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Breast Path Flashcards

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1
Q

Composition of glandular tissue

A

Ducts

Lobules

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2
Q

Function of Ducts

A

Excretion of milk

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3
Q

Function of lobules

A

Secretion of milk

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4
Q

Most common cause of breast pain

A

Cyclical mastalgia

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5
Q

Rx cyclical mastalgia

A

Primrose oil in the evening

Simple analgesia

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6
Q

Cycle of cyclical mastalgia

A

Worse before period

Better after period

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7
Q

Causes of clear discharge

A

Physiological

Prolactinoma (rare)

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8
Q

Cause of Nipple discharge from multiple ducts

A

Mammary duct ectasia

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9
Q

Cause of nipple discharge from a single duct

A

Papilloma

Ductal ca in sitiu (rare)

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10
Q

Epi of duct ectasia

A

35-45 y/o

Smokers

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11
Q

Rx duct ectasia

A

Nothing

Excision

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12
Q

Path of duct ectasia

A

Defective elastic tissue around the duct

Ineffective excretion of milk

Milk pools in sinus and inflammation ensues

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13
Q

Presentation of intraductal papilloma

A

Single duct discharge

Blood stained

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14
Q

Histology of Intraductal papilloma

A

Fibrovascular core surrounded by epithelial and myoepithelial cells

Inside a duct

Attached to wall

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15
Q

How is a breast lump assessed?

A

Triple assessment:

  1. Clinical (Hx, Examination)
  2. Radiological (Mammography, USS)
  3. Biopsy (FNA/ CB)
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16
Q

Breast Lump Hx

A

S= Site (medial = not good)

O= Onset (duration, getting worse better)

C= Character/Consistency (focal, vague, smooth, irregular, soft, firm, tethered)

R= Radiation (Skin / axilla)

A= Associated sx (Pain, discharge)

T= Timing (Cyclical, constant, period, pregnancy, breast feeding)

E =

S= Size (fluctuation, progression?)

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17
Q

What type of radiology is a mammogram?

A

XR

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18
Q

What type of patients benefit from mammogram screening? Why?

A

Older women

Breast tissue is less dense (more fatty)
Masses are more apparent

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19
Q

Mammogram views

A
  1. Cranio-caudal

2. Oblique

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20
Q

Complications of mammogram?

2

A
  • Exposure to radiation (increased risk of ca)

- Often misses medial masses/calcifications

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21
Q

When is a USS used?

3

A
  • To tell if a lump is cystic or solid
  • To tell if a lump is smooth or irregular
  • To guide biopsy
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22
Q

Types of benign breast lumps

5

A
  1. Simple cyst
  2. Fibrocystic change
  3. Fibroadenoma
  4. Papilloma
  5. Fat necrosis
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23
Q

Types of simple cyst

A
  • Epidermal inclusion cyst

- Deep lobular/ductal cyst

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24
Q

What happens to the lobular/ductal epithelium in lobular/ductal cyst formation?

A

Metaplasia to apocrine epithelium

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25
What happens to the epithelium in epidermal inclusion cysts?
There is infolding of the squamous epithelium and a keratin inclusion body is formed
26
How to people present with fibrocystic change?
- Vague, painless lump/bump/thickening | - Asymptomatic: calcification was picked up on a mammogram
27
Histopathology of fibrocystic change
- Cyst - Fibrosis - Adenosis - Calcification
28
Presentation of Fibroadenoma
1. Young: - Lump: mobile, painless, smooth - Hormonally responsive 2. Old: - Asymptomatic but mamographic abnormality
29
Histopathology of Fibroadenoma 2
- Balanced proliferation of epithelial and stromal elements | - well circumscribed and pale
30
Transformation of Fibroadenoma
Fibroadenoma —> Benign Phyllodes Tumour—> Malignant Phyllodes Tumour
31
Histopathology of benign phyllodes tumour
Stromal proliferation > epithelial proliferation
32
Histopathology of malignant phyllodes tumour
Sarcoma
33
Histopathology of papilloma 3
- Fibrovascular core surrounded by cuboidal epithelium - Branching pattern - Within ducts
34
Presentation of Papilloma and associated cancer risk
Bloody discharge from a single duct = lower risk of cancer No discharge but multiple ducts involved = increased risk of ca
35
Cause of fat necrosis
Trauma: - seatbelt - surgical
36
Presentation of Fat necrosis
Painless, well circumscribed lump OR Vague thickening BOTH WITH Hx Trauma
37
Histopathology of Fat necrosis 3
- Multinucleated giant cells - Fat / oil droplets - Foamy macrophages
38
What is the most common cancer in women?
Breast
39
What % of cancers in females does Breast ca account for?
25%
40
How many cases of male breast cancer in UK every year?
400
41
What is the most common cause of cancer death in women?
Lung
42
How does FmHx of breast cancer affect risk? 2
- 1st degree relative = doubled risk | - 15% of women with 1st degree relative get breast ca
43
Inheritance pattern of BRCA mutations
AD
44
Chance of BRCA +ve patient developing breast ca by 70y/o
50% | Range 45%-65%
45
How does increased breast density affect breast ca risk and diagnosis? 2
- Increased risk ca | - Increased risk of false -ve on mammogram
46
Hormonal Risk Factors for Breast ca 6
HRT OCP Early Menarche Nulliparity Late menopause Never breast fed children
47
Lifestyle Risk factors for breast ca 4
Obesity Smoking Alcohol Ionising radiation
48
What do you look for on a mammogram? 2
Mass lesion Calcification
49
What age range is eligible for breast screening in UK? How often?
50-70 y/o Every 3 years
50
What % of screening participants are recalled?
4%
51
What % of screening participants have breast ca?
1% | 25% of recalled patients
52
What would you cover in breast cancer HPC? 11
``` Lumps Bumps Thickening Skin involvement Axilla involvement ``` Discharge Nipple deviation Fatigue Lethargy Weight loss Anaemia
53
What would you cover in Breast ca Hx (excluding HPC)?
FmHx- Breast ca, degree of relative, age of relative, BRCA, Ovarian ca PmHx- Age of menarche, parity, menopause, any other ca, specifically ovarian ca, BRCA, Breast Trauma Surgical Hx- DHx- OCP, HRT SHx- Alcohol, smoking, BMI, Radiation
54
Describe examination of a lump
3S 3T 3C Site, size, shape Temperature, Tenderness, Tethering Colour, Contour, Consistency
55
When would you use MRI as part of tripple assessment?
Young patients | Dense breast tissue Mammography could give false -ve
56
What is test sensitivity?
The ability of a test to identify true positives | a sensitive test would have low false +ve rates
57
What is test specificity?
The ability of a test to identify true negatives | A specific test would have a low false negative rate
58
Describe the sensitivity and specificity of FNA?
FNA is sensitive but not specific - Rules in malignancy (Low false +ve rate) - Can’t rule out malignancy even if nothing suspicious shows on the slide (Low false -ve rate) Good at identifying true positives, bad at identifying true negatives
59
Advantages of FNA 5
- Quick - Easy - Cheap - Painless - Rarely complications
60
Disadvantages of FNA 5
- Can’t give definite benign diagnosis - Can’t subtype malignant lesions - Can’t differentiate invasive from in sitiu - Can’t sample calcifications - High equivocal rate (ambiguous)
61
What stain is used for looking at FNA?
Giemsa | Blue-purple
62
What does benign FNA aspirate look like on cytology? 3
Cohesive groups Small cells Background = sparse myoepithelial cells
63
What does malignant FNA aspirate look like on cytology? 4
Dis-cohesive Bigger Pleomorphic Necrotic background
64
Advantages of CB
- Very low false +ve (Very sensitive) - Can give specific benign dx - Can differentiate in situ from invasive - Subtypes - Can tell receptor status
65
Disadvantages of CB
Local anaesthetic needed Expensive Complications more frequent More complex Requires radiological guidance
66
Subtypes of breast cancer
Ductal carcinoma Lobular carcinoma
67
What would a CB of in situ ca show?
Neoplastic cells Basement membrane intact
68
What would a CB of invasive ca show?
Neoplastic cells Basement membrane breeched
69
Clinical findings of ductal ca
Well defined lump
70
Radiological findings of ductal ca
Well-circumscribed mass
71
Macroscopic pathological findings of ductal ca
Firm, clearly outlined tumour
72
Miscroscopic pathological findings of ductal ca
Abnormal glandular structures | Adenocarcinoma
73
Clinical findings of Lobular Ca
Vague thickening
74
Radiological findings of Lobular Ca
Poorly distinguished mass
75
Which radiological Ix is best in lobular ca?
MRI
76
Macroscopic Pathological findings of Lobular Ca
Poorly defined mass
77
Macroscopic pathological findings of Lobular Ca
Infiltrating single cells
78
Why does lobular ca present as thickening instead of a lump?
- The malignant cells lose e-cadherin | - The cells don’t stick together well
79
How is breast Ca graded?
Rate each of these out of 1-3 Tubule formation Nuclear pleomorphism Mitotic figures Add each of these up Grade 1 : 3-5 Grade 2 : 6-7 Grade 3 : 8-9
80
How is breast ca staged?
TNM
81
In TNM staging, what does this mean?: N0
Node negative
82
In TNM staging, what does this mean?: N1
Nodes involved Mobile
83
In TNM staging, what does this mean?: N2
Nodes involved Fixed
84
In TNM staging, what does this mean?: N3
Supraclavicular Nodes OR Oedema
85
In TNM staging, what does this mean?: M0
No distant mets
86
In TNM staging, what does this mean?: M1
Distant mets
87
In TNM staging, what does this mean?: T1
Tumour sized 20mm or less
88
In TNM staging, what does this mean?: T2
Tumour sized 20-50mm
89
In TNM staging, what does this mean?: T3
Tumour sized 50-100 mm OR <50mm with infiltration
90
In TNM staging, what does this mean?: T4
Tumour sized > 100mm
91
Which has a worse prognosis, ductal or lobular ca?
Ductal
92
What does tubules represent in Breast ca?
Ductal ca | adenocarcinoma
93
Location of ERs?
Nucleus
94
Location of HER-2 receptors?
Cell membrane
95
What does ER+ve look like on a slide?
Dots coloured in brown
96
What does HER-2 +ve look like on a slide?
Dots with brown perimetry
97
Prognosis ER +ve
Good
98
Prognosis HER-2 +ve
Better in the short term
99
Rx ER +ve tumours (3) + MOA
Tamoxifen Anastrozole Rimidrex Block oestrogen binding (ER antagonists)
100
Rx HER+ve
Herceptin

Pathology (6 decks)

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