Pathology

Question 1

Which hormone drives endometrial growth during the first 14 days of the menstrual cycle?

Answer 1

Oestrogen

Question 2

Secretory changes, resulting from ovulation is under the influence of which hormone?

Answer 2

Progesterone

Question 3

What is the dominant follicle also known as?

Answer 3

The graafian follicle.

This contains the secondary oocyte and granulosa cells.

Question 4

What do granulosa cells produce?

Answer 4

Hormones

Question 5

What is menorrhagia?

Answer 5

Prolonged and increased menstrual flow.

Question 6

What thickness of endometrium in post-menopausal women indicates that an endometrial biopsy should be carried out?

Answer 6

> 4mm

Question 7

What is disordered uterine bleeding?

Answer 7

Irregular uterine bleeding owing to disruption of the normal cyclic hormonal pattern.

Question 8

What is the most common cause of DUB?

Answer 8

Anovulatory cycles.

Seen at the start and end of reproductive life.

Question 9

What causes luteal phase deficiencies?

Answer 9

Poor response/Insufficient progesterone.

May be due to abnormal follicular development or a poor corpus luteum.

Question 10

What is endometritis?

Answer 10

Inflammation of the endometrium.

Can be caused by infection, an IUD or occur following pregnancy.

Question 11

What is molar pregnancy?

Answer 11

Abnormal pregnancy in which a non-viable egg implants. No chance of progression.

Sperm combines with egg that has lost its DNA.

Question 12

What cancer is increased risk in molar pregnancy?

Answer 12

Choriocarcinoma

Question 13

What is adenomyosis?

Answer 13

The presence of endometrial glands and stroma within the myometrium.

Can cause long, heavy, painful periods.

Question 14

What is leiomyoma?

Answer 14

A very common benign tumour of smooth muscle found within the uterus.

This is the pathological name for a fibroid.

Question 15

What is leiomyoma growth dependent on?

Answer 15

Oestrogen

Question 16

What is the triple assessment carried out in breast disease?

Answer 16

Clinical (history and examination)
Imaging (can be mammography, USS or MRI)
Histopathology/Cytopathology

Question 17

What does cytopathology involve?

Answer 17

FNA

Fluid and nipple testing

Question 18

Why is histopathology preferred to cytopathology?

Answer 18

Cytopathology disrupts context of sample, therefore cannot determine if any invasion has occurred.

As histopathology involves biopsy, the context is preserved, allowing a clear diagnosis.

Question 19

What is wide local excision?

Answer 19

A method used to remove a lesion of interest, with a margin.

Question 20

What is gynaecomastia?

Answer 20

Breast development in males.

Results from ductal growth, without lobular development.

Question 21

What can cause gynaecomastia?

Answer 21

Exogenous/Endogenous hormones
Cannabis
Prescription drugs
Liver disease

Question 22

What is fibrocystic change?

Answer 22

Development of fluid-filled cysts in the breasts. Accompanied by intervening fibrosis.

Most cases are perimenopausal/in their 40s.

Question 23

How do fibrocystic changes present?

Answer 23

Can be asymptomatic and often an incidental finding.

Some may have sudden/cyclical pain with ill-defined breast lumpiness.

Question 24

What is metaplasia?

Answer 24

A change of one fully differentiated cell type to another.

Question 25

Should fibrocystic change be investigated?

Answer 25

Yes, in order to rule out malignancy.

Question 26

How does fibroadenoma present?

Answer 26

A benign solitary lump which is a painless, firm and mobile mass. Will appear solid on USS.

Question 27

Should fibroadenoma be removed?

Answer 27

Only on patient request - reassurance may be sufficient.

Question 28

What are the 2 types of sclerosing lesions?

Answer 28

Sclerosing adenosis | Radial scar

Question 29

What are sclerosing lesions?

Answer 29

Benign, disorderly, proliferations of acini and stroma. Can cause mass or calcification.

Question 30

How does sclerosing adenosis present?

Answer 30

Can be asymptomatic or painful, with a tenderness and/or lumpiness. Often seen alongside other breast changes. There is a risk of progression to carcinoma.

Question 31

How often is a radial scar seen?

Answer 31

Very common. Often multiple are seen at the same time. These can be bilateral.

Question 32

Should a radial scar be treated?

Answer 32

Yes, as risk of in-situ or invasive carcinoma existing within this lesion. Treat with excision/vacuum biopsy.

Question 33

What causes fat necrosis?

Answer 33

Local trauma | Warfarin therapy

Question 34

What occurs in fat necrosis?

Answer 34

Disruption of adipocytes, causing leakage. Results in an inflammatory response and subsequent scarring.

Question 35

What is seen histologically in the case of fat necrosis?

Answer 35

Foamy macrophages

Question 36

What is affected in duct ectasia?

Answer 36

The subareolar ducts.

Question 37

What symptoms are seen in duct ectasia?

Answer 37

Pain Episodic inflammation Bloody/Purulent discharge

Question 38

What can duct ectasia lead to?

Answer 38

Fistulation Nipple retraction Distortion

Question 39

What is associated with duct ectasia?

Answer 39

Smoking

Question 40

What causes acute mastitis/abscess?

Answer 40

Duct ectasia | Lactation

Question 41

How is acute mastitis/abscess treated?

Answer 41

Antibiotic or drainage (if needed). Treat underlying cause.

Question 42

What is seen in Phyllodes tumour?

Answer 42

Stromal overgrowth

Question 43

Is Phyllodes tumour benign?

Answer 43

Not necessarily. It depends on the stromal features. It can be benign, borderline or malignant.

Question 44

Does Phyllodes tumour metastasize?

Answer 44

Rarely

Question 45

How can intraduct papilloma present?

Answer 45

Nipple discharge (may be bloody) Nodules Calcification Can be asymptomatic in some cases - therefore identified through screening.

Question 46

Is metastasis to the breast common?

Answer 46

No

Question 47

What is commonly the cause of angiosarcoma of the breast?

Answer 47

Breast radiotherapy

Question 48

Where does metastasis to the breast originate from?

Answer 48

``` Bronchial Ovarian (serous) Clear cell carcinoma of the kidney Malignant melanoma Soft tissue tumours ```

Question 49

What cells does a breast carcinoma originate within?

Answer 49

Glandular epithelium of the TDLU. This is a form of adenocarcinoma.

Question 50

What are the 2 forms of carcinoma-in-situ seen in breast pathology?

Answer 50

Lobular | Ductal

Question 51

What is Paget's disease of the nipple?

Answer 51

A high grade DCIS which extends along ducts, reaching the epidermis of the nipple.

Question 52

Is Paget's disease of the nipple invasive?

Answer 52

No, as it only occupies the existing structures.

Question 53

How is DCIS treated?

Answer 53

Surgery and adjuvant radiotherapy.

Question 54

What is microinvasive carcinoma?

Answer 54

DCIS with invasion of less than 1mm.

Question 55

When malignant epithelial cells have breached the basement membrane, what is it referred to as?

Answer 55

Invasive breast carcinoma

Question 56

Which ethnicity is most likely to suffer breast cancer?

Answer 56

White

Question 57

What plays a key role in breast cancer development?

Answer 57

Hormones

Question 58

What genetic conditions predispose to breast cancer?

Answer 58

BRCA1/BRCA2 p53 mutation Peutz-Jeghers syndrome

Question 59

What is the most common form of breast cancer?

Answer 59

Ductal carcinoma

Question 60

What % of breast cancers are oestrogen receptor positive?

Answer 60

80%

Question 61

What does the presence of oestrogen receptors indicate about a breast cancer?

Answer 61

That it would be sensitive to anti-oestrogen therapy.

Question 62

What are examples of anti-oestrogen therapies?

Answer 62

Oophorectomy Tamoxifen Aromatase inhibitors GnRH antagonists

Question 63

What drug is advised in those with HER2 receptor overexpression?

Answer 63

Trastuzumab

Question 64

What are common sites of breast cancer spread?

Answer 64

``` Bone Liver Brain Lungs Abdominal viscera Female genital tract ```