Breast pathology Flashcards Preview

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Flashcards in Breast pathology Deck (38):
1

What does the incidence of breast tumour malignancy rise with?

Age

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2

Are breast lesions in young females usually benign or malignant?

Benign

3

Describe the histology of breast tissue?

Modified sweat gland

Background of adipose and connective tissue

Many ducts (15-25) that lead to nipple - branch repeatedly in stroma > terminal part of duct leads into lobule 

Lobule composed of numerous acini

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4

Describe the histology of the acini?

Inner secretory layer

Outer myoepithelial layer

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5

Where do most breast lesions arise from?

Epithelium of terminal duct lobular unit

6

Describe the possible clinical presentations of a breast lesion?

Lump
General lumpiness
Pain
Nipple changes
Nipple discharge
Change in shape
Skin changes
 

7

Describe fibrocystic change of the breast?

Very common, usually in later reproductive years

Bilateral, multifocal

Duct dilation
Cyst formation
Fibrosis
Adenosis
Apocrine metaplasia (epithelial cells become pink and granular)

May be asymptomatic or produce lumps and discomfort

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8

Describe the investigations that should be carried out when a possible breast lesion is present?

Clinical history and examination

Radiology: US and/or mammography

Biopsy

9

Describe the rationale behind mammography?

Looks at radio density of breast

Pathology will show up differently to normal breast

Look for patterns of calcification

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10

Why are biopsies of breast lesions performed?

To ensure that a lesion is malignant before commencing treatment

11

How are biopsies of breast lesions performed?

Which method is preferred and why?

Fine needle aspiration or needle core/tru-cut biopsy

Core/tru-cut preferred as it takes out an actual piece of tissue, so we can see the relationship of cells to each other, the stroma and basement membrane

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12

Describe fibroadenoma?

Solitary, well circumscribed, benign mass

Most common in younger women

Neoplastic or hyperplastic stromal tumour (fibroblasts in stroma predominate)

Minimal increased risk of malignancy

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13

Approximately how many women will be diagnosed with breast cancer?

What is the average age of diagnosis?

1 in 8 diagnosed before the age of 85

Avergae age of first diagnosis is 60 years

14

Describe the predisposing factors to breast cancer?

Age: more time to accumulate mutations

Genetic factors: most are due to sporadic mutations, but there are some familial cases

Increased oestrogen exposure: stimulates proliferation

Environmental and dietary influences: obesity, alcohol

Past history of certain breast diseases

 

15

Describe the sporadic mutations that may give rise to breast cancer?

Somatic mutations in p53 (cell cycle arrest, reapir of DNA damage)

Mutations in HER2 (proto-oncogene, epidermal growth factor receptor on cell surface)

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16

Describe the germline mutations that may give rise to breast cancer?

BRCA1
BRCA2
p53

(TSGs, involved in cell cycle arrest and DNA repair)

Inherited in autosomal dominant fashion
Onset at younger age
May also develop other tumours

17

Describe why postmenopausal obesity may predispose to breast cancer?

Adipose tissue can make oestrogen > oestrogen stimulates proliferation of cells

18

Describe the effect of breast feeding on breast cancer risk?

Decreases risk

Lactation > ovulation suppressed > decreased oestrogen

19

Describe hyperplasia of the breast tissue?

Non-neoplastic proliferation of breast epithelium

With or without atypia

Usually an incidental finding when testing for something else

Does not cause symptoms

Predicts risk of future cancer development

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20

What is in situ carcinoma of the breast?

Describe the risks associated with it?

Malignant population of cells confined to ducts and/or acini, no invasion through basement membrane

Associated with increased risk of developing invasive tumour

Usually asymptomatic

21

Describe the two types of breast carcinoma in situ?

Ductal carcinoma in situ: most common, frequently associated with calcification seen on mammogram

Lobular carcinoma in situ: incidental finding on biopsy

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22

What is Paget's disease of the nipple?

Malignant cell sof DCIS may extend up ducts to the nipple

Inflammation, erythema and exudate of nipple

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23

What are the two main types of invasive carcinoma of the breast?

Invasive ductal carcinoma: most common

Invasive lobular carcinoma

24

Describe the characteristics of invasive ductal carcinoma?

50% in upper outer quadrant

Typically firm stellate mass

Desmoplastic stroma

Tumour cells form glandular lumen

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25

Describe the charcateristics of invasive lobular carcinoma?

Long, thin, individual single files of tumour

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26

Where does invasive breast carcinoma spread to?

Local: skin, nipple, underlying muscle/chest wall, pleura

Metastatic: lymphatic (axillary), blood > lungs, bone, liver, brain, etc.

27

Describe the management options for breast cancer?

How is appropriate treatment determined?

Surgery
Radiotherapy
Chemotherapy
Anti-oestrogen drugs
Herceptin/transtuzumab

Determined by characteristics of primary tumour and stage

28

Describe the role of pathology in the diagnosis and treatment of breast cancer?

Pre-treatment: characterisation of tumour (diagnosis, staging, treatment)

Post-surgical: completeness of surgery, prognostic features (including staging), adjuvant therapy?

29

Describe the surgery options for treatment of breast cancer?

Quadrantectomy: breast-conserving, also samples lymph nodes

Complete masectomy

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30

Describe the difference between axillary clearance and lymph node sampling?

Why are these prcedures necessary?

Axillary clearance: remove all lymph nodes 

Sampling: remove/sample a few nodes

Performed to determine whether or not cancer is present in node

31

Describe why breast cancer are histologically typed?

Gives a good indication of prognosis

32

Describe the grading of breast cancers?

Scores for: acinar/tubule formation, nuclear pleiomorphism, mitotic index

Grade 1 - low grade
Grade 2 - intermediate grade
Grade 3 - high grade

33

Describe the survival rates for the different grades of breast cancer?

Poorer survival for higher grades

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34

Describe the factors which may lead to a poorer prognosis for breast cancer?

Tumour size (larger)

Lymphovascular space invasion (higher likelihood of nodal metastases)

Surgical margins (incomplete excision)

Hormone receptors: ER and PR

HER2

 

35

When are transtuzumab/herceptin used in the treatment of breast cancer?

When HER2 amplification is present

36

How does the presence of HER2 amplification alter the treatment of breast cancer?

Requires use of transtuzumab/herceptin

37

Describe the staging of breast cancer?

TNM staging

TNM4: invasive carcinoma of any size, distant metastases

38

Describe the common chnages that occur to male breast tissue?

Gynaecomastia: increase in size of male breast tissue, due to proliferation of ducts and stroma

Breast carcinoma: 1% that of women