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YEAR 5: Histopathology AS > Histo: Breast pathology > Flashcards

Histo: Breast pathology Flashcards

1
Q

What are the three components of investigating breast disease?

A
  • Clinical examination
  • Imaging (ultrasound, mammography or MRI)
  • Pathology (cytopathology and/or histopathology)
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2
Q

Outline the coding used by cytopathologists when assessing breast aspirates.

A
  • C1 = inadequate
  • C2 = benign
  • C3 = atypia, probably benign
  • C4 = suspicious of malignancy
  • C5 = malignant
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3
Q

What is the gold standard for diagnosing breast cancer?

A

Histopathology

NOTE: 24-hour turnaround time

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4
Q

Describe the appearance of normal breast histology.

A
  • Glandular tissue will be stained purple with pink stroma around it
  • The duct and extralobular terminal duct are together referred to as the terminal duct lobular unit (TDLU)
  • Myoepithelial cells will be seen around the outside of the epithelial cells - they help pump milk
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5
Q

Define duct ectasia. Describe its presentation.

A
  • Inflammation and dilatation of large breast ducts.
  • Typically presents with a breast lump and nipple discharge.
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6
Q

Describe the histology of duct ectasia.

A
  • The duct will be distended and full of proteinaceous material
  • Foamy macrophages will also be present
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7
Q

Define acute mastitis.

A

Acute inflammation of the breast.

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8
Q

Which group of women tend to be affected by acute mastitis?

A

Often seen in lactating women due to cracked skin and stasis of breast milk.

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9
Q

Which organism is usually responsible for acute mastitis?

A

Staphylococci

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10
Q

Describe the cytological appearance of acute mastitis.

A

Lots of neutrophils

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11
Q

Define fat necrosis.

A

Inflammatory reaction to damaged adipose tissue

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12
Q

Describe the cytological appearance of fat necrosis.

A

Fat cells surrounded by macrophages.

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13
Q

Define fibrocystic disease.

A
  • A group of alterations in the breast which reflect normal, albeit exaggerated, responses to hormonal influences
  • On histology, the ducts are usually dilated and calcified
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14
Q

Define fibroadenoma.

A

Benign fibroepithelial neoplasm of the breast.

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15
Q

Describe the histology of fibroadenoma.

A

Consists of lots of glandular and stromal cells.

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16
Q

Define Phyllodes tumour.

A

A group of potentially aggressive fibroepithelial neoplasms of the breast.

NOTE: the majority are benign

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17
Q

Describe the histology of Phyllodes tumours.

A
  • Cells do not form uniform layers
  • Whether it is benign or malignant depends on the cellularity of the stroma
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18
Q

Define intraductal papilloma.

A

A benign papillary tumour arising within the duct system of the breast.

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19
Q

What are the two different types of intraductal papilloma?

A
  • Peripheral papilloma - arises in small terminal ductules
  • Central papilloma - arises in large lactiferous ductules
20
Q

How do intraductal papillomas present?

A
  • Central papillomas present with nipple discharge
  • Peripheral papillomas usually remain clinically silent
21
Q

Describe the histology of intraductal papillomas.

A
  • Histology will show a large dilated duct with a polypoid mass in the middle
  • The mass tends to have a fibrovascular core
22
Q

What is a radial scar?

A

A benign sclerosing lesion characterised by a central zone of scarring surrounded by a radiating zone of proliferating glandular tissue

23
Q

What pathological phenomenon is thought to be responsible for the formation of radial scars?

A

Exuberant reparative phenomenon in response to areas of tissue damage in the breast

24
Q

How do radial scars present?

A

Seen as stellate masses on mammograms

25
Q

Describe the histological appearance of radial scars.

A

Central stellate area with proliferation of ducts and acini in the periphery

26
Q

Define proliferative breast disease.

A

A diverse group of intraductal proliferative lesions of the breast associated with an increased risk of subsequent development of invasive breast cancer

27
Q

Describe the presentation of proliferative breast disease.

A

Microscopic lesions that usually produce no symptoms

28
Q

Describe the appearance of usual epithelial hyperplasia.

A

Irregular lumens

29
Q

What is flat epithelial atypia/atypical ductal hyperplasia?

A
  • May be the earliest precursor to low grade DCIS
  • There are multiple layers of epithelial cells and the lumens become more regular
30
Q

What is in situ lobular neoplasia?

A

A solid proliferation of cells within the acinus

31
Q

What is ductal carcinoma in situ?

A

A neoplastic intraductal epithelial proliferation in the breast that has not breached the basement membrane

32
Q

Describe the histological appearance of low grade DCIS.

A
  • Lumens are compact and regular (cribriform (punch out) appearance)
  • Rapid death and proliferation of cells leads to calcification
33
Q

Describe the histological appearance of high grade DCIS.

A
  • Cells are large and few lumens left
  • Cells are pleomorphic and occlude the duct
34
Q

List some risk factors for invasive breast carcinoma.

A
  • Early menarche
  • Late menopause
  • Obesity
  • Alcohol
  • OCP
  • Family history
35
Q

Describe the two genetic pathways that result in DCIS.

A
  • Low grade - arise from low grade DCIS or in situ lobular neoplasia and show 16q loss
  • High grade - arise from high grade DCIS and show complex karyotypes with unbalanced chromosomal aberrations
36
Q

Describe the histological appearance of:

  1. Invasive ductal carcinoma
  2. Invasive lobular carcinoma
  3. Invasive tubular carcinoma
  4. Invasive mucinous carcinoma
A
  1. Invasive ductal carcinoma = cells are plaeomorphic and have large nuclei
  2. Invasive lobular carcinoma = cells have a linear arrangement and are monomorphic. NOTE: cords of cells are sometimes referred to as ‘Indian File’ pattern
  3. Invasive tubular carcinoma = elongated tubules of cancer cells invade the stroma
  4. Invasive mucinous carcinoma = lots of ‘empty’ spaces containing mucin
37
Q

Describe the histological appearance of Basal-like carcinoma.

A
  • Sheets of markedly atypical cells with a prominent lymphocytic infiltrate
  • Central necrosis is common
38
Q

Describe the immunohistochemistry findings in Basal-like carcinoma.

A

Positive for basal cytokeratins (CK5/6 and CK14)

NOTE: basal-like carcinoma is associated with BRCA mutations

39
Q

Which histological grading system is used for invasive breast carcinoma?

A

Nottingham modification of the Blood-Richardson system

40
Q

What is histological grading dependent on?

A
  • Tubule formation
  • Nuclear pleomorphism
  • Mitotic activity
41
Q

Which three receptors are all invasive breast cancers assessed for?

A
  • ER
  • PR
  • Her2
42
Q

Describe the receptor phenotype of:

  1. Low grade invasive breast cancer
  2. High grade invasive breast cancer
  3. Basal-like carcinoma
A
  1. Low grade invasive breast cancer
    • ER/PR positive
    • Her2 negative
  2. High grade invasive breast cancer
    • ER/PR negative
    • Her2 positive
  3. Basal-like carcinoma
    • Triple negative
43
Q

What is the most important prognostic factor in invasive breast cancer?

A

Status of axillary lymph nodes

44
Q

Which age group is screened in the NHS breast screening programme?

A

47-73 year olds (every 3 years)

45
Q

Outline the coding of biopsies for suspicious breast lumps.

A
  • B1 = normal breast tissue
  • B2 = benign abnormality
  • B3 = lesion of uncertain malignant potential
  • B4 = suspicious of malignancy
  • B5 = malignancy (a = DCIS; b = invasive carcinoma)
46
Q

Define gynaecomastia.

A

Enlargement of the male breast

47
Q

Describe the histology of gynaecomastia.

A
  • Epithelial hyperplasia with finger-like projections extending into the duct lumen
  • Periductal stroma is often cellular and oedematous
  • Similar to fibroadenoma

YEAR 5: Histopathology AS (20 decks)

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