Flashcards in Breast Histopathology Deck (45):
Give the 3 most common presenting symptoms for breast pathology
Mastalgia/mastodynia (seem like the same thing)
Name the 4 inflammatory breast conditions
Mammary duct ectasia,
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')
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.
(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