Flashcards in Breast Pathology Deck (24)
What happens in acute mastitis?
Inflammation, most commonly due to staph A infection
Presents with erythematous, red, painful breast, around the nipple
Common in breast feeding women - It almost always occurs during lactation
There may be fissures.
There may or may not be systemic features
What is the management of mastitis?
Encourage women to continue breast-feeding
If there are systemic features, fissures, symptoms not improving - antibiotics are indicated - Flucloxacillin
What is meant by duct ectasia?
Dilation and inflammation of the lactiferous ducts
Typically occurs around the time of menopause as the breasts undergo involution
Presents with brown-green nipple discharge and peri-areolar lump
What happens in fibrocystic change/disease?
It describes disturbances in normal breast physiology
The main pathological abnormalities are small cyst formation, fibrosis and hyperplasia of the duct epithelium
Commonest breast lesion, the mass often disappears after FNA.
Presents with cyclical (worse just before period) with bilateral lumpiness and breast pain (mastalgia)
What are the management options in fibroadenoma?
Most commonly they are 2-3cm in size - patients can be reassured that there is no risk of malignancy and resolve spontaneously
Consider surgical removal if larger than 3cm
What happens in fibroadenoma?
Proliferation of the ducts and stroma, presents with a mobile mass (breast mouse), discrete, firm, freely mobile, classically slip from under examining fingers
Common in 15-25 year olds
Under a microscope: there is a mixture of stromal and epithelial elements. Macroscopically: white/grey, well-fined edges
How can breast carcinomas be classified?
Divided into in situ and invasive, they can then be ductal or lobular
Ductal is more common than lobular
What are the risk factors for breast cancer?
Gender, increasing age, obesity, uninterrupted menses (early menarche, nulliparity, late menopause, family history, previous high dose chest radiotherapy
What is the presentation of breast cancer?
Painless lump, redness (but without temperature), nipple retraction, peau d'orange (cutaneous lymphoedema with skin dimpling), unilateral swelling/change in size, axillary lymphadenopathy
What happens in the breast cancer screening programme?
Women aged 47-73
Mammogram every 3 years
2 views are obtained: cranio-caudal and medial-lateral oblique
What are the NICE guidelines for a suspected cancer pathway referral?
Women over the age of 30 with an unexplained breast lump with or without pain
Women over the age of 50 with unilateral nipple discharge or swelling
How are breast lesions investigated and diagnosed?
Clinical: history, family history, examination
Radiographic imaging: mammogram and USS (ultrasound is more sensitive is those under 40 and it the best first test for a breast lump)
Pathology: fine needle aspiration cytology and core biopsy (ultrasound guided)
Why are mammograms easier to interpret in older women?
Over time, the breast tissue regress, and the interlobular stroma is replaced by adipose tissue so it is easier to see lesions
In a mammogram we are looking for calcification and densities
What are the management options in breast cancer?
Surgery: mastectomy vs wide local excision (breast conservation surgery)
Radiotherapy is often given after surgery
Hormonal therapy: if oestrogen receptor positive
Biological therapy: if HER2 antibodies positive
How are large numbers of oestrogen receptors detected in breast cancer?
How can it be treated?
Cell nucleus positivity (ER+)
Tamoxifen for women who are pre-menopausal and peri-menopausal
Aromatase inhibitors for women who are post-menopausal
This is a form of hormonal therapy
How are large numbers of HER2 receptors detected in breast cancer?
How can it be treated?
Cell membrane positivity
Herceptin (aka Trastuzumab)
It is a monoclonal antibody targeting HER2 receptors
This is a form of biological therapy
What are two types of stromal tumours?
Fibroadenoma and Phyllodes tumour
How do assess lymph node involvement in breast cancer?
If normal ultrasound scan - sentinel lymph node biopsy
If suspicious USS - FNA
If FNA benign - sentinel lymph node biopsy
If FNA malignant - axiallry clearance
What are the indications for a wide local excision of a breast cancer over mastectomy?
Less than 4cm
Small lesion in large breast
What happens in Paget's disease?
Erythematous, eczematous changes over the nipple due to the infiltration of malignant cells
What is meant by the Nottingham Prognostic Index?
Indication of survival
Lower score = better prognosis
(Tumour size x 0.2) + Lymph node score + grade score
If 0 lymph nodes = 1 points for score and grade
If 1-3 lymph nodes = 2 points for score and grade
If 3+ lymph nodes = 3 points for score and grade
What is meant by an intraductal papilloma?
Benign, localised areas of epithelial proliferation
Associated with increased risk of developing invasive carcinoma
Patients present with unilateral discharge (serous +/- blood)
A small lump maybe palpable under the nipple
Treatment is excision of the affected duct
What is the presentation of breast cysts?
Usually women in their 40s
Present with sudden, painful swelling
Diagnosis and treatment is by aspiration
If the aspirate draws blood, this suggests malignancy within the wall of the cyst - local excision of the lesion