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Flashcards in Breast path Deck (29):
1

Acute mastitis: symptoms (3), cause (1), what is the involved breast tissue full of?

Red, painful breast + fever
Almost always a staph invasion in breast feeding/ lactating mothers via cracks in the skin
Involved breast tissue is necrotic and full of neutrophils

2

Treatment of acute mastitis? (3)

Continued expression of milk
+ antibiotics
+/- surgical drainage

3

Periductal mastitis: association (2), Histology

Mostly in SMOKERS & NOT associated with lactation
Histology - keratinizing squamous epithelium extends deep into nipple duct orifices

4

Mammary duct ectasia: epidemiology (2), what is it? Cause? what does it mimic on mammography? Cytology? (2)

Multiparous 40-60 yr olds
Poorly defined palpable periareolar mass wit THICK, WHITE NIPPLE SECRETIONS
Caused by granulomatous inflammation of large breast ducts
Mimics mammography of cancer
Cytology - proteinaecous material, inflammatory cells

5

Fat necrosis what is it? presentation (3), causes (all traumatic - 3)

Inflammatory rxc to damaged adipose tissue
presents as PAINLESS breast mass/ skin thickening/ mammographic lesion
Cause - trauma, surgery, radiotherapy

6

Fibrocystic disease/ fibroadenosis (breast lumpiness): what is it? Cystic change. Fibrosis. Adenosis

Group of changes caused by exaggerated normal response to hormones
Cystic change - small cysts from due to dilation of lobules; contain fluid +/- calcified
Fibrosis - inflammation + fibrosis occurs secondary to cyst rupture
Adenosis - increased number of acini per lobule (normal in pregnancy)

7

Gynaecomastia: what is it? indicator of what? Histology (2)

Breast enlargement in males
Indicates HYPEROESTRINISM - alcohol, age, liver cirrosis, functioning testicular tumour
Histology - epithelial hyperplasia, finger like projections into ducts

8

Fibroadenoma (breast mouse - moves): what is it? age group? describe lumps (4). Cure?

Most common benign tumour, from stroma, usually multiple
Ocurrs in any age group of reproductive age 20-30 most common
Epithelium responsive to hormones - enlarges during preg, calcifies in menopause
Lumps - firm, spherical, mobile, rubbery
Overgrowth of collagenous mesenchyme
'shelling out' is curative

9

Duct papillomas are benign or malignant? Arise from where? (2) Discharge? Ix (1)

Benign papillary tumours, arising from duct system:
small terminal ductules - peripheral papilloma. Large lacterferous ducts - central papilloma.
Bloody discharge
Ix - galactogram (not seen on mammogram)

10

Radial scar - what is it? Significance?

Benign sclerosing lesion - central scarring surrounded by proliferating glandular issue in stellate pattern.
Resembles carcinoma on mammogram

11

Breast carcinoma epidemiology: (3)

most common cancer in women
1:8 lifetime risk
99% in women

12

Breast carcinoma risk factors (6)

Susceptibility genes - BRCA1/2; cause lifetime risk to go up to 85% (they also increase risk of ovarian, prostate & pancreatic cancer)
Hormone exposure - anything to do with high oestrogen; remember also pregnancy results in terminal differentiation of milk-producing cells, removing them from pool of potential cancer precursors
Age
FH
Race: caucasian>afro-carribean>asian>hispanic
Obesity/alcohol/tobacco

13

Presentation of breast carcinoma (4)

Hard fixed lump
Paget's disease
Peau d'orange
nipple retracation

14

Screening programme for breast cancer

47-73 yr olds invited every 3 yrs for mammography - which looks for abnormal areas of calcification in the breast

15

Carcinoma in situ (30%) what is it? types? (2)

Neoplastic epithelial proliferation LIMITED to ducts/lobules by BM
DCIS or LCIS

16

LCIS characteristics (3)

ALWAYS an incidental finding on biopsy as no microcalcifications or stromal rxns.
Cells lack adhesion protein E-cadherin
F for subsequent invasive breast carcinoma

17

DCIS characteristics ( (3)

Dramatically increased incidence following development of mammography
Appear as areas of microcalcifications
10% present with clinical symptoms
Much increased risk of progressing to invasive breast CA

18

Invasive breast CA (80%) what are they? what are the 4 subtypes?

Malignant epithelial tumours that infiltrate within breast and can spread to distant sites
Histologically classified into:
Ductal
Lobular
Mucinous
Tubular

19

Invasive ductal carcinoma is the most common - T or F?

T

20

Invasive lobular carcinoma characteristics

Cells aligned in single file chains/strands

21

Invasive tubular carcinoma characteristics (2)

Well formed tubules with low grade nuclei. Rarely palpable as

22

Mucinous carcinoma characteristic

Produces excess EV mucin which dissects into surrounding stroma

23

Triple assessment

Examination
Radiology - mammography/ USS
FNA & cytology

24

Function of core biopsy, what it assesses (3) grading

Neoplastic lesions are biopsied to check histological subtype + grading
Assess nuclear pleomorphism, tubule formation & mitotic activity
Each gets a score out of 3 (max 9): 3-5 = grade 1, 6-7 = grade 2, 8-9 = grade 3

25

What receptors are checked for in neoplastic lesions? (3)

ER
PR
HER2 (EGFR family - overexpressed oncogene)
ER/PR associated with good prognosis (because tamoxifen will work)
HER2 bad prognosis

26

What is Tamoxifen?

SERM

27

What is herceptin/ trastuzumab?

monoclonal Ig to Her2
NB - has direct toxic effect on myocardium so must monitor LVEF

28

Basal-like carcinoma stains positive for what?

Sheets of atypical cells with lymphocyte infiltrates stain positive for CK 5/6/14

29

Phyllodes tumour

Arise from interlobular stroma with increased cellularity and mitoses
present > 50 yrs with palpable mass
mostly relatively benign, but can be aggressive so excised with wide local excision/ mastectomy