Lecture 11 - Breast Pathology

Question 1

What are the 3 normal layers to a breast acinus?

Answer 1

Basement membrane
Myoepithelial cells
Luminal cells

Question 2

What is the smallest functional unit of a gland?

Answer 2

Acinus

Question 3

What part of of the acinus makes the secretions?

Answer 3

Luminal cells

Question 4

What is the terminal duct all lobule unit?

Answer 4

The terminal duct plus the multiple acini that drain into it

Question 5

What is the clinical significance of the terminal ductal lobular units?

Answer 5

The Origin of all epithelial neoplasms of breast tissues

Question 6

How does milk travel to the nipple?

Answer 6

Acinus to terminal ductal lobular unit to major duct to lactiferous duct to nipple

Question 7

What cells line the ducts of the breast?

Answer 7

Cuboidal or columnar a cells

Question 8

What is the approach to assessment for a pataienti witht potential breast disease?

Answer 8

History and examination
Imaging (ultrasound or mammogram)
Biopsy (tissue sampling)

Question 9

What are some classifications of breast diseases?

Answer 9

Developmental disorders
Inflammatory conditions
Benign epithelial lesions
Stromal tumours
Hynaecomaastia
Breast carcinoma

Question 10

What is duct ectasia?

Answer 10

Benign disorder of extralobular ducts

Causes stasis of secretions and dilated ducts with associated inflammation

Question 11

What is a major risk factor for duct ectasia?

Who is it most common in?

Answer 11

Smoking

Common in peri-menopause

Question 12

What type of discharge is seen with duct ectasia?

Answer 12

Brown

Question 13

How does a fibroadenoma present?

Answer 13

Young
Firm
Non tender
Mobile
No skin changes

Question 14

What is the most common tumour in young patients?

Answer 14

Fibroadenoma

Question 15

What type of tissue does fibroadenoma arise from?

Answer 15

Lobular stroma

Is well circumscribed

Question 16

How does fat necrosis typically present?

Answer 16

Associated with trauma or previous surgery

Mass that forms can be ill defined, spiculate and calcified

Question 17

How does fat necrosis appear histoloiggcallly?

Answer 17

Disrupted adipocytes surrounded by foamy macrophages

Question 18

How does gynaecomastia present?

Answer 18

Bilateral breast enlargement in males

Question 19

How should male breast tissue normally present on histology?

Answer 19

Few glands
Very fibrous

Question 20

What happens in male breast tissue in gynaecomastia?

Answer 20

Proliferation of ducts and stroma of the breast tissue

Question 21

What causes gynaecomastia?

Answer 21

Oestrogen and testosterone imbalance

Physiological V Pathological

Question 22

What is a physiological cause of gynaecomastia?

Answer 22

Oestrogen production peaks before testosterone during puberty

Question 23

What are some pathological caseees of gynaecomastia?

Answer 23

Lack of test:
Klinefelters
Testicular atrophy

Excess oestrogen:
Liver disease
Testicuarlr tumours
Obesity

Medication:
Spironolactone
Anabolic steroids

Question 24

What is ductal carcinoma in situ?

Answer 24

Neoplastic epithelial cells confined to the ductolobular system

There’s no invasion beyond basement membrane

Question 25

How does ductal carcinoma in situ appear histological?

Answer 25

Pleomorphism Hyperchromatic Necrosis in ducts Mitotic figures Ducts filled with atypical cells with necrosis Doesn’t extend past basement membrane

Question 26

How is ductal carcinoma in situ managed?

Answer 26

Surgery (breast conserving or mastectomy) Radiotherapy’s Endocrine therapy if oestrogen receptor positive

Question 27

How can immunohistochemistry be used to confirm that a ductal carcinoma is in situ and not malignant yet?

Answer 27

Can show intact myoepithelial cells (if they are intact means basement membrane has not been breached)

Question 28

How does invasive ductal carcinoma typically present?

Answer 28

Firm Fixed Irregular Skin changes AXILLARY LUMP

Question 29

How does invasive ductal carcinoma appear on mammogram?

Answer 29

Irregular dense mass with spiculated margins

Question 30

How does invasive ductal carcinoma presetn on histological exam?

Answer 30

Atypical cells with nuclear pleomorrphism Extension into fat

Question 31

What is the most common subtype of breast adenocarcinoma?

Answer 31

Invasive Ductal Carcinoma

Question 32

How does lobular (breast adenocarcinoma normally always appare on histology?

Answer 32

Chains of irregular pleomorphic cells

Question 33

How does tubular breast adenocarcinoma appear on histology?

Answer 33

Well formed tubular spaces

Question 34

How does micropapillary breast adenocarcinoma appear on histology?

Answer 34

Tufts of cells

Question 35

How does mucinous breast adenocarcinoma appear on histology?

Answer 35

Pools of extracellular mucin

Question 36

What features do we need to consider when grading a breast cancer?

Answer 36

Tubule formation Nuclear pleomorphism Mitotic count

Question 37

What stagin system is used for breast cancer?

Answer 37

TNM

Question 38

How does breast cancer spread?

Answer 38

Lymphatic vessels to local lymph nodes (Axillary) Blood vessels to distant sites

Question 39

What causes dimpling around the nipple?

Answer 39

Lymphatic invasion

Question 40

How do clinicans identify sentinel lymph nodes to excise if the cancer has spread?

Answer 40

Injection radioactive dye into the tumour Use Geiger counter to identify

Question 41

What type of breast cancer easily metastasises?

Answer 41

Lobular

Question 42

What are the managements of breast cancer?

Answer 42

Surgery (mastectomy) Chemotherapy Radiotherapy Drugs

Question 43

What are the 2 main drugs to treat breast cancer?

Answer 43

Tamoxifen Herceptin

Question 44

How does tamoxifen work to treat breast cancer?

Answer 44

Its a selective oestrogen receptor modulator If cancer produces too much oestrogen driving proliferation, tamoxifen given to block the oestrogen receptors

Question 45

How does herceptin work to treat breast cancer?

Answer 45

Overproduction of human epidermal growth facotr drives proliferation Drug blocks HER2 receptors

Question 46

What is a triple negative breast cancer?

Answer 46

Is oestrogen receptor, HER2 receptor and progesterone receptor negative Have very poor prognosis (BRCA tumours)

Question 47

What mutations are responsible for hereditary breast cancer?

Answer 47

BRCA1/BRCA2

Question 48

What prophylactic measures is done if BRCA1/BRCA2 is identified?

Answer 48

Prophylactic mastectomy