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Reproductive System Brian > Pathology of Breast Disease > Flashcards

Pathology of Breast Disease Flashcards

1
Q

What are examples of benign breast conditions?

A
  • Fibrocystic change
    • Fibrosis, adenosis, cysts, apocrine metaplasia, ductal epithelial hyperplasia (usual type and atypical)
  • Fibroadenoma
    • Circumscribed mobile nodule in reproductive age
  • Other adenomas
    • Tubular adenoma and lactating adenoma
  • Intraduct papilloma
    • Lactiferous ducts, nipple discharge
  • Fat necrosis
  • Duct ectasia
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2
Q

What are examples of fibrocystic changes to the breast?

A
  • Fibrosis, adenosis, cysts, apocrine metaplasia, ductal epithelial hyperplasia (usual type and atypical)
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3
Q

What is fibroadenoma?

A

Proliferation of epithelial and stromal elements

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4
Q

What is the most common breast tumour in young adult woman?

A

Fibroadenoma

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5
Q

What are the different types of fibroadenoma?

A
  • Intracanalicular pattern
    • Ducts distorted elongated
  • Pericanalicular pattern
    • Ducts not compressed
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6
Q

What are characteristics of fibroadenoma?

A
  • Well-circumscribed, freely mobile, no painful mass
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7
Q

What is the management for fibroadenoma?

A
  • May regress with age
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8
Q

Describe the epidemiology of tubular adenoma (how common compared to fibroadenoma, young/older woman)?

A
  • Less common than fibro adenomas
  • Young woman
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9
Q

What are characteristics of tubular adenoma?

A
  • Uniform sized ducts
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10
Q

What is lactating adenoma?

A

Enlarging masses during lactation or pregnancy:

  • Prominent secretory change
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11
Q

Describe the epidemiology of intraduct papilloma (young/middle/older woman)?

A
  • Usually middle aged woman
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12
Q

What are characteristics of intraduct papilloma?

A
  • Nipple discharge, bloody
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13
Q

What is the aetiology of fat necrosis?

A
  • History of antecedent trauma, surgery
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14
Q

What is seen in the histology for fat necrosis of the breast?

A
  • Histiocytes with foamy cytoplasm
  • Lipid-filled cysts
  • Fibrosis, calcifications, egg shell on mammography
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15
Q

What is a possible complication of fat necrosis?

A
  • Can stimulate carcinoma
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16
Q

What are characteristics of phyllodes tumour?

A
  • Fleshy tumour, leaf-like pattern and cysts on cut surface
  • Circumscribed, connective tissue and epithelial elements
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17
Q

What are possible complications of phyllodes tumour?

A
  • Rapid growing so is borderline malignant
    • Metastases are haematogenous
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18
Q

What are the 5 subtypes of molecular classification for breast carcinoma?

A
  • ER and luminal A
  • Luminal B
  • Basal
  • Her2
  • Normal breast like
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19
Q

What molecular classification of breast carcinoma is most common?

A

Luminal A

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20
Q

For each molecular subtype of breast carcinoma, are they positive or negative for:

  • ER
  • PR
  • HER2
A
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21
Q

What is the aetiology for breast carcinoma?

A
  • Different breast lesions have potential to become cancer
    • Epithelial proliferation without atypia – RR 1.5-2x
    • With atypia ductal or lobular – RR 4-5x
    • LCIS – RR 8-10x
    • DCIS – RR 8-10x
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22
Q

Describe the epidemiology for breat cancer (fraction of females, fraction of all female cancers)?

A
  • 1/8 females, 22% all female cancer
23
Q

What are the different histological classifications for breast carcinoma?

A
  • Non-invasive
    • Different types
      • Ductal carcinoma in situ (DCIS)
      • Lobular carcinoma in situ (LCIS/LISN)
    • Not detected clinically (only x-ray)
    • Risk of invasion depending on grade
      • Low grade DCIS – 30% in 15 years
      • High grade DCIS – 50% in 8 years
      • LCIS - 19% in 25 years and bilaterally
  • Invasive
    • Invasive ductal carcinoma 75%
    • Invasive lobular carcinoma
    • Special types
      • Tubular carcinoma, mucinous carcinoma, carcinoma with medullary features, metaplastic carcinoma
24
Q

What are different types of non-invasive breast carcinoma?

A
  • Ductal carcinoma in situ (DCIS)
  • Lobular carcinoma in situ (LCIS/LISN)
25
Q

What does DCIS stand for?

A

Ductal carcinoma in situ

26
Q

What does LCIS stand for?

A

Lobular carcinoma in situ

27
Q

Risk of invasion for non-invasive breast carcinomas depends on what?

A
  • Risk of invasion depending on grade
    • Low grade DCIS – 30% in 15 years
    • High grade DCIS – 50% in 8 years
    • LCIS - 19% in 25 years and bilaterally
28
Q

What are different kinds of invasive breast cancers?

A
  • Invasive ductal carcinoma 75%
  • Invasive lobular carcinoma
  • Special types
    • Tubular carcinoma, mucinous carcinoma, carcinoma with medullary features, metaplastic carcinoma
29
Q

What are risk factors for breast carcinoma?

A
  • Gender
  • Age
  • Menstrual history
  • Age at first pregnancy
  • Radiation
  • Family history
  • Genetic
    • BRCA1 and BRCA2
  • Personal history
  • Hormonal treatment
    • Oestrogen exposure
  • Other factors
    • Obesity, lack of exercise, alcohol
30
Q

What genes have biggest impact for developing breast carcinoma?

A

BRCA1 and BRCA2

31
Q

What are characteristics of breast carcinoma (mammogram and macroscopic)?

A
  • Mammogram
    • Soft tissue opacity, microcalcification
  • Macroscopic
    • Hard lump, fixed mass, tethering to skin
32
Q

How does breast cancer spread?

A
  • Local
    • Skin, pectoral muscles
  • Lymphatic
    • Axillary and internal mammary nodes
  • Blood
    • Bone, lungs, liver, brain
33
Q

What organs does breast cancer commonly spread to through the blood?

A
  • Bone, lungs, liver, brain
34
Q

What investigations should be done for breast carcinoma?

A
  • Examination
  • Imaging
    • Mammogram, USS, MRI
    • Sensitivity of mammography reduced in younger woman due to more glandular tissue being present
  • Biopsy
    • Fine needle aspiration cytology (FNA)
    • Needle core biopsy
    • Histology report looks at invasive vs non-invasive, histological type, grade, size, margins, lymph nodes, oestrogen/progesterone receptor, HER-2
    • Also do sentinel lymph node biopsy
      • If negative, rest of nodes are negative
35
Q

What is the presentation of breast carcinoma?

A
  • Asymptomatic
  • Symptomatic
    • Lump
    • Mastalgia – persistent unilateral pain
    • Nipple discharge – blood stained
    • Nipple changes – Paget’s disease, retraction
    • Change in size or shape of breast
    • Lymphoedema – swelling of arm
    • Dimpling of breast skin
36
Q

Describe the managemnent for breast carcinoma?

A
  • Staging
  • Surgery
    • Masectomy, breast conserving surgery with or without lymph nodes
  • Radiotherapy
  • Antihormonal therapy
    • Tamoxifen
  • Chemotherapy
37
Q

What antihormonal therapy can be used for breast carcinoma?

A
  • Antihormonal therapy
    • Tamoxifen
38
Q

What does the prognosis of breast carcinoma depend on?

A
  • Patient and tumour related, depends on
    • Node status, tumour size, type, grade (1, 2, 3), age, lymphovascular space invasion
    • Oestrogen receptors, progesterone receptors, HER-2, proliferative rate of tumour, gene expression profiling
  • Can use Nottingham Prognostic Index (NPI) based on tumour size, grade and nodal status
  • Overall 64% 5 year survival
39
Q

What system is used to estimate prognosis of breast carcinoma?

A
  • Can use Nottingham Prognostic Index (NPI) based on tumour size, grade and nodal status
40
Q

What does NPI stand for?

A

Nottingham prognostic index

41
Q

Is Paget’s disease of the nipple benign or malignant?

A

Malignant

42
Q

What is the aetiology for Paget’s disease of the nipple?

A
  • Intraepithelial spread of intraductal carcinoma
43
Q

What is the presentation for Paget’s disease of the nipple?

A
  • Large pale-staining cells within epidermis of nipple
  • Limited to nipple or extend to the areola
  • Pain or itching, scaling and redness
  • Ulceration, crusting, serous or bloody discharge
44
Q

What investigations are done for Paget’s disease of the nipple?

A
  • Same as breast carcinoma
45
Q

How is screening for breast cancer done?

A

Mammogram every 3 years for woman aged 50-70 years:

  • 30% reduction in mortality
  • Indicators on mammogram
    • Masses
    • Microcalfications
46
Q

What age group qualifies for breast cancer screening and how often do they get this?

A

Mammogram every 3 years for woman aged 50-70 years:

  • 30% reduction in mortality
  • Indicators on mammogram
    • Masses
    • Microcalfications
47
Q

What are indicators on a mammogram of breast cancer?

A
  • Masses
  • Microcalfications
48
Q

What are examples of pathology of the male breast?

A
  • Gynecomastia
  • Carcinoma of male breast
49
Q

What is gynecomastia?

A

Increase in subareolar tissue

50
Q

What is the most common pathology of the male breast?

A

Gynecomastia

51
Q

What are risk factors for gynecomastia?

A
  • Hyperthyroidism
  • Cirrhosis of liver
  • Renal failure
  • Chronic pulmonary disease
  • Hypogonadism
  • Use of hormones
    • Oestrogens, androgens
52
Q

What hormones increase the risk of gynecomastia?

A
  • Oestrogens, androgens
53
Q
A

Reproductive System Brian (34 decks)

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