Breast Pathology

Question 1

How is breast cytology/biopsy classified?

Answer 1

C1/B1 = unsatisfactory 
C2/B2 = benign 
C3/B3 = Atypical probably bening 
C4/B4 =suspicious of malignancy 
C5 = Malignant 
B5a = carcinoma in situ 
B5b = invasive carcinoma

Question 2

What are the causes of gynaecomastia?

Answer 2

Hormones
Cannabis
Drugs (spironolactone)
Liver disease

Question 3

What age group does fibrocystic change in the breast tend to present?

Answer 3

Majority 40-50 but can be any age 20-50

Question 4

How does fibrocystic change in the breast tend to present?

Answer 4

Smooth discrete lumps
Sudden pain
Cyclical pain

Question 5

Describe a fibrocystic change cyst

Answer 5

Blue domed cyst filled with fluid lined by apocrine epithelium

Question 6

What is a breast hamartoma?

Answer 6

Circumscribed lesion of normal breast cells but in abnormal proportion or distribution

Question 7

When is the peak incidence of fibroadenomas?

Answer 7

In 30’s (& in black women)

Question 8

How does a breast fibroadenoma present?

Answer 8

“Breast mouse”

Painless, firm, rubbery, mobile mass

Question 9

How does sclerosing adenossi present on the breast?

Answer 9

Pain

Tenderness or lumpiness/thickening

Question 10

What is a radial scar composed of?

Answer 10

Fibroelastic core with fibrocstic change

Question 11

How does fat necrosis end to present?

Answer 11

History of previous trauma

Question 12

What are “foamy macrophages present in?

Answer 12

Fat necrosis

Question 13

How does duct ectasia present?

Answer 13

Affects subareolar ducts 
Pain 
Blood and/or purulent discharge 
Nipple retraction & distortion 
Acute episodic inflammation 
Periductal inflammation/fibrosis

Question 14

What is duct ectasia associated with?

Answer 14

Smoking

Question 15

How is mastitis treated in pregnancy?

Answer 15

Symptomatic relief (NSAIDs or warm compresses)
If no improvement in 12-24 hours = Flucloxacillin (4 days)

Question 16

Treatment of isolated nipple fissure with discharge?

Answer 16

Topical fusidic acid (if spread use same antibiotics as mastitis)

Question 17

What is the treatment for thrush on the nipple in a breast feeding woman?

Answer 17

Miconadazole cream

Question 18

How does phyllodes tumour present?

Answer 18

40-50 y/o with slow growing unilateral breast mass

Prone to local recurrence

Question 19

How does intraduct papilloma present?

Answer 19

Age 35-60
Nipple discharge +/- blood
In subareolar ducts

Question 20

What organism usually causes of lactation breast abscess?

Answer 20

Staph aureus

Question 21

When might apatient get a angiosarcomaof the breast?

Answer 21

Post XRT

Question 22

What are the features of DCIS?

Answer 22

Columnar cell change

Atypical ductal hyperplasia

Question 23

How is an in-situ carcinoma defined?

Answer 23

Confined within basement membrane of acini& ducts

Question 24

How is atypical lobular hyperplasia (ALH) differentiated from LCIS?

Answer 24

ALH = <50% oflobuleinvolved
LCIS = >50% of lobule involved

Question 25

What are the characteristics of LCIS?

Answer 25

Small-immediate sized nuclei Not palpable/visible Solid proliferation intracytoplasmic lumens/vacuoles

Question 26

How is LCIS investigated?

Answer 26

ER positive | E-caherin negative

Question 27

How should LCIS be managed?

Answer 27

Excise!!!

Question 28

Where does DCIS arise?

Answer 28

Terminal duct lobular unit (characterstically unicentric_

Question 29

What is the termfor DCIS involving the nipple?

Answer 29

Paget's

Question 30

How is DCIS managed?

Answer 30

Surgery + adjuvant radioto whole breast

Question 31

What is microinvasive carcinomaofthebreast?

Answer 31

are | DCIS (high grade) with invasion of <1mm

Question 32

What are the risk factors for invasive breast cancer?

Answer 32

``` Age Repro history (nulliparity, first child >30y/o) Hormones Lifestyle Genetics (BRCA, TP53, PTEN) ```

Question 33

Which lymph nodes does the breast drain to?

Answer 33

Internal mammary Supraclavicular Aillary

Question 34

How is invasive breast crcinoma classified?

Answer 34

``` Ductal = 70% Lobular = 10% ```

Question 35

How are invasive breast carcinomas graded?

Answer 35

``` Tubular differentiation (1-3) Nucleur pleomorphism (1-3) Mitotic activity (1-3) ``` Grade I = 3, 4 or 5 Grade II = 6 or 7 Grade III = 8 or 9

Question 36

How can breast cancers that are ER positive (80%) be treated?

Answer 36

Oophrectomy Tamoxifen Letrozole Zoladex

Question 37

How can breast cancers that are HER2 positive be treated?

Answer 37

Trastuzamab (Herceptin)

Question 38

What tools are used to determine prognosis in breast cancer?

Answer 38

Nottingham prognostic index | Adjuvant

Question 39

How is breast cancer treated?

Answer 39

Surgery + radio

Question 40

How is the amount of radiotherapy determined for breast cancer?

Answer 40

Breast alone if negative SNB | Tumour bed if < 54 y/o

Question 41

When is neoadjuvant chemo more effective?

Answer 41

When cancer is grade 3

Question 42

In what symptoms is breast imaging not indicated?

Answer 42

Pain Tenderness Symmetrcal nodularity

Question 43

How are masses in the breastimaged?

Answer 43

US <40 y/o | XRM +/- US if >40 y/o

Question 44

What shape should lymph nodes be on a normalmammogram?

Answer 44

Oval/horseshoe

Question 45

What are the 2 best single views on a mammogram?

Answer 45

Mediolateral oblique then craniocaudal

Question 46

What should be used if unsure about images having tried mediolateral oblique & craniocaudal?

Answer 46

Paddle (localised compression) view

Question 47

What form do malignant calcifications take on a mammogram?

Answer 47

Rhomboid forms Individual linear branching Y shaped forms ``` Benign = "wider than tall" Malignant = "taller than wide" ```

Question 48

What is the first line imaging for women with implants?

Answer 48

US

Question 49

What investigation is used for monitoring response to chemo?

Answer 49

US