Week 7 part 1

Question 1

In the basic structure of the non-lactating breast what is secretory tissue made up from?

Answer 1

15-25 lobules each consisting of a compound tubulo-acinar gland which drains via a series of ducts leading to nipple

Question 2

What structure system of the mammary gland is described: terminal ductules lead into an intralobular collecting duct which leads into the lactiferous duct for that lobe. The lactiferous duct leads to the nipple, passing through an expanded duct region near the nipple termed the lactiferous sinus?

Answer 2

Duct system

Question 3

What cells in the mammary gland stain brown for actin and have contractile filaments

Answer 3

Myoepithelial cells

Question 4

What covers the nipple?

Answer 4

Highly pigmented keratinised stratified squamous epithelium

Question 5

What is in the nipple core?

Answer 5

Dense irregular connective tissue mixed with bundles of smooth muscle - severeal lactiferous sinuses can be seen

Question 6

What lines the lactierous duct?

Answer 6

As it approaches surface - stratified squamous epithelium

deeper - lined with stratified cuboidal epithelium

Question 7

During the luiteal phase of menstrual cycle what happens to epithelial cells and ducts in breast?

Answer 7

Epithelial cells increase in height, lumina of ducts becomes enlarged and small amounts of secretion appear in ducts

Question 8

What trimester of pregnancy has these breast changes: glandular tissue continues to develop with differentiation of secretory alveoli. Also, plasma cells and lymphocytes infiltrate the nearby connective tissue.

Answer 8

Second

Question 9

What trimester in pregnancy has these changes in breast: there is elongation and branching of the smaller ducts, combined with proliferation of the epithelial cells of the glands and the myoepithelial cells.

Answer 9

First

Question 10

What trimester has these changes: secretory alveoli continue to mature, with development of extensive rER.

Answer 10

Third

Question 11

In pregnancy oestrogen and progesterone stimulate proliferation of what tissue?

Answer 11

Secretory. Fibrofatty becomes sparse

Question 12

What four components make up human milk?

Answer 12

1. 88% water
2. 1.5% protein
3. 7% Carbohydrate
4. 3.5% lipid

With small quantities of ions, vitamins and IgA

Question 13

How are lipid droplets in human milk secreted?

Answer 13

Apocrine secretion - bud off carrying small amount of cytoplasm with it

Question 14

How are proteins in milk secreted?

Answer 14

Merocrine secretion - secreted in vesicles which merge with apical membrane to release onkly their contents into duct sustem

Question 15

following menopause what happens to the secretory cells of the terminal ductal lobule unit?

Answer 15

Degenerate leaving only ducts

Question 16

Four methods of breast cytopathology?

Answer 16

1. FNA
2. Fluid
3. Nipple discharge
4. Nipple scrape

Question 17

In breast FNA cytology - what is atypia, probably benign?

Answer 17

C3

Question 18

In breast FNA cytology what is maligannt?

Answer 18

C5

Question 19

In needle core biopsy, what is benign?

Answer 19

B2

Question 20

In needle core biopsy, what is suspicious of malignmancy

Answer 20

B4

Question 21

In needle core biopsy, what is B5?

Answer 21

mAlignant - B5b invasice, a is carcinoma in situ

Question 22

What is the term for ductal growth without lobular development in males?

Answer 22

Gynaecomastia - caused by liver disease, cannabis, drugs and steroids

Question 23

What benign breast condition affects women 20-50, very common, has menstrual abnormaltiies, early menarche, late menopause and often resolves after menopause?

Answer 23

Fibrocystic change

Question 24

What benign breast condition: smooth discrete lumps, sudden pain, cyclical pain, lumpiness, incidental finding on screening?

Answer 24

Fibrocystic change

Question 25

What gross pathology does fibrocystic change show?

Answer 25

Cysts blue domed with pale fluid | microscopically lined by apocrine epithelium

Question 26

Circumscribed lesion composed of cell types normal to the breast but present in an abnormal proportion or distribution

Answer 26

Hamartoma

Question 27

What woen is fibroademoma commoner in?

Answer 27

Africans

Question 28

What benign breast lesions has peak incidence 3rd decade, painless, firm, discrete, mobile mass which is solid on ultrasound?

Answer 28

Fibroadenoma

Question 29

Breast mouse

Answer 29

Fibroadenoma - rubbery, grey-white colour, biphasic tumour

Question 30

Age 20-70, asymptomatic, pain, tenderness or lumpiness/thickening?

Answer 30

Sclerosing adenosis

Question 31

Stellate architecture, central puckering, radiating fibrosis?

Answer 31

Radial scar

Question 32

On histology what is seen with a radial scar?

Answer 32

Fibroelastotic core Radiating fibrosis containing distorted ductules Fibrocystic change Epithelial proliferation

Question 33

What can cause fat necrosis?

Answer 33

Local trauma - seat belt injury | Warfarin therapy

Question 34

Damage and disruption of adipocytes, infiltration by acute inflammatory cells, "foamy" macrophages, subseuent fibrosis and scarring?

Answer 34

Fat necrosis of breast

Question 35

``` Affects sub-areolar ducts Pain Acute episodic inflammatory changes Bloody and/or purulent discharge Fistulation Nipple retraction and distortion ```

Answer 35

Duct ectasia

Question 36

What is duct ectasia associated with?

Answer 36

Smoking

Question 37

In acute mastitis/abscess what are the two causes related to duct ectasia?

Answer 37

Mixed organisms | Anaerobes

Question 38

In acute mastitis/abscess what are the two causes related to lactqtion?

Answer 38

Staph auresus | Strep pyogenes

Question 39

40-50 years | Slow growing unilateral breast mass?

Answer 39

Phyllodes tumour

Question 40

``` Age 35-60 Nipple discharge +/- blood Asymptomatic at screening Nodules calcification Papillary fronds containing a fibrovascular core covered by myoepithelium and epithelium Epithelium may show proliferative activity ```

Answer 40

Intraduct papilloma

Question 41

What miscellaneous malignant breast tumour comes post radiotherapy?

Answer 41

Angiosarcoma

Question 42

Name three carcinomas that metastasise to breast?

Answer 42

Bronchial Ovarian serous carcinoma Clear cell carcinoma of kidney

Question 43

What is the definition of breats carcinoma?

Answer 43

A malignant tumour of breast epithelial cells

Question 44

Where does a breast carcinoma arise?

Answer 44

In the glandular epithelium of the terminal duct lobular unit

Question 45

In relation to breast pathology what are precursor lesions?

Answer 45

Epithelial proliferations

Question 46

Intra-lobular proliferation of characteristic cells. Small-intermediate sized nuclei Solid proliferation Intra-cytoplasmic lumens/vacuoles ER positive E-cadherin negative (deletion & mutation of CDH1 gene on Chr 16q22.1)

Answer 46

Lobular in situ neoplasia

Question 47

15-20% of breast malignancies are DCIS (formerly 5%) Arises in TDLU Characteristically unicentric (single duct system)

Answer 47

Ductal carcinoma in situ

Question 48

What might involve nipple skin (Pagets disease?

Answer 48

Ductal carcinoma in situ

Question 49

High grade DCIS extending along ducts to reach the epidermis of the nipple Still in situ carcinoma (ie non-invasive)

Answer 49

Pagets disease of the nipple

Question 50

What is an invasive breast carcinoma?

Answer 50

Malignant epithelial cells that have breached the basement membrane

Question 51

What are the risk factors for breast cancer?

Answer 51

Age Age of menarche, use of OCP, parity, breast feeding, menopause, HRT Diet, smoking, BMI, alcohol Genetics

Question 52

What is the commonest female cancer?

Answer 52

Invasive breast cancer | 1 in 8 will develop it

Question 53

Classification of Invasive Breast Carcinoma: most common types/

Answer 53

Ductal | Lobular

Question 54

What are the predictive and prognostic factors for invasive carcinoma?

Answer 54

ER (PgR) - estrogen receptor | HER 2

Question 55

Symptoms of breast cancer?

Answer 55

1. Dimled or depressed nipple 2. Visible lump 3. Nipple change ex. inversion 4. Bloody discharge 5. Texture change 6. Colour change

Question 56

What is the most common benign neoplasm of the breast?

Answer 56

Fibroadenoma

Question 57

When are fibroadenimas usually diagnosed?

Answer 57

Early reproductive years- usually with ultrasound core biopsy

Question 58

rubbery to firm, mobile, smooth with distinct borders, and is usually nontender.

Answer 58

Fibroadenoma

Question 59

What resembles a fibroadenoma?

Answer 59

Phyllodes tumour - often larger 3-6cm, 35-45 y/o

Question 60

When do breast cysts occur?

Answer 60

Late reproductive years

Question 61

When are breast cysts most tender?

Answer 61

before menstruation

Question 62

How do you diagnose and treat a cyst?

Answer 62

FNA

Question 63

wHAT Can sometimes occur within a cyst and is often associated with bloody cyst fluid?

Answer 63

A benign intracystic papillary proliferation called a papilloma

Question 64

How is normal nipple discharge described?

Answer 64

Clear, yellow and watery

Question 65

What can present as an erythematous weeping lesion on the surface of the nipple and aerola?

Answer 65

Pagets disease of nipple

Question 66

What can present as a flocculent sometimes bulging mass in central area of mastitis?

Answer 66

Breast abscess

Question 67

If there is a breast mass under 40 years old what imaging is done?

Answer 67

Ultrasound

Question 68

If there is a breast mass over 40 years old what imaging is done?

Answer 68

Mammography and ultrasound

Question 69

On mammography: what is the best single view?

Answer 69

Mediolateral oblique

Question 70

In relation to malignant calcification features: what is the distribution like to hint suspicious?

Answer 70

Cluster or segmental | If scattered or diffuse most likely benign

Question 71

In relation to malignant calcification features on mammogram: what form of cluster shape is suspicous?

Answer 71

Rhomboid forms

Question 72

Common in women under the age of 30 years | Often described as 'breast mice' due as they are discrete, non-tender, highly mobile lumps

Answer 72

fibroadenoma

Question 73

More common in obese women with large breasts May follow trivial or unnoticed trauma Initial inflammatory response, the lesion is typical firm and round but may develop into a hard, irregular breast lump Rare and may mimic breast cancer so further investigation is always warranted

Answer 73

fat necrosis

Question 74

Stimulates breast development (both initially and further hyperplasia during pregnancy) Stimulates milk productio It decreases GnRH pulsatility at the hypothalamic level and to a lesser extent, blocks the action of LH on the ovary or testis.

Answer 74

prolactin

Question 75

Stimulates the lactiferous duct system to grow at puberty

Answer 75

oestrogen

Question 76

Stimulates the mammary glands to produce milk

Answer 76

prolactin

Question 77

The most common histological type of breast cancer is,

Answer 77

invasie ductal cancer

Question 78

extensive microcalcifications in the inner quadrant of her left breast.

Answer 78

ductal carcinoma in situ