Breast Pathology Flashcards
(37 cards)
State the 4 common conditions leading to formation of breast lumps. (4)
- acute mastitis
- fibroadenoma
- fibrocystic change
- invasive ductal carcinoma
State the histological feature of acute mastitis
- macroinflammatory tissue with collection of pus under skin
State everything you know about acute mastitis
Lactating breast > proliferation of staphylococci in stagnant milk > acute inflammation with accumulation of neutrophils > acute abscess
- associated with periductal mastitis, duct ectasia, fat necrosis, infammatory breast cancer
- treatment: I&D, antibiotics, excision
Presentation:
1. redness of nipple = erythema
2. pain and swelling
3. breast abscess (sc under skin, within breast parenchyma, retromammary areas near pectoralis major)
State histological features of idiopathic granulomatous mastitis.
- epitheloid granulomas
- collection of macrophages
- multinuclear giant cells
State everything you know about idiopathic granulomatous mastitis.
- rare, occurs in parous women
- d/dx = malignancy, TB
- treatment: steroids, immunosuppressants, surgery
Presentation:
1. hard firm mass within breast or sinus (lobulo-centric)
2. colour change of breast
State the histological features of paraffinoma
- multinucleated giant cell resection
- formation of granulomas
- scarring and fibrosis
State everything you know about paraffinoma
- paraffin injections > chronic inflammatory response in breast tissue
Presentation:
1. breast pain
2. breast tenderness
3. hard mass in breast
4. retraction of nipple
State the histological features of fibrocystic breast disease.
- apocrine change
- cysts
- fibrosis
- epithelial hyperplasia
State everything you know about fibrocystic breast disease
- common in reproductive age as lesions are hormone sensitive
- risk of malignancy is based on degree of epithelial hyperplasia
- symptomatic, lumps
State the histological features of intraduct papilloma (benign)
EPITHELIAL TUMOUR
- abnormal dilated duct with proliferating lesions
- finger-like projections into dilated space
State everything you know about intraduct papilloma (benign)
EPITHELIAL TUMOUR
- arises from lactiferous duct closer to nipple
- presentation: nipple discharge, lump under nipple
State the histological features of fibroadenoma
FIBROEPITHELIAL TUMOUR
- minimal epithelial hyperplasia
- compressed ducts lined by single epithelium
- well circumscribed
- stromal elements show low cellularity
- no necrosis
State everything you know about fibroadenoma.
FIBROEPITHELIAL TUMOUR
- common in young women
- arises from glandular and fibrous connective tissue
- shows up as well-circumscribed radiodense lesion on radiology
Gross:
1. circumscribed, uniform, lobulated, compressed ducts surrounding pink fibrous stroma with yellowish fat
State the histological features of Phyllodes tumour.
FIBROEPITHELIAL TUMOUR
1. leaflike architecture
2. stromal proliferation
3. significant atypia
4. high rate of mitosis
5. necrosis
State everything you know about phyllodes tumour
FIBROEPITHELIAL TUMOUR
- arises from stromal tissue of breast
- very rare
- can be benign, borderline (10%), malignant (5-10%)
- tumour is large and can occupy entire breast
Gross:
- haemorrhage and necrosis
- stromal proliferation
Presentation:
1. rapid growth into large, painless, palpable mass and lumps
State the difference between in-situ, invasive and metastatic
in-situ = epithelial cells proliferate within ductal space, BM intact
invasive = tumour cells invade stroma, BM disrupted
metastatic = vascular and lymphatic spread
State the risk factors of breast cancer
- race - caucasian/jew/parsi
- age - perimenopausal
- SES - high
- weight - obese
- previous breast disease - yes
- family history - PTEN, p53, BRCA1 and 2 mutations
- early menarche
- late menopause
Where are breast carcinomas usually found?
Upper outer > subareolar > other
What is a common accompanying presentation of breast carcinomas?
Paget’s disease of nipple (erythema, erosion, ulcers)
State the histological features of ductal carcinoma in-situ (DCIS)
NON-INVASIVE, MALIGNANT
1. presence of calcification
2. dilated ducts with malignant cells
3. cribiform appearance
4. intact BM
5. some necrosis
State everything you know about DCIS
- associated with milk ducts of breast
- precursor to invasive breast cancer (OCCURS IPSILATERALLY)
Gross:
- whitish specks of necrosis
- comedo appearance
State the histological features of Lobular carcinoma in-situ
NON-INVASIVE, MALIGNNAT
1. proliferating tumour cells fill secretory units -> dilate lobules
2. loss of e-cadherin
3. low nuclear grade
4. no necrosis
5. intact BM
6. some pagetoid spread (extending into ducts)
State everything you know about LCIS
- associated with terminal duct lobular units, not ducts
- lower risk of progression to invasive breast cancer as compared to DCIS (OCCURS IPSILATERALLY AND CONTRALATERALLY)
Gross:
- no distinct gross features due to incidental finding
State the differences between DCIS and LCIS.
Predominant location:
DCIS - ducts, LCIS - lobules
Cell size:
DCIS - large or medium, LCIS - small
Calcifications:
DCIS - present, LCIS - absent
Risk of subsequent invasive cancer:
DCIS - higher risk, LCIS - lower risk
Location of subsequent cancer:
DCIS - ipsiateral, LCIS - ipsilateral or contralateral
