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HistoPath > Histopathology 3: Breast pathology > Flashcards

Histopathology 3: Breast pathology Flashcards

1
Q

45 year old lady presents with thick, white nipple discharge and a periareolar lump. Histology shows distended lactiferous duct.

Most likely diagnosis ?

A

Mammary duct ectasia

  • May also cause breast pain, breast mass and nipple retraction
  • NB not linked with breastfeeding
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2
Q

Breastfeeding mother presents with a red, painful, swollen breast. Histology shows neutrophils and pus.

Most likely diagnosis and likely organism?

A

Acute mastitis - S.Aureus

  • This is when you get acute inflammation of the breast (glandular tissue)
  • Due to milk stasis and cracked skin
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3
Q

60 year old women presents with a painless breast lump. She reports being in a car accident 10 years ago and wonders if the trauma from her seatbelt might have caused it.

Most likely diagnosis ? Other causes ?

A

Fat necrosis

  • Causes: trauma + Radiotherapy, surgery, panniculitis

Aetiology: fat in the breast tissue is attacked by inflammatory cells, and it dies producing a hard lump

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4
Q

A 20 year old lady presents with a breast lump which is well demarcated, mobile and feels rubbery. Histology shows stromal (fibrous tissue) proliferation.

Most likely diagnosis ?

A

Fibroadenoma

  • This is benign neoplasm
  • glandular proliferation (of the ducts) and of stroma
  • NB usually in younger people
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5
Q

Which breast tumour can originate from Fibroadenomas ?

A

Phyllodes tumour

  • group of potentially aggressive fibroepithelial neoplasms of the breas
  • NB they are leaf-like
  • Most are benign
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6
Q

A 60 year old lady presents after she noticed her breast lump previously diagnosed as a fibroadenoma has started to increase in size. Histology shows: increased cellularity + Stromal overgrowth and overlapping cells.

most likely diagnosis ?

A

Phyllodes tumour (Possibly malignant)

  • Normally phyllodes tumours are benign
  • Arise from fibroadenoma
  • Classified as enlarging mass in women > 50 years
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7
Q

45 year old lady presents with bloody nipple discharge. No lump is felt and no mass is seen on mammography.
Histology shows: Large dilated duck with fibrovascular core and stromal vessels.

Most likely diagnosis ?

A

Duct Papilloma

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8
Q

Histology shows a stellate pattern with central sclerosis/scarring surrounded by proliferating glandular tissue (radiating zone).

Most likely diagnosis ?

A

Radial scar

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9
Q

A 79 year old lady presents with a hard fixed lump of the breast. Paget’s disease of the breast is present and there are signs of nipple retraction.

Most likely diagnosis ?

A

Breast carcinoma

Paget’s disease of the breast is eczema affecting the nipple

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10
Q

Histology: Intraductal epithelial proliferation, with pleomorphic cells in the duct and necrotic material in the central lumen.

Mammogram: Microcalcifications

Most likely diagnosis ?

A

DCIS

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11
Q

Young women presents with multiple small lumps in the breast.

Most likely diagnosis ?

A

Fibrocystic disease

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12
Q

Histology shows linear arrangement of monomorphic cells in a distribution known as the Indian file pattern.

Most likely diagnosis ?

A

Lobular carcinoma

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13
Q

List 3 receptors tested for in breast carcinoma ?

A

Oestrogen
Progesteron
HER2

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14
Q

Which drug is used to treat HER2 positive breast carcinoma?

A

Herceptin

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15
Q

How does the E cadherin help differentiate between invasive ductal and invasive lobular carcinoma ?

A

If E cadherin +ve = invasive ductal
if E cadherin -ve = Invasive lobular

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16
Q

Describe normal breast histology

A

glandular tissue surrounded by stromal tissue
centre = duct surrounded by acini
unit = TDLU (terminal duct lobar unit)
myoepithelial cells help produce milk

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17
Q

USS or mammogram more specific for breast disease?

A
  • USS is slightly more specific than mammogram as it picks up more echos/ shadow in the breast
  • NB MRI is good for smaller lesions that the above miss
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18
Q

2 tests for cytopathology and/or histopathology of breast tissue

A
  • Fine need aspiration (aspirated by a 16/18 gauge needle)
  • Core biopsy
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19
Q

GOLD STANDARD for the diagnosis of breast cancer

A

Biopsy

NB takes 24 hours to process

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20
Q

Cytology for duct ectasia

A

proteinaceous material and inflammatory cells

NB benign condition (no R of malignancy)

21
Q

Main organism for acute mastitis

What is seen on cytology

A

staphylococci

Lots of neutrophils + necrotic material with degeneration of cells

22
Q

Cytology of fat necrosis

A
  • empty spaces are fat tissue
  • inflammatory cells (macrophages)
  • giant cells formed by histiocytes coming together
23
Q

Main aetiology of fat necrosis of breast (3)

A

Trauma, radiotherapy, surgery

24
Q

Histology of gynaecomastia

A

Epithelial hyperplasia with finger-like projections extending into the duct lumen

25
Q

Screening schedule for breast cancer + what Ix is done

A

47-73 years are screened every 3 years

Done using mammogram - 5% will have an abnormal mammogram and are recalled for further investigation with FNA/biopsy

26
Q

Coding biopsies in breast cancer (B1-B5)

A
  • B1= normal breast tissue
  • B2= benign abnormality
  • B3= lesion of uncertain malignant potential
  • B4= suspicious of malignancy
  • B5= malignant

NOTE: Anything after B3 is often offered excision due to risk of transforming into malignancy

27
Q

Which breast disease is a plastic intraductal epithelial proliferation in the breast within an inherent risk of progression to breast cancer (has NOT breached the basement membrane)? How do you detect?

A

Ductal Carcinoma in situ (DCIS) - detected on mammography screening (see microcalcification)

28
Q

Low grade histology of ductal carcinoma in situ

High grade histology

A

lumens are very compact and regular - described as cribriform DCIS (punched out appearance)

cells are quite large and there aren’t very many lumens left - have central lumen full of necrotic material + cells are large, pleiomorphic and occlude the duct

29
Q

Tx of ductal carcinoma in situ

A

surgical excision with clear margins

30
Q

MOST IMPORTANT PROGNOSTIC FACTOR in breast cancer

A

status of the axillary lymph nodes

31
Q

Have breast lump. Due to fibrosis of the breast tissue along with cystic changes, linked to responses to hormonal influences. What is this? Is there increased R of breast carcinoma?

A

Fibrocystic Disease - VERY COMMON

No R of carcinoma

32
Q

Cytology of Fibrocystic Disease

A
  • Ducts are quite dilated
  • Ducts may get calcified
33
Q

Cytology of fibroadenoma

A
  • There are lots of glandular cells and stromal cells
  • Smooth monolayers of sheets of cells
34
Q

Cytology of phyllodes tumour

A
  • The cells are NOT in uniform layers anymore, they are overlapping (it looks more smudged)
35
Q

benign papillary tumour arising in the duct system of the breast

A

Intraductal Papilloma

*

36
Q

Two types of intraductal papilloma

A
  • The small terminal ductules- peripheral papillomas
  • Larger lactiferous ducts- central papillomas (get nipple discharge with this one)
37
Q

Tx of intraductal papilloma

A

Excision

38
Q

Histology of intraductal papilloma

A
  • large cystically dilated duct with a polypoid mass in the middle
  • tends to have a fibrovascular core
39
Q

What presents as stellate masses on screening mammograms

Tx?

A

Radial Scar

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

Tx: excision

40
Q

3 receptors assessed in invasive breast cancer

A
  • Oestrogen receptor (ER)
  • Progesterone receptor (PR)
  • Her2 receptor
41
Q

Phenotype of low grade, high grade, and basal-like carcinomas in invasive breast cancers

A

Low grade

  • ER/ PR positive
  • Her2 negative

High Grade

  • ER/ PR negative
  • Her2 positive

Basal-like Carcinomas

  • ER/ PR/ Her2 negative (triple negative)
42
Q

System used to grade invasive breast carcinomas

A

Nottingham Modification of Bloom-Richardson System

Grades on:

  • Tubule formation
  • Nuclear pleomorphism
  • Mitotic activity
43
Q

microscopic lesions that usually produce NO symptoms, and that can develop into invasive breast carcinoma - they calcify within the breast

How to Dx?

A

Proliferative Breast Diseases

Dx: breast tissue removed for other reasons or on screening mammograms if they calcify

44
Q

Most common cancer in women

A

Invasive Breast Carcinomas

  • Invade through the basement membrane and into the stromal tissue
45
Q

Genetics for low grade and high grade invasive breast carcinomas

  • Low Grade- show 16q loss
  • High Grade- show complex karyotypes with many unbalanced chromosomal aberrations

**PLEASE CLOZE DELETE EACH ANSWERS BOTH AS C1**

A
46
Q

Histology of invasive ductal carcinoma

Histology of Invasive LOBULAR Carcinoma

Histology of Invasive TUBULAR Carcinoma

Histology of Invasive MUCINOUS Carcinoma

A
  • Cells are pleiomorphic (large, pleiomorphic, nucleated cells)
  • have a linear arrangement
  • The cells are monomorphic (tend to look like each other)
  • The cords of cells is referred to as the Indian File pattern
  • elongated tubules of cancer cells which are invading stroma
  • All the ‘empty’ spaces contain a lot of mucin
47
Q

4 types of proliferative breast disease

A
  • Usual Epithelial Hyperplasia
  • Flat Epithelial Atypia/ Atypical Ductal Carcinoma
  • In situ Lobular Neoplasia
  • Basal-like Carcinoma
48
Q

Sheets and sheets of very atypical pleiomorphic-type cells with prominent lymphocytic infiltrate + central necrosis. Which type of proliferative breast disease?

What is immunohistochemistry?

A

Basal-like Carcinoma

Positive for basal cytokeratins (CK5/6 and CK14)

HistoPath (21 decks)

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