Breast pathology Flashcards
(119 cards)
1
Q
benign breast disease is very common/rare
A
common
2
Q
what is the difference between cytopathology and histopathology
A
cytopathology - cells are obtained from fluid by FNA
histopathology - pieces of tissue are examined from biopsy
3
Q
techniques for obtaining cells for cytopathology
A
FNA
fluid from cyst
nipple discharge
nipple scrape
4
Q
How is breast FNA cytology categorised
A
C1 - unsatisfactory C2 - benign C3 - atypia, probably benign C4 - suspicious of malignancy C5 - malignant
5
Q
can FNA cytology differentiate between CIS and invasive carcinoma
A
no, which is why it is not used as much anymore
6
Q
methods of obtaining breast histopathology samples
A
needle core biopsy
vacuum assisted biopsy
skin biopsy
incisional biopsy of a mass
7
Q
how is needle core biopsy categorised
A
B1 - unsatisfactory/normal B2 - benign B3 - atypia, probably benign B4 - suspicious of malignancy B5 - malignant B5a CIS B5b invasive carcinoma
8
Q
what is a wide local excision also known as
A
breast conservation therapy
removes tumour with clear margin
9
Q
what groups of benign breast disease are there
A
developmental anomalies
non-neoplastic
inflammatory
tumours
10
Q
what is breast hypoplasia
A
condition where 1 or both breasts don’t fully mature or develop
11
Q
what is breast juvenile hypertrophy
A
rapid growth of 1 or both breasts
12
Q
list the benign breast developmental anomalies
A
hypoplasia
juvenile hypertrophy
accessory breast tissue
accessory nipple
13
Q
what is accessory breast tissue
A
mass anywhere along the embryological mammary streak
14
Q
what is an accessory nipple
A
minor malformation of mammary tissue resulting in an extra nipple
15
Q
what non-neoplastic changes can occur in the breast
A
gynaecomastia fibrocystic change hamartoma fibroadenoma sclerosing lesions
16
Q
what inflammatory conditions of the breast are there
A
fat necrosis
duct ectasia
acute mastitis
abscess
17
Q
what are the benign tumours of the breast
A
Phyllodes tumour
intraduct papilloma
18
Q
what is gynaecomastia
A
breast development in males
ductal growth without lobular development
19
Q
what are the causes of gynaecomastia
A
hormones - exogenous/endogenous
drugs - spironolactone, furosemide
cannabis
liver disease
20
Q
who does fibrocystic change affect
A
women ages 20-50 (usually 40-50)
21
Q
what is fibrocystic change associated with
A
menstrual abnormalities
early menarche
late menopause
22
Q
fibrocystic change resolves after menopause, true or false
A
true
from reduced oestrogen
23
Q
how does fibrocystic change present
A
smooth discrete lumps sudden pain (rupture or bleeding of cysts) cyclical pain lumpiness incidental / screening
24
Q
what is the pathology of fibrocystic change
A
cysts
intervening fibrosis
25
what is a red flag in gross pathology
blood staining
26
define metaplasia
change of one fully differentiated cell type to another fully differentiated cell type
27
is metaplasia neoplastic/precursor lesion
no
28
management of fibrocystic change
exclude malignancy
reassure
only excise if it is a problem
29
define hamartoma
circumscribed lesion composed of cell types normal to the breast but are present in an abnormal proportion/distribution
30
in which group of women is fibroadenoma common
African women
| 3rd decade of life
31
presentation of fibroadenoma
painless
firm
discrete
mobile mass "breast mouse" as it moves away from your finger as you try to examine it
32
pathological features of a fibroadenoma
localised hyperplasia
| proliferation of intralobular stroma
33
is fibroadenoma a biphasic tumour, what does this mean
yes
| there is overgrowth of 2 components: epithelium and stroma
34
features of a fibroadenoma
circumsribed
rubbery
grey white colour
35
management of fibroadenoma
diagnose
reassure
excise
36
what are the subtypes of sclerosing lesions of the breast
sclerosing adenosis
radial scar
complex sclerosing lesion
37
what are sclerosing lesions
benign, disorderly proliferation of acini and stroma
| can cause a mass or calcification
38
sclerosing lesions may/may not mimic carcinoma radiologically
may mimic carcinoma
39
characteristics of sclerosing adenosis
pain/tenderness
lumpiness/thickening
asymptomatic
20-70 yo
40
characteristics of radial scar
wide age range
| incidental findings
41
what is a radial scar called if:
1-9mm
>10mm
```
1-9mm = radial scar
>10mm = complex sclerosing lesion
```
42
histology of a radial scar
fibroelastic core
distorted ductules
fibrocystic change
epithelial proliferation
43
can CIS or invasive carcinoma occur within radial scars
yes
44
treatment of radial scars
excise or sample extensively by vaccum biopsy
45
causes of fat necrosis
local trauma
| warfarin therapy
46
what is fat necrosis
damage to adipocytes
infiltration by acute inflammatory cells
foamy macrophages
subsequent fibrosis and scarring eg nipple indrawing
47
management of fat necrosis
confirm diagnosis
| rule out malignancy
48
clinical features of duct ectasia
```
pain
acute episodic inflammatory changes
bloody/purulent discharge
fistulation
periductal inflammation and fibrosis
nipple retraction and distortion
```
49
what does duct ectasia affect
sub areolar ducts
50
what is duct ectasia associated with
smoking
51
management of duct ectasia
treat acute infections
exclude malignancy
stop smoking
excise ducts
52
what are the 2 main causes of mastitis and which organisms are responsible
duct ectasia - mixed organisms, anaerobes
| lactation - staph A, strep pyogenes
53
management of mastitis
antibiotics
percutaneous drainage
incision and drainage
treat underlying cause
54
clinical features of Phyllodes tumour
40-50s
slow growing unilateral breast mass
biphasic tumour
stromal overgrowth > epithelium
55
what is Phyllodes tumour also known as
Cytosarcoma phyllodes
56
what are the categories of Phyllodes tumour
benign
borderline
malignant sarcomatous
57
Are phyllodes tumours prone to recurrence if not adequately excised
yes
58
list papillary lesions of the breast
intraduct papilloma
nipple adenoma
ecapsulated papillary carcinoma
59
which age group os affected by intraduct papilloma
35-60
60
clinical features of intraduct papilloma
```
nipple discharge +- blood
nodules
calcification
sub areolar ducts
covered by MEp
```
61
what kinds of epithelial proliferation can you get in an intraduct papilloma
none
usual type hyperplasia
atypical ductal hyperplasia
ductal carcinoma in situ
62
what kind of malignant breast tumours can you get
```
breast carcinoma
non-epithelial breast malignancies
metastases
malignant Phyllodes tumour
angiosarcoma
lymphoma
```
63
risk factor for angiosarcoma of the breast
history of previous radiotherapy
64
what is a malignant Phyllodes tumour treated as
sarcoma
65
which tumours metastasise to the breast
```
bronchial carcinoma
Ovarian serous carcinoma
clear cell carcinoma of the kidney
malignant melanoma
leiomyosarcoma
```
66
define breast carcinoma and what is its technical name
malignant tumour of breast epithelial cells (ductal/acinar cells)
breast adenocarcinoma
67
where does breast carcinoma arise from
glandular epithelium of the Terminal duct Lobular Unit TDLU
68
where can precursor lesions arise in the breast
ductal
| lobular
69
list ductal precursor lesions of breast carcinoma
epithelial hyperplasia of usual type
columnar cell change +- atypia
atypical ductal hyperplasia
ductal carcinoma in situ
70
list lobular precursor lesions of breast carcinoma
atypical lobular hyperplasia
| lobular carcinoma in situ
71
define carcinoma in situ CIS
cytologically malignant cells confined within basement membrane of acini and ducts
72
what types of CIS are there
ductal
| lobular
73
what kinds of lobular in situ neoplasia are there
atypical lobular hyperplasia
| lobular CIS
74
what % of the lobule is involved in atypical lobular hyperplasia
<50%
75
what % of the lobule is involved in lobular CIS
>50%
76
pathological characteristics of lobular in situ neoplasia
small nuclei
solid
ER positive
E-cadherin negative
77
clinical features of lobular in situ neoplasia
```
multifocal and bilateral
reduced incidence after menopause (because ER+)
not palpable
may calcify
usually incidental
```
78
what is the significance of lobular in situ neoplasia
marker of subsequent risk
| true precursor lesion
79
management of lobular in situ neoplasia
excision/vacuum biopsy
follow up
clinical trials
80
where does ductal CIS arise
TDLU
81
Pathological features of DCIS (ductal carcinoma in situ)
cytologically malignant epithelial cells
confined in basement membrane of duct
may involve lobules (cancerisation)
may involve nipple skin (Paget's disease of the breast)
82
how does Paget's disease of the breast arise and is it invasive
high grade DCIS moves along the duct to nipple epidermis
| Paget's is still in situ as basement membrane is in tact
83
how can you classify DCIS
cytological grade
histological type
presence of necrosis
84
what is the significance of DCIS
RF for developing invasive carcinoma
| true precursor lesion for invasive carcinoma
85
management of DCIS
diagnose
surgery
adjuvant radiotherapy
chemoprevention
86
what is microinvasive carcinoma
rare condition where high grade DCIS has gone through the basement membrane but invasion is <1mm
87
how is microinvasive carcinoma treated
same as high grade DCIS
88
what are the pathways of breast carcinogenesis
low, intermediate and high grade
89
what does high grade DCIS turn into
G3 ductal carcinoma
90
define invasive breast carcinoma
malignant epithelial cells which have breached the basement membrane
infiltration of normal tissue
91
which age group is screened for breast cancer
50-70 year olds
92
what are risk factors for breast carcinoma
```
age
reproductive history
OCP, HRT
previous breast disease
western countries
lifestyle
alcohol
genetics
```
93
which age group is screened for breast cancer
50-70 year olds
94
what are risk factors for breast carcinoma
```
age
reproductive history: early menarche, late menopause, parity, breastfeeding (more oestrogen stimulation, increases risk)
OCP, HRT
previous breast disease
western countries
lifestyle - high BMI
alcohol
genetics
```
95
what aspects of reproductive history increases the risk of breast cancer
early menarche
late menopause
nulliparity
96
what lifestyle factors increase risk of breast cancer
high BMI
alcohol
less exercise
97
what procedure could you consider in those with BRCA mutations
prophylactic mastectomies
98
how is invasive breast carcinoma staged
T0-4, N1-3, M0-1
local invasion of breast stroma, skin, muscle
lymphatic involvement of axillae, internal mammary chain
blood spread to bone, liver, brain, lungs, female genital tract
99
what procedure could you consider in those with BRCA mutations
prophylactic mastectomies
100
how is invasive breast carcinoma staged
TNM
local invasion of breast stroma, skin, muscle
lymphatic involvement of axillae, internal mammary chain
blood spread to bone, liver, brain, lungs, female genital tract
101
which group of lymph nodes do the majority of breast cancer spread to
axilla
102
what are sentinel nodes
first nodes that drain the tumour
103
how can invasive breast carcinoma be classified
morphologically
gene expression profiling
hormone receptor expression
104
what does ER + mean
oestrogen receptor positive tumour
105
what does PR + mean
progesterone receptor positive tumour
106
what is the most common type of breast carcinoma
| give examples of others too
ductal
lobular
mucinous
NST - no special type
107
what does tumour grade mean
how well differentiated the tumour is
| ie how similar it is to the parent tissue
108
a well differentiated tumour is similar/not similar to its parent tissue
similar
109
how can you assess the grade of breast carcinoma
tubular differentiation
nuclear pleomorphism
mitotic activity
110
if a tumour is grade 1, what did it score
3, 4 or 5
111
if a tumour is grade 2, what did it score
6 or 7
112
if a tumour is grade 3, what did it score
8 or 9
113
which hormone receptor is most commonly positive in tumours
ER +
114
How do you manage ER+ tumours
```
anti-oestrogen therapy
oophorectomy
tamoxifen
aromatase inhibitors
GnRH agonists
```
115
what does HER2 stand for
Human Epidermal growth factor Receptor 2
| in abnormal cells there are many multiple copies
116
what kind of drug is goserilin
GnRH agonist
117
what treatment is available for HER2 + tumours
herceptin (trastuzamab)
118
which cancer type (hormone receptor) has the best survival outcome
ER+
PR+
HER2 -
119
list protective factors for breast cancer
NSAIDs
having children
breast feeding
maintaining healthy weight and exercise
