Breast Pathology, Cancer & Imaging Flashcards
(36 cards)
FIbroadenoma aetiology
- Benign, well-circumscribed lesion found in breast
- Comprised of stromal and glandular tissue, and thought to be influenced by oestroen (therefore more common in reproductive years)
Clinical features of fibroadenoma
- Painless, firm/rubbery mass
- Freely mobile (breast mouse)
- Possible fluctuation based on menstrual cycle
Diagnosis of fibroadenoma
- Triple test: clinical exam to determine mobile mass
- Imaging (mammography/ultrasound)
- Tissue sampling
Management of fibroadenoma
- Smaller, slower-growing lesions: watchful waiting
- Larger/faster growing: lumpectomy, radiofrequency ablation, vacuum-assisted excision
Breast cysts aetiology
Occur when fluid fills in dilated sacs within the ductal system of the breast.
Clinical features of breast cysts
- Smooth, well-defined FLUCTUANT lump
- May be tender or painful
- Can be single/multiple and uni/bilateral
Diagnosis of breast cyst
- Clinical exam (like triple test)
- Imaging (US/mammography) like triple test
- If fluid-filled: fine needle aspiration (collapse confirms diagnosis)
- If bloody fluid/recurrence: biopsy for path lab
Management of breast cyst
- Observation
- Aspiration can relieve discomfort
- If keeps filling/can’t rule out cancer: surgical excision
What are the three kinds of biopsy we can do on breast?
- Fine needle aspiration (aspirates cells)
- Core biopsy (produces “core” of tissue; this one can be vacuum assisted
Yokohama classification of breast FNA? Under what circumstances is core biopsy indicated?
- Not enough material
- Benign
- Atypia of unknown significance
- Suspicious for malignancy
- Malignant
(Anything 3 or up should trigger core biopsy)
Risk factors (modifiable vs non modifiable) for breast cancer
- Modifiable: Exogenous oestrogen exposure (e.g. HRT), Obesity (why might this be?), nulliparity (why?)
- Non-modifiable: increased age, early menarche/late menopaise, BRCA gene mutations, FHx.
How do we screen for breast cancer? Describe the program in Australia
- Mammography
- Once every two years from age 40. Free at this frequency from age 40 onwards, but only notified from 50-74 (same notification as which other program?)
Describe the diagnostic algorithm for any breast lump (in the context of breast cancer)
- Triple test
- Clinical exam, imaging (mammogram/US), biopsy (what are the types?)
How are breast cancers staged? Elaborate
- TNM staging
- Tumour size and extent from (Tis = in situ to T4 >5cm or directly chest wall/skin involvement)
- Node involvement (N0 = none to N3 = extensive nodal disease, including supra/infraclavicular)
- Metastases (M1 or M0)
Local/regional/distant complications of breast cancer
- Local: skin ulceration, edema, nipple retraction, axillary swelling
- Regional: breast/chest/arm oedema from lymphatic obstruction)
- Distant: met issues (lung problems, bone pain such as back pain, or neuro deficits/SOL from brain masses)
A breast lesion is suspicious on imaging. As part of the triple test, what kind of biopsy is indicated?
Core biopsy (FNA only for simple/cystic lesions)
A risk factor for this condition is pre-menopausal adjuvant chemo in the setting of breast cancer
Primary ovarian insufficiency
List as many health professionals as you can think of that could be involved in breast cancer care
- Radiologist/radiographer
- Pathologist
- Breast surgeon
- Oncologist
- Physiotherapist
- Psychologist
Outline breast cancer management (incl: who is eligible for neoadjuvant chemo?)
- Neoadjuvant chemo: HER2 positive or triple negative
- Surgery (lumpectomy, mastectomy, recon; also sentinel node biopsy or axillary clearance)
- Adjuvant chemo (comes with risk of ???)
- Targeted therapies (trastuzumab for Her2; tamoxifen/letrozole for ER positive [why?])
- Radiotherapy
DCIS and LCIS vs invasive Breast Cancer
- DCIS (Ductal) and LCIS (Lobular) are carcinomas in situ (i.e. that have not escaped the ductal/lobular system of the breast)
- Once spread to surrounding tissue, become invasive breast cancer
This type of cancer develops from breast stroma
Phyllodes tumour (phylo = leaf -> chlorophyl)
This type of cancer develops from breast blood vessels
Angiosarcoma
What causes fat necrosis in the breast? Describe the histology
- Caused by localised trauma (injury, surgery, abscess)
- Histology: lipid-laden macrophages, degenerate adipocytes, fibrosis/fibroblasts
Fibroadenoma histology
- Well circumscribed
- Cytologically bland epithelium
- Stroma present but not in excess; no/low atypia
