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Breast Pathology Flashcards

1
Q

Define gynaecomastia

A

Breast development in the male with ductal growth but no lobular development

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2
Q

Give 4 causes of gynaecomastia

A

Exogenous/endogenous hormones
Liver disease
Medication
Cannabis

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3
Q

List 4 benign developmental abnormalities in the breast

A

Hypoplasia
Juvenile hypertrophy
Accessory breast tissue
Accessory nipple

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4
Q

what age range of women are commonly affected by fibrocystic changes?

A

20-50 y/o

Majority 40-50

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5
Q

What 2 menstrual features are associated with fibrocystic changes

A

Early menarche

Late menopause

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6
Q

Fibrocystic changes resolve after menopause. True or false

A

True

Often is the case, or may diminish in size

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7
Q

Give 4 potential presenting symptoms seen in fibrocystic change

A

Smooth discrete lumps
Sudden pain
Cyclical pain
Lumpiness

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8
Q

On gross pathology, what two things are seen in fibrocystic change?

A

Cysts

Intervening fibrosis

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9
Q

What do fibrocystic cysts typically look like?

A

Blue domed with pale fluid
roughly 1 mm-several cm
Thin walled
Lined with apocrine epithelium

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10
Q

Define metaplasia:

A

The change from one fully differentiated cell type to another fully differentiated cell type

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11
Q

What management options are there for fibrocystic changes

A

Exclude malignancy
Reassure patient
Excise only if necessary

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12
Q

Define Hamartoma:

A

Circumcised lesion composed of cell types which are normal to the breast but present in an abnormal proportion or distribution

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13
Q

What ethnicity are fibroadenoma’s most common in?

A

African women

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14
Q

What % of fibroadenoma’s are solitary lesions?

A

90%

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15
Q

What age range are fibroadenoma’s most common?

A

3rd decade peak incidence

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16
Q

A painless but firm mobile mass which is discrete is a typical presentation of what?

A

Fibroadenoma

Often referred to as “breast mouse”

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17
Q

What is the appearance of a fibroadenoma on USS

A

Solid well circumcised solitary lesion

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18
Q

Management plan for fibroadenoma:

A

Diagnose, exclude malignancy
Reassure
Rarely excise unless absolutely necessary

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19
Q

What option is there for excision when a fibroadenoma is <2cm

A

Vacuum biopsy

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20
Q

Define sclerosing adenosis

A

A benign disorderly proliferation of the acini and stroma which may lead to calcification or a mass.
Can mimic carcinomas

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21
Q

Pain and tenderness along with lumpiness/thickening of the breast in an asymptomatic patient of any age range between 20 - 70 is a typical presentation of what?

A

Sclerosing Adenosis

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22
Q

Sclerosing adenosis has malignancy potential? True or False

A

False (for the most part)

there is negligible risk of subsequent carcinoma

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23
Q

What is a radial scar?

A

A form of sclerosing duct hyperplasia

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24
Q

What is the difference between a radial scar and a complex sclerosing lesion (CSL)

A

Radial scar 1-9mm

CSL >10mm

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25
Q

Give three things seen on pathology of radial scar

A

Stellate architecture
Central Puckering
Radiating fibrosis

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26
Q

“Fibroelastotic core with radiating fibrosis containing distorted ductules
Epithelial proliferation and fibrocystic change” would be a common histology report for what?

A

Radial scar/CSL

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27
Q

treatment for radial scars

A

Excise or extensive sample via vacuum biospy

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28
Q

Give three examples of inflammatory lesion causing pathologies

A

Fat necrosis
Duct ectasia
Acute mastitis

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29
Q

What is a common cause of fat necrosis

A

Seat belt trauma

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30
Q

What medication is thought to cause fat necrosis of the breast

A

Warfarin therapy

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31
Q

What is the mechanism behind fat necrosis

A

Damage and disruption to the adipocytes leading to the infiltration of inflammatory cells and “foamy” macrophages
Leads to fibrosis and scarring

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32
Q

List some clinical features of duct ectasia

A 
Affecting sub areolar ducts
Pain
Acute episodic inflammatory changes
Bloody/purulent nipple discharge 
Fistula
Nipple distortion/retraction
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33
Q

What social factor is associated with duct ectasia?

A

Smoking

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34
Q 
Sub areolar duct dilation
Periductal inflammation 
Periductal fibrosis
Scarring and distortion
Are all common examination findings of what?
A

Duct ectasia

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35
Q

What is the appropriate management for duct ectasia?

A

Treat any acute infection
Exclude malignancy
Smoking cessation
Excise the ducts if necessary

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36
Q

What are the two main aetiologies of mastitis/abscess?

A

Duct ectasia - mixed organisms and anaerobes

Lactation - staph aureus and strep pyogenes

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37
Q

List appropriate management for acute mastitis/abscess

A

Antibiotics (must have metronidazole if duct ectasia)
Percutaneous drainage
Incision & drainage
Treat underlying cause

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38
Q

What are the clinical features of a phyllodes tumor

A

Leaf like
Affects roughly 40-50y/o
Slow growing unilateral breast mass

39
Q

Stromal overgrowth is common in what benign breast tumor?

A

Phyllodes tumor

40
Q

Phyllodes tumor is prone to recurrence. True/False

A

True

Must be adequately excised

41
Q

Phyllodes commonly metastasizes true/false?

A

False

Very rarely

42
Q

State three benign papillary lesions

A

Intraduct papilloma
Nipple adenoma
Encapsulated papillary carcinoma

43
Q

What age range does an intraduct papilloma tend to affect?

A

35-60

44
Q

What can be seen on screening for an intraduct papilloma

A

Nodules and calcification

45
Q

Sub areolar ducts ranging from 2-20 mm in diameter with papillary fronds containing a fibrovascular core
Covered by myoepithelium and epithelium with potential proliferation”
Is a histology report for what breast pathology

A

Intraduct papilloma

46
Q

What type of tissue is found in a malignant phyllodes tumour?

A

Sarcomatous stromal soft tissue

47
Q

What cancers commonly metastasize to the breast?

A 
Bronchial
Ovarian serous carcinoma
Kidney clear cell carcinoma
Malignant melanoma
Leiomyosarcoma
48
Q

What is the definition of breast carcinoma?

A

A malignant tumour of the epithelial cells of the breast

49
Q

Where does a breast carcinoma arise?

A

Glandular epithelium or the TDLU

terminal duct lobular unit

50
Q

What type of cancer is a breast carcinoma?

A

An adenocarcinoma

Tends to be referred to as breast cancer

51
Q

What two types of precursor legions are there for breast carcinoma?

A

Ductal

Lobular

52
Q

List 4 types of ductal precursor lesions

A

Epithelial hyperplasia
Columnar cell change
Atypical ductal hyperplasia Ductal carcinoma in situ

53
Q

Define an in situ carcinoma

A

Confined within the basement membranes of the acini and ducts and non invasive but is cytologically malignant.

54
Q

What two types of in situ carcinomas of the breast are there

A

Ductal (DCIS)

Lobular (LCIS)

55
Q

What is the difference between atypical lobular hyperplasia (ALH) and Lobular carcinoma in situ (LCIS)?

A

Atypical Lobular hyperplasia involves <50% of the lobule

LCIS involves >50% of the lobule

56
Q

What are Atypical lobular hyperplasia and lobular carcinoma in situ types of?

A

Different types of lobular in situ neoplasia

57
Q

Define Lobular in situ neoplasia

A

Intra-lobular proliferation of characteristic cells

58
Q

Lobular in situ neoplasia is ER positive/negative?

A

ER positive

59
Q

Lobular in situ neoplasia is E-cadherin positive or negative?

A

E-cadherin negative

60
Q

What gene is affected in lobular in situ neoplasia?

A

CDH1 gene is deleted/mutated

found on Chromosome 16

61
Q

In lobular in situ neoplasia incidence _______ after menopause

A

Decreases

62
Q

List some features of lobular in situ carcinoma

A

Non palpable
Frequently multi focal and bilateral
May calcify

63
Q

Lobular in situ neoplasia is usually an incidental finding. True/False?

A

true

64
Q

What is the clinical significance of finding lobular in situ neoplasia?

A

It is a marker of increased risk of breast cancer

A true precursor lesion

65
Q

What is the standard management for lobular in situ neoplasia?

A

If discovered on core biopsy:
- vacuum or excision
Follow up and exclude higher grade lesion/malignancy

66
Q

How much does the risk of invasive carcinoma increase for the following findings?

  • Epithelial hyperplasia
  • Atypical ductal hyperplasia
  • DCIS (low grade)
A

Epithelial hyperplasia - 2x risk

Atypical ductal hyperplasia - 4x risk

DCIS
10x risk

67
Q

Is Ductal carcinoma in situ typically focal or multifocal?

A

Focal

Easier to remove surgically

68
Q

Where does Ductal carcinoma in situ occur?

A

Terminal ductal lobular unit

69
Q

Does ductal carcinoma in situ typically affect one or multiple duct systems

A

Single

70
Q

What is the name given when high grade DCIS involves the nipple epidermis?

A

Paget’s Disease

71
Q

Ductal Carcinoma in situ has cytologically _____ ______ cells

A

Malignant Epithelial

72
Q

What type of classification is used for predicting outcome in DCIS?

A

Cytological grading only

73
Q

What % of DCIS can progress to invasion (following incisional biopsy only)

A

up to 75%

74
Q

What is the management plan for DCIS

A

Surgical removal
Adjuvant radiotherapy
Chemoprevention (trial period atm)

75
Q

Why is adjuvant radiotherapy given for DCIS

A

It reduces the risk of recurrence

76
Q

What follow up is required post DCIS surgical removal?

A

Mammogram follow up

77
Q

Define micro invasive carcinoma

A

A rare form of high grade DCIS involving early stage invasion less than 1mm.

78
Q

Define invasive breast carcinoma

A

Malignant (breast) epithelial cells have breached the basement membrane and infiltrated normal tissue
There is a high risk of metastasis and death

79
Q

List some risk factors for breast carcinoma

A 
Increased age
Early menarche
Late menopause
Nulliparous 
Hormone Replacement Therapy
Hormones - (exo/endo)
OCP
Geography
Previous breast disease
80
Q

Give some protective measures for breast carcinomas

A 
Breast feeding
multiple pregnancies 
Giving birth to first child when younger
Physical Activities 
(mild correlation between NSAID use and lower risk)
81
Q

Why Is early menarche/late menopause considered a risk factor?

A

The more menstrual cycles you go through the higher your risk.
More exposure to high levels of oestrogen

82
Q

Having a BMI >30 increases the risk of breast carcinoma by __ %?

A

30%

83
Q

Why does an increased BMI increase the risk of breast carcinoma?

A

Increased levels of oestrogen

84
Q

What two genes are know for having strong correlation with breast cancer?

A

BRCA 1
BRCA 2

45-64% lifetime risk

85
Q

BRCA 1 and 2 are associated with what % of all breast cancers?

A

2%

86
Q

How many women will develop breast cancer?

A

1 in 8

87
Q

What areas do breast carcinomas commonly metastasize to?

A 
Bone 
Liver
Brain
Lungs
Abdominal viscera
Female genital tract
88
Q

What risk is there when removing lymph nodes during breast surgery

A

Lymphoedema

Therefore we try not to remove all unless necessary

89
Q

What is significant about the lymph drainage of the breast?

A

Some of it shares a lymph drainage with the upper limb

90
Q

What three headings must you consider when classifying invasive breast cancer?

A

Morphology
Gene expression profiling
Hormone receptor expression

91
Q

What is the most common form of breast carcinoma?

A

Ductal = 70%

Then lobular (10%)

92
Q

What are the 3 hormone receptors involved in breast carcinomas?

A 
ER = oestrogen 
PgR = progesterone 
HER2 = human epidermal growth factor receptor 2
93
Q

What does ER expression predict?

A

Response to anti-oestrogen therapy

ie higher expression = better response to therapy

94
Q

What class of anti cancer medication is effective in HER2 positive disease?

A

Humanised mouse monoclonal Antibodies

e.g. Trastuzamab

Reproduction (19 decks)

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