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Histopathology > Breast Pathology > Flashcards

Breast Pathology Flashcards

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1
Q

What are the main investigations of breast disease?

A

Clinical examination
Imaging-sonography,mammography, MRI (sensitive and specific)
Biopsy-cytopathology or histopathology

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2
Q

Is ultrasound more specific than mammogram?

A

Yes, picks up more echoes and shadows

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3
Q

What kind of cancers are normally detected by MRI.

A

Lobular cancers, tend to be bilateral, small. High resolution.

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4
Q

What is involved in a FNA.

A

Insert a 16 gauge needle into the lesion, material is aspirated,ms eared onto a slide, dip into fixative.
Slides are stained.

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5
Q

What are the benefits of cytopathology?

A

Good cellular detail
Quick to prepare, but no architecture
Used in nvestigation of nipple discharge and palpable lumps

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6
Q

How are aspirates of breast lumps coded for cytology?

A 
C1- inadequate
C2- benign
C3- atypia, probably benign. Lesions which surgeons chase and repeat
C4- suspicious of malignancy
C5- malignant
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7
Q

What is the gold standard to prove diagnosis?

A

Biopsy

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8
Q

What happens once the biopsy is taken?

A 
Intact tissue is removed
fixed in formalin to preserve 
embedded in paraffin wax 
Thinly sliced and stained with H&E
Takes 24-36 hrs 
Cellular AND architecture
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9
Q

What is in a breast histology slide?

A

Duct in the centre and acinar in the periphery.
The terminal duct lobular unit
breast cancers arise from this structure.

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10
Q

What cells are in the ducts?

A

Myopethelial cells and luminal cells.

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11
Q

What does duct ectasia mean?

A

Inflammation and dilation of large breast ducts.

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12
Q

How do patients with duct ectasia present?

A

Nipple discharge
Breast pain
Breast mass
Nipple retraction

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13
Q

What does the cytology show in duct ectasia?

A

Proteinaceous material and inflammatory cells only (foamy macrophages)

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14
Q

Is there an increased risk of malignancy with duct ectasia?

A

No

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15
Q

What is acute mastitis?

A

Inflammation of the glandular tissue

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16
Q

Why is acute mastitis often seen in women?

A

Often seen in lactating women due to cracked skin and stasis of milk.

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17
Q

What disease may mastitis complicate?

A

Duct ectasia

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18
Q

What is the usual causative organism for acute mastitis?

A

Staphylococci

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19
Q

How does acute mastitis present?

A

With a painful red breast

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20
Q

What is the cure for acute mastitis?

A

Drainage and abx

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21
Q

How can fat necrosis present?

A

Breast mass, can be worrying

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22
Q

What is fat necrosis a response to?

A

Trauma
Surgery
Radiotherapy

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23
Q

What is fat necrosis?

A

Inflammatory reaction to damaged adipose tissue

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24
Q

What is fibrocystic disease?

A

Group of alterations in breast which reflect normal, albeit exaggerated responses to hormonal influences

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25
How do patients with fibrocystic disease present?
Breast lumpiness, very common, no risk of carcinoma
26
What can happen to the fluid that accumulates in fibrocystic disease?
It can become calcified and is picked up on mammogram
27
What is fibroadenoma?
Benign, fibroeptheilial lesion, very common. | Proliferation of the stroma and the glandular ducts
28
How does fibroadenoma present?
Circumcised mobile lump in young women 20-30
29
How can you cure fibroadenoma?
Simple 'shelling out'.
30
What category does fibroadenoma belong to?
C2
31
What do the glands look like in fibroadenoma?
Slit like
32
What does phyllodes mean?
Latin for leaf like
33
What are phyllodes tumours?
Potentially aggressive fibroeptheilial neoplasms, uncommon
34
How do phyllodes tumours present?
Enlarging mass in women aged over 50
35
What may phyllodes tumours arise with?
Pre-existing fibroadenoma
36
Are phyllodes tumours cancerous?
Most are benign, a small proportion behave aggressively
37
What makes phyllodes benign, borderline or malignant?
Stromal cellularity and stromal overgrowth
38
What is an intraductal papilloma?
Benign papillary tumour, arising within duct system small terminal ductules (peripheral) Larger lack ferrous ducts (Central) Multiple- increased risk of cancer
39
What do intraductal papilloma have in the core?
Fibrovascuale tissue
40
What is a radial scar?
A benign sclerosing lesion | Central zone of scarring, surrounded by radiating zone of proliferate glandular tissue
41
What size are radial scars?
Tiny microscopic lesions to large clinically apparent masses
42
What are lesions more than 1cm called?
Complex sclerosing lesions
43
Where can you get malignancy in radial scar?
The edges
44
What is radial scar thought to represent?
An exuberant reparative phenomenon in response to areas of tissue damage in the breast.
45
How do radial scars present?
Stellate masses on screening mammograms | Excision is curative
46
What are proliferating breast disease?
Intraductal proliferation lesions associated with increased risk, different magnitudes, subsequent development of carcinoma
47
Do proliferative breast diseases cause symptoms?
No, they are microscopic lesions
48
When are proliferative breast diseases diagnosed?
When breast tissue is removed for other reasons | On screening mammograms if they calcify
49
What is epithelial hyperplasia?
Not considered a direct precursor to invasive breast cancer but marker for slightly increased risk for subsequent carcinoma
50
What is flat epithelial atypia?
Represents morphological precursor to low grade ductal carcinoma in situ 4 times relative risk of developing cancer
51
What is in situ lobular neoplasia?
Risk factor for subsequent invasive breast carcinoma in either breast, 7-12 fold.
52
What is ductal carcinoma in situ?
Neoplastic intraductal epithelial proliferation in the breast with an inherent but not inevitable risk of progression to invasive breast carcinoma (non invasive) Common Can be excised
53
What percentage of DCIS are detected on mammography as areas of microcalcifaction?
85%
54
What percentage of DCIS produce clinical findings like a lump, nipple discharge, Paget's disease of nipple?
10%
55
What percentage of DCIS are diagnosed incidentally in breast specimens removed for other reasons?
5%
56
What are DCIS classified into?
Low Intermediate High grade
57
What is treatment like for DCIS?
Surgical excision, clear margins/mastectomy | Recurrence more likely with extensive disease and high grade DCIS
58
What is invasive breast carcinoma?
Cancer has come out of basement membrane and into stroma. Epithelial 1 in 8 risk
59
What percentage of lifetime risk is there for invasive breast carcinoma with BRCA mutation?
85%
60
Where do low grade carcinomas tend to arise from?
Low grade DCIS or in situ lobular neoplasia and show 16q loss
61
Where do high grade breast carcinoma arise from?
High grade DCIS and show complex karyotypes with many unbalanced chromosomal aberrations
62
What pattern is seen invasive lobular carcinoma?
Indian fine pattern
63
What is basal-like carcinoma?
Characterised by sheets of markedly atypical cells, with a prominent lymphocytic infiltrate Central necrosis
64
What is the immunohistochemistry of basal like carcinoma?
Positivity for basal cytokeratin ck5/6 and ck14 BRCA mutation Propensity for vascular invasion and mets
65
How are cancers histologically graded?
Tubule formation Nuclear pleomorphism Mitotic activity Each is scored 1-3
66
What are the grade/points for histology grading?
``` 3-5= grade 1 6-7= grade 2 8-9= grade 3 ```
67
What is the receptor status for the different grades of carcinoma?
Low grade- ER and PR positive, Her2 negative High grade- ER and PR negative, Her2 positive Basal like- triple negative
68
What is the single most important prognostic factor for carcinoma?
Status of axillary lymph nodes | Tumour size, histological type, and grade
69
What is the coding system for biopsy?
``` B1- normal B2- benign abnormality B3- lesion of uncertain malignant potential B4- suspicious of malignancy B5- malignant (a is DCIS, b is invasive) ```
70
What does gynaecomastia look like?
Breast ducts show epithelial hyperplasia with finger like projections extending into the duct lumen. Periductal stroma is cellular and oedematous
71
What are the common presentations of best disease?
Breast lump Abnormal screening mammogram-incidental Nipple discharge from lactiferous ducts

Histopathology (4 decks)

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