Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Reproduction > Breast Pathology > Flashcards

Breast Pathology Flashcards

1
Q

what are the methods of breast cytopathology

A

FNA
fluid
nipple discharge
nipple scrape

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are the stages of breast FNA cytology

A 
C1 - Unsatisfactory
C2 - Benign
C3 - Atypia, probably benign
C4 - Suspicious of malignancy
C5 - Malignant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

why is breast FNA not done as much now

A

as if malignant cant tell if invasive or in situ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are the diagnostic forms of breast histopathology

A

needle core biopsy
vacuum assisted biopsy (large volume of sample)
skin biopsy
incisional biopsy of mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are the therapeutic modalities of breast histopathology

A

vacuum assisted excision
excisional biopsy of mass
resection of cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are the types of breast cancer resection

A

wide local excision- conserves breast

mastectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are the stages of needle core biopsy

A 
B1 - Unsatisfactory / normal
B2 - Benign
B3 - Atypia, probably benign
B4 - Suspicious of malignancy
B5 - Malignant
B5a - carcinoma in situ
B5b - invasive carcinoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is breast carcinoma in situ

A

still in ducts (removal of tissue can be curative)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what test is necessary for invasive breast carcinoma

A

minimum of axiallry node sampling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are the developmental abnormalities of the breast

A

hypoplasia
juvenile hypertrophy (grow lots in short amount of time)
accessory breast tissue/ nipple

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are the non neoplastic benign breast diseases

A 
gynaecomastia 
fibrocystic change 
hamartoma 
fibroadeonoma 
sclerosing lesions: 
-sclerosis adenosis 
-radial scar/ complex sclerosing adenosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is gynaecomastia

A

breast development in males

ductal growth without lobular development (dont get acini)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

how many lacteriferous ducts at the nipple

A

15-20

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are the inflammatory breast diseases

A 
fat necrosis (common after trauma) 
duct ectasia (ducts get dilated and blocked)
acute mastitis/ abscess
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are the benign breast tumours

A 
phyllodes tumour (spectrum to benign to malignant- most benign) 
intraduct papilloma (benign to malignant, rarely invasive)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are the causes of gynaecomastia

A

exogenous (happens in newborns, self limiting)/ endogenous hormones
cannabis
prescription drugs
liver disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

how does liver disease cause gynaecomastia

A

metabolism of cholesterol based hormones disrupted excess of oestrogen based hormones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what age group get fibrocystic change in breast

A

20-50, majority 40-50

very common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what causes fibrocystic change

A

menstrual abnormalities (esp anovulatory cycles, prolonged osterogenic stimulation)
early menarche
late menopause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is the usual outcome for breast fibrocystic change

A

resolves/ diminished after menopause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what is the presentation of fibrocystic change

A 
smooth discreet lumps (cysts)
sudden pain (ruptures/ bleeding of cysts) 
cyclical pain 
incidental finding screening 
often bilateral
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is the pathology of fibrocystic change

A

cysts;

  • 1mm- several cm
  • blue domed with pale fluid (not blood filled, this would be red flag)
  • usually multiple
  • associated with other benign changes

intervening fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what type of seceretory cells line the ducts

A

merocrine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what is the histology of fibrocystic change

A

cysts:
- thin walled, may hive fibrotic wall
- lined by apocrine epithlium

intervening fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what is metaplasia

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what is the management of fibrocystic change

A

exclude malignancy
reassure
excise if necessary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what cell change is happening in fibrocystic change

A

metaplasia- not pre cursor lesion/ neoplastic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what is a hamartoma

A

circumscribed lesion composed of cell types normal to the breast but present in an abnormal proportion or distribution
(not excised unless causing problem)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what is the usual patient group for a fibroadenoma

A

common (17%)
commoner in african women
usually solitary, 10% multiple
can get multiple recurring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what is the presentation of a fibroadenoma

A

peak incidence in 3rd decade
screening
painless, firm, discrete, mobile mass (breast mouse)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what does a fibroadenoma look like on USS

A

solid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what is the pathology of a fibroadenoma

A 
circumscribed 
rubbery 
grey/ white colour
biphasic tumour/ lesion (two components in equal proportion) : epithelium, stroma
localised hyperplasia
proliferation of intralobular stroma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what is the management for a fibrodenoma

A

diagnose
reassure
excise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what is sclerosing adenosis associated with

A

fibrocystic change

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what is the pathology of sclerosing lesions

A

benign, disorderly proliferation of acini and stroma
can cause a mass or calicifcation
may mimic carcinoma- hard to diagnose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what is the presentation of sclerosing adenosis

A

pain, tenderness or lumpiness/ thickening
asymptomatic
age 20-70

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

is there a risk of malignancy in sclerosing adenosis

A

is benign

negligible risk of carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

what is the presentation of a radial scar

A

wide age range, common
incidental finding
mammographically detected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

what is the pathology of a radial scar

A 
radial scar= 1-9mm 
complex sclerosing lesions= >10mm 
stellate architecture 
central puckering
radiating fibrosis
40
Q

what is the histology of a radial scar

A

fibroelastic core
radiating fibrosis containing distorted ductules
fibrocystic change
epithelial proliferation

41
Q

how risky are radial scars

A

Mimic carcinoma radiologically
Probably not premalignant per se
Often show epithelial proliferation
In situ or invasive carcinoma may occur within these lesions

42
Q

what is the treatment for a radial scar

A

excise/ sample extensively by vacuum biopsy

43
Q

what causes fat necrosis of the breast

A 
local trauma (seat belt injury, often no Hx)
warfarin therapy
44
Q

what is the pathology of fat necrosis

A

damage and disruption of adipocytes
infiltration by acute inflammatory cells
foamy macrophages
subsequent fibrosis and scarring

distorts breast causing dimpling or nipple indrawing

45
Q

what is the management for fat necorsis

A

confirm diagnosis

exclude malignancy

46
Q

what are the clinical features of duct ectasia

A 
affects sub-areolar ducts 
pain 
acute episodic inflammatory changes 
bloody and/ or purulent discharge 
fistulation 
nipple retraction and distortion
47
Q

what is duct ectasia associated with

A

smoking

48
Q

what is the pathology of duct ectasia

A

sub areolar duct dilation
periductal inflammation
periductal fibrosis
scarring and distortion

49
Q

what is the management of duct ectrasia

A

Treat acute infections
Exclude malignancy
Stop smoking
Excise ducts

50
Q

what are the main causes of acute mastitis/ abscess

A

duct ectasia:

  • mixed organisms
  • anaerobes

lactation

  • staph aureus
  • strep pyogenes
51
Q

what is the management for acute mastitis/ abscess

A

antibiotics
percutaneous drainage
incision and drainage
treat underlying cause

52
Q

what are the clinical features of a phyllodes tumour

A

40-50

slow growing unilateral breast mass

53
Q

what is the pathology of a phyllodes tumour

A

biphasic tumour
stromal overgrowth
behaviour depends on stromal features (benign, borderline, malignant): prone to local recurrence if not adequately excised
rarely metastasise

54
Q

what are the breast papillary lesions

A

intraduct papilloma
nipple adenoma
encapsulated papillary carcinoma

55
Q

what is the presentation on an intraduct papilloma

A 
age 35-60 
nipple discharge +/- blood 
asymptomatic at screening: 
-nodules 
-calcification
56
Q

what is the pathology of intraduct papilloma

A

sub areolar ducts
2-20 mm diameter
papillary fronds containing a fibrovascular core
covered by myoepithelium and epithelium
epithelium may show proliferative activity (usual type hyperplasia, atypical ductal hyperplasia, ductal carcinoma in situ)

57
Q

what is breast angiosarcoma associated with

A

previous x ray therapy

58
Q

what makes a phyllodes tumour malignant

A

sarcomatous stromal component

59
Q

what cancers spread to breast

A 
carcinoma:
-bronchial 
-ovarian serous carcinoma 
-clear cell carcinoma of kidney 
malignant melanoma 
soft tissue tumours 
-leiomysarcoma
60
Q

what cell type does breast carcinoma arise from

A

breast epithelial cells
arises in glandular epithelium of the terminal duct lobular unit
(technically an adenocarcinoma but call carcinoma)

61
Q

what are the precursor lesions for breast carcinoma

A 
(epithelial proliferations)
intraductal: 
-epithelial hyperplasia usual type 
-columnar cell change (+/- atypia)
-aytpical ductal hyperplasia 
-ductal carcinoma in situ
lobular:
-lobular in situ neoplasia (atypical lobular hyperplasia, lobular carcinoma in situ)
62
Q

what are the features of in situ carcinoma

A

confined within BM of acini and ducts
cytologically malignant but non invasive
non obligate precursor of invasive carcinoma (not all will progress)
classified into lobular or ductal

63
Q

what are the types of lobular in situ neoplasia

A

atypical lobular hyperplasia (<50% of lobule involved)

lobular carcinoma in situ (>50% of lobule involved)

64
Q

what are the histological characteristics of lobular in situ neoplasia

A 
small intermediate sized nuclei 
solid proliferation 
intra-cytoplasmic lumen/ vacuoles 
oestrogen receptor positive 
E-cadherin negative (CDH1 gene, immunohistochemistry)
65
Q

what are the clinical features of lobular in situ neoplasia

A

frequently multifocal and bilateral
incidence decreases after menopause (ER positive)
not palpable or visible grossly
usually an incidental finding, may calcify- mammography

66
Q

what is the significance of lobular in situ neoplasia

A

15-10% have higher grade lesion on open diagnostic biopsy
higher risk of invasive carcinoma
is itself a true precursor lesion

67
Q

what is the management for lobular in situ neoplasia

A

if discovered on core biopsy- excision/ vacuum biopsy to exclude higher grade lesions

if discovered on vacuum or excision biopsy- follow up with annual mmg for 5 years

68
Q

what is the risk of intrdauctal proliferations

A

risk of progression to invasive carcinoma

69
Q

what are the histological features of ductal carcinoma in situ

A

arises in TDLU
unicentric (single duct system)
Calcification (formed by cell necrosis) can be picked up on screening before it is palpable
cytologically malignant epithelial cells
confined within BM of duct
may involve lobules
may involve nipple skin- Pagets

70
Q

what is pagets disease of the nipple

A

high grade DCIS extending along ducts to reach the epidermis of the nipple
STILL IN SITU

71
Q

how is DCIS classified

A

cytological grade
histology
presence of necrosis

72
Q

what is the significance of DCIS

A

risk as true precursor of invasive carcinoma

73
Q

what is the management for DCIS

A

diagnosis
surgery
adjuvant radiotherapy
chemoprevention- endocrine therapy

74
Q

what is microinvasive carcinoma

A

DCIS with invasion of <1mm beyond the BM

75
Q

what is the management for microinvasive carcinoma

A

(treat as high grade DCIS as low risk of mets)
surgery
adjuvant radio
chemoprevention

76
Q

what are the grades of ductal carcinoma in situ

A

low, intermediate and high

77
Q

what is the pathway of ductal epithelial proliferations

A 
normal 
hyperplasia of usuall type 
atypical ductal hyperplasia 
ductal carcinoma in situ 
invasive carcinoma
78
Q

when does breast carcinoma become invasive

A

when is breaches BM >1mm and infiltrates normal tissue

microinvasion <1mm

79
Q

what is the peak age group for breast cancer

A

50-70

80
Q

what are the risk factors for breast carcinoma

A 
age 
early menarche 
late first birth 
nulliparity 
not breastfeeding
late menopause 
endogenous hormones 
exogenous hormones (OCP, HRT)
previous breast disease (environment/ genetics stay same) 
geography (western europe, australia/ new zealand, north europe, north america)
increase BMI (oestrogen levels) 
low physical activity 
alcohol 
fatty diet 
(NSAID lower risk)
smoking 
genetics
81
Q

does risk of breast cancer reduce after stopping OCP or HRT

A

yes

pretty much back to normal after 5-10 years

82
Q

what genetic cancer syndromes cause breast cancer

A 
BRCA 1 and 2
TP53 
cowdens 
peutz-jeghers syndrome 
ataxia telengiectasia
83
Q

what are the differences in BRCA 1 and 2

A

1- breast, ovarian, bowel prostate

2- breast (inc male), ovarian, prostate, pancreatic

84
Q

what can be done prophylatically in breast cancer genetic syndromes

A

MRI (doesnt work for BRCA 1)

surgery

85
Q

what are breast cancers usually like in BRCA 1 and 2

A

high grade without a precursor

86
Q

what is the current trend in breast cx mortality rate

A

going down

10 year survival 78%

87
Q

what is the 2nd commonest cause of cancer death in women

A

breast cx

88
Q

what is the lifetime risk of breast cx

A

1 in 8

89
Q

what is the natural Hx of invasive breast carcinoma

A 
local invasion (breast stroma, skin, muscles of chest wall)
lymphatics 
blood born (esp ER +ve tumour)- bone, liver, brain, lungs, abdo viscera, female genital tract
90
Q

what nodes to majority of breast cancers spread to

A

axillary

small percent go to internal mammary

91
Q

what are the typeso f hormone receptor expressing invasive breast cancers

A

oestrogen receptor (ER)- if +ve will respond to anti oestrogen therapy (oophrectomy, tamoxifen (blocks receptor), aromatase inhibitors (letrozole, stops production), GnRh antagonists (goserilin, induces menopause in younger women)

progesterone receptor (PR)

HER2- human epidermal growth factor receptor 2 - responds to trastuzamab

92
Q

what is the most common type of invasive breast carcinoma

A

ductal (aka no special type) 70%

lobular 10% more less common ones

93
Q

what is tumour grade a measure of

A

tumour differentiation

high grade= poorly differentiated= poor prognosis

94
Q

how is breast carcinoma graded

A

tubular differentiation
nuclear pleomorphism
mitotic activity

95
Q

what does a triple negative breast cancer mean

A

does express a hormone receptor, wont respond to hormonal therapy, need chemo

96
Q

how is breast cancer stages

A 
Direct invasion of adjacent tissues
T0 - T4 Local tumour growth (size of tumour and extent of involvement of adjacent structures)
Lymphatic spread
N0 - N3 Regional lymph nodes
Blood-borne spread
M0 - M1 Distant metastasis
97
Q

what are the predictive and prognostic factors for invasive breast carcinoma

A

ER (PgR)
HER 2

histopathology
clinical factor

notting predictive index (diameter, grade, lymph node status)

Reproduction (51 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions