Breast Pathology

Question 1

function of the breast

Answer 1

production and expression of milk

Question 2

what happen to the breast in pregnancy

Answer 2

lobules proliferate
epithelial cells differentiate - secretion of milk

Question 3

what happens to the breast in ageing

Answer 3

lobules decrease in size and number and interlobular stroma is replaced by adipose tissue

Question 4

diagnostic methods to breast cancer

Answer 4

Mammography- Densities, Calcification
Ultrasonography– Solid v cystic lesion
Biopsy– FNAB– Core biopsy
Screening– every 2y for women 50-69y

Question 5

4 developmental abnormalities of the breast

Answer 5

Failure of development– Rare: ovarian agenesis, eg Turner Syndrome
Juvenile hypertrophy– Rapid, disproportionate development during puberty
– Surgery
Milkline Remnants– Supernumerary nipples, hormone responsive
Nipple Inversion– Congenital: usually revert during pregnancy– Acquired: concerning

Question 6

3 causes of breast inflammation

Answer 6

• Infection
• Mammary duct ectasia
• Fat necrosis

Question 7

what is Squamous metaplasia of lactiferous ducts

Answer 7

Painful erythematous subareolar mass
Keratin plugs, block ducts -> dilation, rupture
Chronic inflammation

Question 8

what is duct ectasia

Answer 8

post-menopausal, parous women
periareolar palpable mass - painless
duct dilation, rupture
fibrosis leads to nipple retraction

Question 9

what cells are seen in necrotic tissue

Answer 9

macrophages, giant cells, fibrosis,

Question 10

what are fibrocystic changes

Answer 10

non proliferating breast changes
normal but exaggerated response to hormones in pre menopausal women

Question 11

types of fibrocystic changes

Answer 11

1. cystic change
2. fibrosis
3. adenosis - normal in pregnancy

Question 12

proliferative breast changes without atypia

Answer 12

1. epithelial hyperplasia
2. sclerosing adenosis
3. complex sclerosing lesion
4. papilloma

Question 13

what is sclerosing adenosis

Answer 13

over double number of acini in terminal ducts

Question 14

complex sclerosing lesion

Answer 14

epithelial hyperplasia, sclerosing adenosis, papillomas

Question 15

proliferative breast changes with atypical hyperplasia

Answer 15

Atypical ductal hyperplasia (ADH)
Duct filled with cells
Spaces: some round, regular, some slit like

Atypical lobular hyperplasia (ALH)
Population of cells partially fill lobule
Some intracellular lumens
Usually incidental finding

Question 16

heterogenous disease in breast carcinoma

Answer 16

oestrogen receptor ER and HER2 expression

Question 17

hereditary breast cancer genes

Answer 17

BRCA1 gene - 50% hereditary
BRCA2 gene - 30% hereditary

Question 18

main risk of sporadic breast cancer

Answer 18

hormone exposure - menopause, pregnancy, breastfeeding

Question 19

what type of cancer is most common in the breast

Answer 19

adenocarcinomas (95%)

Question 20

types of carcinoma in situ

Answer 20

ductal carcinoma in situ
lobular carcinoma in situ

Question 21

types of invasive carcinoma

Answer 21

invasive carcinoma no special type
invasive lobular carcinoma
medullar, mucinous, metaplastic, papillary, tubular

Question 22

what is ductal carcinoma in situ

Answer 22

malignant clonal proliferation of epithelial cells limited to ducts and lobules by the basement membrane

Question 23

presentation of ductal carcinoma in situ

Answer 23

calcifications (50%) and rarely nipple discharge

Question 24

what is paget disease of the nipple

Answer 24

unilateral erythematous eruption with scale crust

Question 25

do malignant cells breach the basement membrane in pagets disease of the nipple

Answer 25

no

Question 26

what is lobular carcinoma in situ

Answer 26

clonal proliferation of cells within ducts and lobules that grow in a discohesive fashion usually due to acquired loss of e cadherin

Question 27

what is seen on a mammography of lobular carcinoma in situ

Answer 27

no calcifications of densities

Question 28

histology of lobular carcinoma in situ

Answer 28

loosely cohesive clusters within lobules, mucin positive signet ring cells, e cadherin loss

Question 29

treatment of lobular carcinoma in situ

Answer 29

chemoprevention with tamoxifen, bilateral prophylactic mastectomy

Question 30

indications of invasive carcinoma

Answer 30

palpable mass nipple retraction blocked lymphatics radiodense mass detected by mammography

Question 31

histological features of invasive ductal carcinoma

Answer 31

firm, irregular border, grating sound when cut, chalky areas of stroma, foci of calcification

Question 32

histological feature of invasive lobular carcinoma

Answer 32

poorly defined, irregular border, loose clusters of tumour cells, invade dense fibrous stroma, signet ring shape, absence of e cadherin

Question 33

prognostic factors for breast cancer survival

Answer 33

lymph node status - >10 nodes - 10-15% tumour size - >2cm 77% invasive in situ - 50% distant metastases locally advanced disease histological subtype

Question 34

what is the most common benign tumour in young women

Answer 34

fibroadenoma

Question 35

what is a phyllodes tumour

Answer 35

stromal tumour arises from intralobular stroma - leaflike architecture

Question 36

what is gynaecomastia

Answer 36

benign enlargement of male breast caused by hormones, liver cirrhosis, klinefelter syndrome