Breast Pathology

Question 1

What is the presentation of breast disease?

Answer 1

• lumps
• pain
• inflammation/infection
• nipple discharge
• Puckered skin/indrawn nipple
• Abnormal/ sore nipple

Question 2

What are the components of a triple assessment?

Answer 2

• Clinical= examination, palpation
• Radiological
• Pathological= cytology or histopathology

Question 3

Describe fibroadenomas

Answer 3

• Mobile lumps/radiological masses

- AKA fibroepithelial neoplasms with co-ordinated growth of glandular & connective tissue(stromal)

Question 4

Describe phyllodes tumours

Answer 4

• rare fibroepithelial neoplasm forming spectrum of lesions

- Aggressive show overgrowth of stromal element

Question 5

Describe lumps felt in breasts and what they can mean

Answer 5

-benign= lipoma, fibroadenoma, fibrocystic change
-depends= phyllodes tumour
-malignant= invasive
Can co-exist

Question 6

What is fibrocystic change?

Answer 6

• includes usual type ductal hyperplasia, apocrine metaplasia, cysts
• lump
• associated with microcalcification
• Oestrogenic environment

Question 7

What can fibroblasts cause pathologically?

Answer 7

Inverted nipple

Skin puckering

Question 8

What causes P’eau d’orange?

Answer 8

Inflammatory breast cancer multiple tumours blocking lymphatic ducts

Question 9

What can cause inflammation/infection in the breast?

Answer 9

• Mastitis during breastfeeding
• TB
• Carcinoma/sarcoma
• Breast abscesses & fistulae

Question 10

Describe Paget’s disease of the nipple

Answer 10

• consequence of cancer cells growing in skin of nipple

- over expression of her2 gene

Question 11

What factors can decrease the risk of breast cancer?

Answer 11

• breastfeeding
• body fat
• physical activity

Question 12

What is the grading scale for a core biopsy?

Answer 12

• B1=unsatisfactory/normal
• B2= benign lesion
• B3= atypical probably benign
• B4= atypical probably malignant
• B5= malignant (5a-in situ 5b-invasive)

Question 13

What can cause puckered skin or an indrawn nipple?

Answer 13

• Fat necrosis
• Carcinoma
• Peau d’orange

Question 14

How does breast disease present?

Answer 14

• Nipple discharge

- Abnormal/sore nipple

Question 15

What can nipple duct discharge be a sign of?

Answer 15

• Duct ectasia
• Intraductal papilloma
• In situ papillary carcinoma
• Intracystic papillary carcinoma

Question 16

What are the main recognised types of breast carcinoma?

Answer 16

• Ductal (75%)
• Lobular
• Tubular/cribriform
• Medullary
• Mucoid
• Metaplastic

Question 17

What will a path report tell you about a malignancy?

Answer 17

• In situ/invasive
• Typer
• Grade
• Size
• Vascular invasion
• Nodal status
• Relationship to margins
• ER, PR, HER2 status

Question 18

What is PTH-rp?

Answer 18

PTH-rp is a peptide involved in normal development of bone, tooth and breast tissue. It may also be produced by tumour cells, typically breast cancer