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TRANSITION BLOCK 1 > Breast Pathology > Flashcards

Breast Pathology Flashcards

1
Q

What sample can be taken from the breast for cytopathology analysis?

A

fine needle aspiration

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2
Q

Describe how the cytology of an FNA is graded?

A 
C1 - Unsatisfactory
C2 - Benign
C3 - Atypia, probably benign
C4 - Suspicious of malignancy
C5 - Malignant
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3
Q

What samples of breast tissue can be taken for histopathology to make a diagnosis?

A
  • (Needle) core biopsy
  • Vacuum assisted biopsy (large volume)
  • Skin biopsy
  • Incisional biopsy of mass
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4
Q

How can breast tissue be removed therapeutically (i.e. for diagnosis and treatment)?

A
  • Vacuum assisted excision
  • Excisional biopsy of mass
  • Resection of cancer (Wide local OR Mastectomy)
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5
Q

Describe how a needle core biopsy can be graded

A 
B1 - Unsatisfactory / normal
B2 - Benign
B3 - Atypia, probably benign
B4 - Suspicious of malignancy
B5 - Malignant
B5a - carcinoma in situ
B5b - invasive carcinoma
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6
Q

Give examples of developmental anomalies in the breast

A
  • Hypoplasia
  • Juvenile hypertrophy
  • Accessory breast tissue
  • Accessory nipple
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7
Q

What non-neoplastic causes are there for benign breast lumps to occur?

A
  • Gynaecomastia
  • Fibrocystic change
  • Hamartoma
  • Fibroadenoma
  • Sclerosing lesions (e.g. radial scar/complex lesion)
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8
Q

What inflammatory conditions can cause benign breast disease?

A
  • Fat necrosis
  • Duct ectasia
  • Acute mastitis/abscess
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9
Q

What types of breast tumour can be benign?

A

Phyllodes tumour

Intraduct Papilloma

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10
Q

What is gynaecomastia?

A

Male breast development

- ducts grow but lobules dont form

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11
Q

What causes gynaecomastia?

A

Hormones
Cannabis
Prescription drugs
Liver disease

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12
Q

When does fibrocystic change normally present?

A
  • Women aged 20-50 (Majority 40-50)
  • pain cysts and masses in breast that may worsen at points in menstrual cycle
  • Early menarche/Late menopause
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13
Q

What symptoms are common in a presentation of fibrocystic change?

A
  • Smooth discrete lumps
  • Sudden pain
  • Cyclical pain
  • Lumpiness (“doughy”)
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14
Q

How does fibrocystic change appear macroscopically?

A
  • Usually multiple cysts
  • blue domed with pale fluid
  • intervening fibrosis
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15
Q

How do the cysts in fibrocystic change look microscopically?

A
  • Thin walled (may have fibrotic wall)

- Lined by apocrine epithelium

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16
Q

What is a hamartoma?

A
  • Circumscribed lesion
  • made up of breast cell types
  • but abnormal amount/distribution of them
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17
Q

When do fibroadenomas usually present?

A

3rd decade most common

- usually picked up on self examination or screening

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18
Q

How do fibroadenomas feel on palpation and how do they appear on US?

A

Painless
firm
discrete
mobile mass

Solid on ultrasound

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19
Q

How do fibroadenomas look macroscopically?

A

Circumscribed
Rubbery
Grey-white colour

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20
Q

What tissue in the breast undergoes hyperplasia to form a fibroadenoma?

A

INTRA-lobular stroma

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21
Q

What is meant by sclerosing lesions of the breast?

A
  • Benign

- proliferation of acini and stroma

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22
Q

Why do people worry about sclerosing lesions?

A

Can cause a mass or calcification

May mimic carcinoma

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23
Q

What symptoms are caused by sclerosing adenosis?

A
  • Pain, tenderness or lumpiness/thickening
  • Some pts are Asymptomatic
  • affects any age (20-70)
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24
Q

Sclerosing adenosis has a very low risk of progressing to carcinoma of breast. TRUE/FALSE?

A

TRUE

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25
Q

What are the common pathological features of a radial scar/ complex scerlosing lesion?

A

Stellate architecture
central puckering
Radiating fibrosis

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26
Q

A radial scar of over what size is then defined as a complex sclerosing lesion?

A

RS – 1-9mm

CSL - >10mm

27
Q

How are radial scars normally detected?

A

incidental finding

picked up on imaging/screening

28
Q

What can develop within a radial scar?

A

In situ or invasive carcinoma may occur within these lesions

29
Q

How are radial scars/ CSLs treated?

A

Excise

OR sample extensively by vacuum biopsy

30
Q

What can cause fat necrosis?

A 
Local trauma (e.g. Seat belt injury)
Warfarin therapy
31
Q

Describe the pathogenesis of fat necrosis?

A

disruption of adipocytes
=> inflammatory cells recruited
“foamy” macrophages
Subsequent fibrosis and scarring

32
Q

How does duct ectasia normally present?

A 
Pain
Acute episodic inflammatory changes
Bloody/ purulent discharge
Fistulae
Nipple retraction and distortion
33
Q

What is duct ectasia commonly caused by/ associated with ?

A

Smoking

34
Q

Describe the pathogenesis of duct ectasia

A
  • Sub-areolar duct dilatation
  • Periductal inflammation
  • fibrosis
  • Scarring and distortion
35
Q

How is duct ectasia treated?

A
  • Treat acute infections
  • Stop smoking
  • Excise ducts
36
Q

Duct ectasia can go on to cause mastitis and abscesses. What organisms are normally involved?

A
  • Mixed organisms

- Anaerobes

37
Q

If lactation causes mastitis or an abscess, what organisms are normally involved?

A
  • Staph aureus

- Strep pyogenes

38
Q

How is mastitis or an abscess treated?

A

Antibiotics
Percutaneous drainage
Incision & drainage
Treat underlying cause (if possible)

39
Q

How does a Phyllodes tumour usually present?

A

Age 40-50
Slow growing unilateral breast mass
contains both epithelium and stroma (biphasic)

40
Q

Describe the normla behaviour of a phyllodes tumour

A
  • can be benign OR borderline OR malignant (depends on degree of stromal overgrowth)
  • Prone to local recurrence if not adequately excised
  • Rarely metastasize
41
Q

How does an intraduct papilloma usually present?

A
  • Age 35-60
  • May present with nipple discharge +/- blood
  • Many = asymptomatic at screening
42
Q

What ducts are affected in an intraduct papilloma?

A

Sub-areolar ducts

43
Q

The epithelium of the ducts in intraduct papilloma may show proliferative activity. What does this mean?

A

May convert to:

  • Usual type hyperplasia
  • Atypical ductal hyperplasia
  • Ductal carcinoma in situ (DCIS)
44
Q

What tumours commonly metastasise to the breast?

A

Bronchial carcinoma
Ovarian serous carcinoma
Clear cell carcinoma of kidney

Malignant melanoma

Leiomysarcoma

45
Q

Where does carcinoma of the breast arise and what type of carcinoma is it?

A

Arises in glandular epithelium of the terminal duct lobular unit (TDLU)

glandular tissue => “adenocarcinoma”

46
Q

What precursor lesions may exist prior to developing breast carcinoma?

A 
Ductal:
Epithelial hyperplasia
Columnar cell change (+/- atypia)
Atypical Ductal Hyperplasia
Ductal Carcinoma in situ (DCIS)

Lobular:
Lobular in situ neoplasia
Atypical lobular hyperplasia
Lobular carcinoma in situ (LCIS)

47
Q

What is the difference in Atypical Lobular Hyperplasia and LCIS?

A 
ALH = <50% of lobule involved
LCIS = >50% of lobule involved (=> more chance of developing into cancer)
48
Q

Lobular in situ neoplasia is usually oestrogen receptor positive TRUE/FALSE?

A

TRUE

49
Q

What is the significance of Lobular in situ neoplasia on a biopsy?

A

15-20% of cases with LN on core biopsy have a HIGHER grade lesion on open diagnostic biopsy

=> may not be invasive cancer, but a higher grade lesion has more risk of developing into cancer

50
Q

If lobular in situ neoplasia is found on a core biopsy, how is this treated?

A

excision or vacuum biopsy to exclude higher grade lesion

51
Q

DCIS is characteristically UNIcentric (i.e. only involves one duct system.) TRUE/FALSE?

A

TRUE

52
Q

DCIS is confined within what structure?

A

basement membrane of duct

- if it invades this it becomes cancer

53
Q

If DCIS involves the lobules or the skin of the nipple, what is it referred to as in each of these situations?

A
  • if involves lobules => cancer (spread from ducts)

- May involve nipple skin => Paget’s disease (still IN SITU i.e. non-invasive)

54
Q

How is DCIS treated?

A
  • Surgery
  • Adjuvant radiotherapy
  • Chemoprevention
  • Endocrine therapy

Low risk DCIS trial of no surgery just mammography follow up

55
Q

What is meant by microinvasive carcinoma of the breast?

A
  • DCIS (high grade) with invasion of <1mm

- Treated as high grade DCIS

56
Q

What are the risk factors for developing invasive breast cancer?

A

Age

Reproductive Hx
- menarche/first birth/Parity/Breastfeeding/menopause

Hormones
- HRT/ OCP

Lifestyle
- obesity/smoking

Genetics

  • BRCA
  • TP53 (Li Fraumeni)
57
Q

Breast screening takes place at what age?

A

50-70

58
Q

Where can breast cancer locally spread to?

A

Stroma
Skin
Muscles of chest wall

59
Q

Where can breast cancer metastasise to?

A 
Bone
Liver
brain
lungs
abdominal viscera
female genital tract
60
Q

What lymph nodes drain the breast tissue first?

A

sentinel lymph nodes

61
Q

What is considered before grading breast cancer?

A

Tubular differentiation
Nuclear pleomorphism
Mitotic activity

62
Q

Breast cancers can express what hormone receptors?

A

80% ER positive
67% Progesterone Recep. positive
14% HER2 positive

63
Q

Oestrogen receptor positive breast cancer responds to anti-oestrogen therapy. Give examples of these.

A

Oophorectomy
Tamoxifen
Aromatase inhibitors (Letrozole)
GnRH antagonists - (Zoladex)

64
Q

HER2 positive breast cancer responds to what medication?

A

Trastuzamab (Herceptin)

TRANSITION BLOCK 1 (4 decks)

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