions from the nips


What kind of mass is there in mammary duct ectasia?

Poorly defined palpable periareolar mass


What is the cause of mammary duct ectasia

granulomatous inflammation and dilation of large breast ducts


What are the findings on cytology for mammary duct ectasia?

proteinaceous material, inflammatory cells


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



What is the pathophysiology of fat necrosis?

inflammatory response to damaged adipose tissue


How does fat necrosis present?

Often painless, sometimes tender breast mass/lesion


What are 3 causes of fat necrosis?

trauma, radiotherapy, surgery


Name the 2 main groups of benign proliferative breast conditions



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

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)


Describe gynaecomastia including:
definition, causes, and histology

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


what are the 3 main groups of benign neoplastic conditions

Fibroadenoma ('breast mouse')
Duct papilloma
Radial scar


Describe a fibroadenoma
(group affected, tissue of origin, hormone responsiveness, calcification)

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.


Describe fibroadenoma
(location, shape and consistency)

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


Describe features of a duct papilloma

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


Describe a radial scar

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


What are the key feature of a phyllodes tumour

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


What is the lifetime risk of breast cancer for women

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


Give 8 risk factors for breast cancer

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


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

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.


Give 4 ways in which breast cancer most commonly presents

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


Describe the NHS breast cancer screening programme

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


Define carcinoma in situ (for the breast)

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


Describe investigation findings of LCIS

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


Describe histological features of LCIS

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


Describe investigation findings of DCIS

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


Define invasive breast carcinoma

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


What are the 4 subcategories of invasive breast carcinoma

Histologically categorise into:
ductal, lobular, tubular, mucinous


What is the most common invasive breast cancer

invasive ductal carcinoma. cannot be subclassified.


what are the histological findings for invasive lobular carcinomas?

cells are aligned in single file chains/strands


What are the histological findings for invasive tubular carcinomas?

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


What is the triple assessment after taking the history

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


Why do neoplastic lesions undergo core needle biopsy?

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.


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

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


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

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


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

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


Are phyllodes tumors aggressive?

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