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78 Cards in this Set
- Front
- Back
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What are Lactiferous Ducts? |
Large ducts at the nipple. Ducts repeatedly branch into the breast tissue to formm anastomosing lobes separated by fibrofatty tissue |
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The branching of the Lactiferous ducts eventually end in... |
terminal duct lobular units |
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Describe the duct systems in the breast |
6-10 Major duct systems, each occupying more than one quadrant with extensive overlapping (Make sure you look at the histo pictures on the Breast Pathology slides). |
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How many cell layers do Breast Duct Walls have? What cell types do they consist of? |
2 layers: -Cuboidal epithelial cell layer -Myoepithelial cell layer |
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Describe the Terminal Duct Lobular Unit |
Branching off the main duct, you have the extralobular terminal duct. This branches into clusters of grape-like acini that form a lobule. A lobule consists of the blunt end of the extralobular terminal duct (Intralobular terminal duct) with ductules branching off it. This lies in a lobular stroma. |
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What is the function of a Lobule? |
to produce milk to be discharged through the duct system. |
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What is the difference between intralobular and interlobular stroma? |
Intralobular is less dense than interlobular |
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How many cell layers do the acini have? What are their functioms? |
2 layers. Only the luminal cells can produce milk. The Myoepithelial cells assist in milk ejection |
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At what age women does Mammary Duct Ectasia normally present? |
5th-6th decades of life, Multiparous women |
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True or False: Mammary Duct Ectasia is associated with smoking |
False: Not associated with smoking |
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How does Mammary Duct Ectasia present? |
Non-painful lump, poorly defined periareolar mass. Nipple discharge Can mimic malignancy on mamography (so could come in through screening) |
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Describe the microscopic features of Mammary Duct Ectasia |
Dilated ducts Thick, proteinaceous secretions Lipid laden macrophages Periductal lymphocytic infiltrate Fibrosis and scarring
Dat Thick Lady Peed Fire |
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How does Periductal Mastitis/Abscess present? |
Painful subareolar erythematous mass 90% of those affected are smokers NOT associated with lactation Can create a fistula tract |
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Describe the microscopic features of Periductal Mastitis/Abscess |
Squamous metaplasia of nipple ducts Chronic and granulomatous inflammation Secondary bacterial infection=>abscess |
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How does Fat Necrosis present? |
Painless mass with or without skin retraction Ill defined white/yellow nodules |
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What causes Fat Necrosis? |
Incidental trauma Prior surgery Radiation treatment
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Describe the microscopic features of Fat Necrosis |
Necrotic fat cells without nuclei, macrophages cuff fat cells Chronic inflammatory cells surround injured area Haemorrhage, fibrosis and scarring |
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Mammary Duct Ectasia, Periductal Mastitis, and fat necrosis are examples of... |
Inflammatory Breast disease |
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Describe Fibrocystic change/ |
Condition of Benign non-proliferative lesions. Get a lumpy breast on palpation. Radiographically dense, with cysts seen on imaging. |
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Describe the microscopic findings of Fibrocystic Change |
Cysts, lined by epithelial and myoepithelial cells. May show apocrine metaplasia. Thick (inspissated) secretions and calcifications. Supported by a dense fibrous stroma. |
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From where in the breast ductal system do fibroadenomas arise? |
Intralobular stroma. Has epithelial and stromal components. |
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At what age are fibroadenomas most common? |
Can get at any age, but peak in 2nd and 3rd decades |
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Describe macroscopic findings of Fibroadenomas. |
Often have multiple. Well circumscribed, solid, sometimes lobulated, Firm, pale, variably sized |
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Describe the microscopic findings of fibroadenomas. |
Proliferation of hypocellular stroma Uniform stromal cells Minimal to no mitotic activity rounded duct spaces: pericanalicular pattern Compressed duct spaces: Intracanalicular pattern Epithelial component can show the same abnormalities that can be present in normal breast i.e. hyperplasia, atypia |
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Where do Phyllodes tumors arise from? |
intralobular stroma |
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When are Phyllodes tumors most common? |
6th decade but can get any age |
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Describe the macroscopic features of Phyllodes tumor |
Small to massive (varying size) Tends to show bulbous protrusions Clefts="leaf-like" |
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Describe the microscopic features of Phyllodes tumor |
Stromal overgrowth +/- cleft-like spaces Increased cellularity of stroma Mitotic activity Stromal cell atypia Borderline and malignant tumours show increasing cellularity, atypia and mitotic activity High grade lesions look like sarcomas |
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Microscopic features of Malignant Phyllodes? |
Icreased cellularity, prominent cytologic pleiomorphism, brisk mitotic activity |
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How often do Phyllodes tumors metastasize? |
Majority are low grade and very rarely metastasize. High grade lesions are more likely to recur after treatment and up to 1/3rd will metastasize. |
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What is the treatment for Phyllodes tumor? |
Wide excision to avoid local recurrence |
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Phyllodes tumours and Fibroadenomas are examples of... |
Fibroepithelial lesions |
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What are the microscopic features of Epithelial Hyperplasia? |
Presence of more than two cell layers Disorganised 'jumbled' proliferation No cytological atypia Myoepitheial cells present |
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How does a Complex sclerosing lesion/radial scar present? |
Spiculated mass on mammography, mimicking cancer No previous trama Heterologous lesion |
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Comment on the malignant potential of a Complex Sclerosing Lesion. |
Usually benign however up to 20% can show DCIS |
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Microscopic features of Complex sclerosing lesion |
Central focus of scar-like hyalinised stroma, radiates outwards Entrapped benign ducts and foci of fibrocystic change, adenosis, papillomata
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How does Intraduct Papilloma present? |
When in larger ducts, usually a solitary lesion, and gives bloody nipple discharge In small ducts, usually multiple lesions |
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Describe the microscopic features of Intraduct Papilloma |
Dilated ducts expanded by a lesion of branching fibrovascular cores Cores lined by epithelial and myoepithelial cells Can show epithelial hyperplasia, atypia and in situ malignancy |
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Intraduct papilloma, Complex Sclerosing lesion and Epitthelial Hyperplasia are examples of... |
Benign Proliferative Lesions (though CSL and Intraduct Papilloma have malignant potential) |
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By age 90, what is the chance of a woman developing breast cancer |
1 in 8 |
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What is the general histological appearance of Carcinoma of the Breast? |
Well, urrm, its a very heterogenous disease, with a wide array of histologic appearances. I suppose it would have general signs of malignancy though |
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What are some risk factors of Ca Breast? |
Majority hoormonal and genetic Gender, Age (peak at 75-80), Age at Menarche (<11YO=20% increased risk), Age at first live birth, First degree relatives with Breast Ca, Atypical Hyperplasia, Ethnicity (higher in non-hispanic white women, African and Hispanic women have increased mortality), Oestrogen exposure, High breast density, Radiation, Ca Contralateral breast, diet (caffiene good, alcohol bad), Obesity, Breast feeding good |
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What genes are responsible for Hereditary Breast Ca? |
BRCA1 BRCA2. |
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What other Cas do BRCA 1 and 2 confer risk for? |
BRCA1 ovarian, BRCA2 some ovarian, Male Ca |
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Who do you conduct genetic testing on? |
those with strong family history |
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What are the other genetic characteisstics of BRCA1 associated Cas? |
Triple negative - no ER PR or HER2 expression |
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What is the most common Breast Malignancy? |
Adenocarcinoma |
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How is In situ Ca of the breast categorised? |
Lobular or ductal. Difference in Cell Biology, not site |
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Expression of what protein is lost in lobular neoplasia? |
e-cadherin |
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Describe Ductal Carcinoma In Situ |
Clonal population of cells limited by Basement membrane Myoepithelial cells preserved. Can form mass-like lesion |
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How are most DCIS detected? |
due to calcification |
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How does DCIS spread? |
through ducts, into lobules, over wide area |
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What are some microscopic features of Ductal CIS? |
Varied growth pattens (solid, cribriform, micropapillary, clinging), Nuclear Pleomorphism (low intermediate or high grade) High grade DCIS: Comedo necrosis DCIS spreading down ducts to nipple: Paget's disease |
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What is the treatment for DCIS? |
Surgical excision +/- radiotherapy. Mastectomy curative in 95% |
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What condition resembles DCIS |
Atypical Ductal Hyperplasia. Does not fulfill quantitative criteria |
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How is Lobular CIS found? |
Generally incidental, rarely associated with calcification, or masses |
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Describe LCIS |
Mre frequently bilateral than DCIS, cells identical to invasive lobular Ca, including loss of e-cadherin |
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Describe the microscopic features of LCIS |
Discohesive cells with rounded nuclei and small nucleoli LLow nuclear pleomorphism May show signet ring cells
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Compare and contrast LCIS and Atypical Lobular Hyperplasia |
LCIS: all acini in the lobule need to be involved and distended by abnormal cells ALH: Some but not all acini expanded or all acini show atypical cells but not distended |
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How does Invasive Breast Ca present? |
Sceening Palpable tumor.
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What are some other clinical findings in Inv BCa |
Skin tethering Nipple retraction Peau d'orange: dermal lymphatic invasion Palpable tumor associated with axillary lymph node mets in ~50% of patients Screen detected<20% have axillaryy nodal mets Loss of myoepithelial layer |
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Invasive Ductal Ca is the most common type of mammary Ca (75-80%). What are the 2 categories of infiltrating Ductal Ca? |
No Special Type (NST) or Not Otherwise Specified (NOS) |
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Describe the macroscopic features of Infiltrating Ductal Ca |
Pale, Irregular, Hard 'cirrhous' lesions |
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Describe the features of histologically Well Differentiated Infiltrating Ductal Ca |
Prominent tubule formation relatively uniform nuclear features Rare mitoses |
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Describe the features of histologically Poorly Differentiated Infiltrating Ductal Ca |
Grows as diffuse nests and sheets High grade pleiomorphic nuclei Mitoses and necrosis |
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How does invasive lobular Ca present? |
Mass or irregular mamogram density Can be too subtle for examination and imaging. Increased incidence of bilaterality |
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Where does invasive lobular Ca metastasize to? |
Peritoneum, meningitis, GIT, ovaries, uterus Can be mistaken for diffuse gastric ca |
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Describe microscopic features of Invasive Lobular Ca |
Disconhesive infiltrating tumour cells, oftenn single file or loose clusters/sheets No tubule formation Low grade nuclei Signet rings Minimal desmoplasia High grade= pleomorphc lobular Ca |
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Describe microscopic features of tubular Ca |
Small uncommon tumours Well formed angular tubules in a dense desmoplastic stroma (scar like background) |
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Describe some general features of tubular Ca |
<10% axillary mets Associated with LCIS and low grade DCIS Prognosis is great |
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Describe Mucinous Ca |
Older women, slow growing Ca Gelatinous appearance grossly Pushing borders Large lakes of mucin with small tumour cell islands Well to moderately differentiated Axillary LN met uncommon |
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Describe Metaplastic Ca |
Includes a variety of tissue types: SquamCC, spindle cell Ca Matrix producing (bone, cartilage) With or without a ductal adenoCa component Triple negative: ER, PR and Her2 neg Poor prognosis |
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Describe Medullary like Ca |
Soft circumscribed tumour mass, often rapidly growing Solid sheets with syncytial growth Prominent nuclear pleomorphism, ++mitoses Dense lymphoplasmacytic infiltrate Pushing border Triple negative Pure form rare. Has slightly better prognosis than IDC |
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What factors can be used to determine the prognosis of Breast Ca? |
LN status (most important), size of lesion, Grading (estimate of differentiation), subtype (special type better), Lymphovascular Invasion, Locally advanced disease, Hormone receptor/HER2 status |
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Describe the Gene Expression Profile of group Luminal A |
Characteristic profile of normal luminal cells. ER+ Her2-. Slow, responds to hormonal treatment |
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Describe the gene profile of Luminal B |
ER+ HER2+. Higher grade |
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Describe the gene profile of Basal-like Ca |
Triple negative Expresses basal keratiins BRCA1 Aggressive tumour |
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Describe the gene profile of Her2 positive Ca |
ER -, Her2 + Her2 overexpression and increase in cell signaling |
