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Breast Pathology 2 Flashcards

(61 cards)

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1
Q

What component of a Phyllodes tumour is malignant?

A

stromal element

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2
Q

What is classification of Phyllodes tumours?

A

sarcoma

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3
Q

What is the main risk factor for developing angiosarcoma of the breast?

A

radiotherapy

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4
Q

What are the most common metastases to the breast?

A

bronchial; ovarian serous carcinoma; clear cell carcinoma of the kidney

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5
Q

What does breast carcinoma arise from?

A

glandular epithelium of the terminal duct lobular unit

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6
Q

What is columnar cell change?

A

ductal epithelial proliferation with minor genetic changes

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7
Q

What is ductal carcinoma in situ?

A

malignant cells bounded by the BM

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8
Q

What two components used to make up lobular in situ neoplasia

A

atypical lobular hyperplasia and lobular carcinoma in situ

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9
Q

What is the difference between atypical lobular hyperplasia and lobular carcinoma in situ

A

atypical lobular hyperplasia <50% of lobule involved whereas LCIS has >50% of the lobule involved

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10
Q

What are the characteristics of cells in lobular in situ neoplasia?

A

small-intermediate sized nuclei; solid proliferation; intra-cytoplasmic lumens

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11
Q

What are the genetic features of lobular in situ neoplasia/

A

ER positive and E-cadherin negative

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12
Q

When does incidence of lobular in situ neoplasia decrease?

A

post-menopause

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13
Q

How is lobular in situ neoplasia usually diagnosed and why?

A

incidentally- not palpable and no visible grossly

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14
Q

What is the significance of finding lobular in situ neoplasia?

A

10-15% risk of higher grade lesion on diagnostic biopsy

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15
Q

What is the risk with lobular in situ neoplasia of progression to invasive carcinoma?

A

x8

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16
Q

What is the management for lobular in situ neoplasia?

A

excise or vacuum biopsy to exclude higher grade lesion; follow up

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17
Q

What is the risk of progression to invasive carcinoma with epithelial hyperplasia of the usual type?

A

x2

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18
Q

What is the risk of progression to invasive carcinoma with atypical ductal hyperplasia?

A

x4

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19
Q

What is the risk of progression to invasive carcinoma with ductal carcinoma in situ?

A

x10 (25% over following 10 years)

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20
Q

Where does DCIS arise?

A

TDLU

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21
Q

How many duct systems does DCIS typically affect?

A

single duct system- unicentric

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22
Q

What is cancerisation?

A

if DCIS involves the lobules

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23
Q

What is DCIS named if it also involves the nipple skin?

A

Paget’s disease of the breast

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24
Q

What is Paget’s disease of the nipple?

A

high grade DCIS extending along ducts to reach epidermis of nipple

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25
What is the most important factor in classifying DCIS?
cytological grade- most important in prognosis
26
What is the significance of DCIS?
RF for development of invasive carcinoma and is a true precursor lesion for invasive carcinoma (75% will progress with incisional biopsy only)
27
What is the management for DCIS?
surgery and radiotherapy
28
What is microinvasive carcinoma?
high grade DCIS with invasion of <1mm
29
How is microinvasive carcinoma treated?
as high grade DCIS
30
What are the reproductive risk factors for carcinoma of the breast?
early menarche; >30 first birth; nulliparous; no breastfeeding; late menopause-----how many periods in a life
31
What exogenous hormones carry a risk for carcinoma of breast?
OCP and HRT
32
What lifestyle factors are implicated in carcinoma of the breast?
high BMI (>30 inc. risk 30%); low physical activity; alcohol and diet; smoking and NSAIDs (protective)
33
What does having an affected first degree relative do to your risk of carcinoma of breast?
x2
34
how is breast carcinoma graded?
tubular differentiation; nuclear polymorphism and mitotic activity
35
What is basal-like breast cancer known as?
triple negative- ER, PR and HER2 (basal CK +ve)
36
What does ER expression predict?
response to anti-oestrogen therapy
37
What is anti-oestrogen therapy?
oopherectomy; tamoxifen; aromatase inhibitors and GnRH analogues
38
What is HER2?
human epidermal growth factor receptor 2
39
What does overexpression or amplification of HER2 predict respone to?
trastuzamab (herceptin)
40
What is trastuzamab?
humanised mouse monoclonal antibody
41
What does the prognostic index PREDICT use ?
histopathology + ER + clinical factors + HER2 + mode of detection
42
What does the Nottingham prognostic index use?
0.2 x tumour diameter; tumour grade and lymph node status
43
What is the most common type of breast malignancy?
ductal
44
What are the common symptoms of breast cancer?
visible lump; dimpled or depressed skin; nipple change; bloody discharge; texture change; colour change
45
What are the indications for adjuvant RT?
involvement of >3 nodes; positive surgical margins and/or tumours >5cm
46
What is bevacizumab?
monoclonal antibody against VEGF
47
What is bevacizumab used for?
metastatic breast cancer
48
What is lapatinib?
dual inihibitor of epidermal growth factor receptor and HER-2 tyrosin kinases
49
What is the most common benign neoplasm of the breast?
fibroadenoma
50
How is diagnosis of fibroadenoma confirmed?
ultrasound core biopsy
51
When should aspiration of breast cysts be sent for cytology?
grossly bloody fluid
52
What can be associated iwth a bloody cyst fluid or residual mass after aspiration?
intracystic papillary proliferation: papilloma
53
What is normal nipple discharge for women of reproductive age?
clear, yellow and watery
54
What is the most common cause of spontaneous nipple discharge?
intraductal papilloma
55
What is the most common bug in mastitis?
S. aureus
56
What are the symptoms of mastitis?
fever; erythema; induration; tenderness and swelling
57
How often should a patient with mastitis be examined?
every 3 days
58
What is the prognosis of fat necrosis of the breast?
usually subsides spontaneously
59
What is Mondor's disease?
phlebitis and subsequent clot formation in the superifical veins of the breast
60
What is Mondor's disease usually associated with?
hx of trauma to the breast eg surgery
61
How long does it take Mondor's disease to resolve?
8-12 weeks

Reproduction (52 decks)

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