Breast Pathologies Flashcards by John Darlington

Where are ectopic Breast tissue most likely to develop?

what are these breast tissues called?

Along the milk line on the mammary ridge

Polymasia

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When is nipple inversion of worry?

If it has started suddenly

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What is it called when the breast is inflammed?

Mastitis

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What is the common cause of Acute mastitis?

Cellulitis of the breast due to bacterial infection through a fissure. this combined with milk stasis - ideal breading ground

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What changes may occur in fibrocystic changes on the breast, seperating them into proliferative and non-proliferative:

Non- proliferative:
- fibrosis around ducts.

Cyst formation:
- lined squamous epithelium with water filling

Apocrine metaplasia:
- epithelium undergo metaplasia making them apocrine glandular

Proliferative:
- epithelial hyperplasia

Ductal columnar epithelium changes.

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Whats it called when there is an increase in glandular tissue of the breast?

Adenosis

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Is there a risk of fibrocytic changes in the breast?

Depends if there is proliferative changes along with atypia changes in cells

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What is a benign growth that occurs in women between 20-30, which feels like a smooth firm lump?

Fibroadenoma

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What benign growth may indicated on a mammogram by a star like configuration? and what is at the centre of this benign growth?

Radial scars
- sclerosing of duct hyperplasia

Centred by elastotic core

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What is a benign growth of the myoepithelial cells around the lobules?

Pseudo-angiomatous stromal hyperplasia

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List some symptoms of breast cancer:

New lump/ thickening of breast

Altered shape of breast

Pain (not common)

Skin changes

puckering
Dimpling
Rash

Nipple changes

Paget’s disease
tethering
inversion

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Name the two types of Non-invassive breast cancer:

Ductal Carcinoma in Situ

Lobular Carcinoma in Situ

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Symptoms of DIS?

Post menopausal women

palpable mass, often with paget’s disease.

usually confined to one area and one breast

Necrosis is common

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Symptoms of LIS?

Pre - menopause

no palpable mass.

Multi-focal and bilaterally.

Necrosis is uncommon.

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Name the main types of invasive breast cancer:

Infiltration ductal of no special type

Infiltration of lobular

Mucinous

Tubular

Medullary

Papillary

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List some risk factors to developing breast cancer:

Early Menarche

Late menopause

Older first pregnancy

Lack of breast feeding

HRT

Obesity

Positive family history

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What are the molecular sub-types of breast cancer?

Luminal A

Steroid Receptor positive
Her2 negative

Luminal B

steroid positive
Her2 positive

Triple Neg/ Basal like:
- all neg. BRCA1 related

Her2 rich:

steroid negative
Her2 positive

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Histologically what do infiltrating ductal carcinomas of no specific type look like?

Cords and tubules

Uniformed into gland like structures

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Histologiclaly what do infiltrating lobular look like?

stacks of cells following ductules

highly motile

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What type of cancer of the breast will not have E-Cadherin?

Lobular infiltrating

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What is the most common benign breast cancer?

Fibroadenoma

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What is the most common cause of bloody Nipple discharge?

Inductal Papilloma

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What benign tumour presents like a leaf?

Phyllodes tumour

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In acute mastitis what is the biggest cause and what is the most common pathogen?

Study These Flashcards

Milk stasis

S. Aureus

What drug is used for Her2 positive cancers?

Trastuzumab

What drug is used for ER and PR positive?

Tamoxifen

What are the three most important prognostic factors in breast cancer?

Stage Grade Size

List 4 common causes of benign breast lumps:

fibroadenoma Fibrocystic changes Mastitis Fat necrosis

Where do almost all the breast cancers originate from?

Terminal duct lobular unit

Which patients are candidates for neo-adjunctive therapy prior to breast surgery and what are some benefits of this?

* *Very large breast tumours * **Axilla involvement treatments can be: - chemotherapy - endocrine treatment - may shrink the tumour size - reducing the surgical invasion - allows for analysis if the treatment is working

Which patients typically receive radiotherapy?

those that get lumpectomies - not mastectomy those with axilla involvement High grade - grade 3

If a breast cancer is removed - there has to be an area around it taken as well to ensure no tumour cells are present. What is this called, and what is the minimal distance?

Cavity shavings >1mm

What are the indications for mastectomy?

Multiple tumours within the breast Diffuse DCIS Large tumour in small breast - would try neoadjuvant treatment first Involved margin - if you keep taken margins then eventually leads to mastectomy Recurrent cancer Contraindication of radiotherapy (remember usually if just a lumpectomy is performed, then radiotherapy is given afterwards, but if this can't be done (pregnancy) then full mastectomy is done) previous radiotherapy

How is breast reconstruction done?

Immediate - skin sparing - use bodies own tissue - latissimus dorsi muscle - abdomen fat - Diep flap

If you had a young women come in with breast cancer and is ER, PR and HER2 negative (triple negative), what should be thought about?

Genetic testing BRCA1

Who are candidates for neoadjuvant therapy?

Large tumors to try and shrink it Oestrogen or HER2 positive can be considered - allows us to see if it has an effect

If there was scarring in the nodes following neo-adjunctive therapy - what is this suggestive off?

that there was cancer there and it has shrunk down in response

How is follow up done following breast cancer treatment?

yearly: - clinical examination - mammogram **mammogram done for 5 years.

What is the breast screening programme?

50-70 years 2 viewing mammography - side views - top to bottom Recalled every 3 years

What are some negatives of fine needle biopsy?

No architecture need trained cytologists lots of false positives.

What type of biopsy is most commonly carried out on the breast now?

Core biopsy

What cells do cancerous cells develop from?

Epithelial cells

What is fibroadenomas made up off?

Epithelial and stroma tissue

What has a stellate appearance? and what do they have that cancers do not?

Radial scar - diagnosed with biopsy contain myoepithelial cells - which cancers do not

What is duct Ectasia linked too?

Smoking stopping smoking helps it

What things need to be established when someone has granulomatous mastitis? How is it management?

Is there TB? Is there sarcoidosis Is there vasculitis? NSAIDS Steroids

What are the atypical proliferation of breast tissue?

Atypical Ductal Hyperplasia Atypical lobular hyperplasia Leads to 4x increase in breast cancer - need follow ups

Whats the major risk factors for breast cancer:

Age - 40-70 Family history Hormone environment - lack of pregnancies - early periods - lack of breast feeding - HRT - Contraceptive pill

Whats the treatment of DCIS?

if large of diffuse - mastectomy (with or without reconstruction) local excision + radiotherapy

What is the management for Lobular carcinoma in situ?

Because its often bilateral and diffuse throughout the breast, the options are limited. Bilateral mastectomy or Follow up regularly and then carry out surgery if needed

What are the gradings based on in breast cancer?

Tubules Pleomorphism Mitoses

What type of cancer is Lobular carcinoma?

ER positive

In lobular cancer, what do you need to do prior to surgery?

MRI - because its difficult to see on mammogram

What are the common spread of breast cancer?

Lung, bone, liver and brain

What drugs are used for ER positive cancers?

Tamoxifen Aromatase inhibitors

What does the Nottingham prognostic index look at?

Size of tumour Grade of tumour Nodal involvement

What cancer will need chemotherapy?

Her2 positive

What can be done to determine the recurrence of breast cancer?

Oncotype Diagnosis

What colour does oestrogen positive stain?

Brown stain

Breast Pathologies Flashcards

(59 cards)