Breast Pathology

• What is a carcinoma?

  Malignant tumour of epithelial origin
• What is a sarcoma?

  Malignant tumour arising from mesenchymal tissue
• What is a lymphoma?

  Malignancy arising from lymphoid tissue
• What is leukaemia?

  Malignancy arising from haematopoietic cells
• What is malignant myeloma?

  Malignant tumour of melanocyte origin
• What is the difference between a diagnostic & excision biopsy?

  Diagnostic

  • try to establish diagnosis
  • e.g. needle core biopsy, punch biopsy

  Excision

  • excise area of abnormality with clear margins
• What is the normal histology of the breast?

  Lobule = grape-like cluster of acini

  Lobules connect into ducts

  Luminal epithelial cells -> overlie myoepithelial cells on basement membrane

  
• Fill in the blanks

  A) Lobule

  B) Duct

  C) Interlobular stroma

  D) Intralobular stroma

  E) Acinus

  F) Basement membrane

  G) Myoepithelial cells

  H) Luminal epithelial cells

  I) Lumen

  J) eosinophilic

  
• Fill in the blanks

  A) Nipple

  B) Normal lobule

  C) Normal

  D) Epithelial hyperplasia

  E) Papilloma

  F) Fibroadenoma

  G) Hemangioma

  H) Benign

  I) Ductal carcinoma in situ

  J) Invasive carcinoma

  K) Phyllodes tumour

  L) Angiosarcoma

  M) Malignant

  
• What is a breast abscess?

  Infection -> usually acquired during breast feeding

  Common pathogen = staph aureus

  Treatment = Abx, continued expression of milk

  Rare treatment = incision & drainage
• What is fibrocystic disease?

  Most common benign breast disease (not associated with increased risk of malignancy)

  Common in ages 30-50

  Benign cysts -> typically mobile & rubbery on examination

  Fibrocystic changes are prone to hormonal alteration
• What is fibroadenoma?

  Most common benign tumour of the female breast

  Well-circumscribed & unencapsulated

  Biphasic tumour -> proliferation of glandular & stromal elements

  Median age = 25 yrs (can occur at any age)

  Management -> depends on pt RFs & pt preference -> conservative (follow up), local surgical excision

  NO risk of malignancy
• 1 in 7 women in the UK develop breast cancer during their lifetime.
• What are the RFs of breast carcinoma?

  Increasing age

  FHx (multiple 1st degree relatives, BRCA 1 & 2)

  Early age at menarche

  No children/pregnancies

  Absence of breast feeding

  Europe & North America (more prevalence)
• What does in situ mean (in breast malignancy)?

  Neoplastic proliferative limited to ducts & lobules by basement membrane

  Can become invasive carcinoma
• What is invasive carcinoma?

  Carcinoma penetrated the basement membrane into the stroma (potential for lymphovascular invasion & metastatic spread)
• What are the differences between ductal & lobular carcinoma in situ?

  Ductal

  • in ducts
  • express E-cadherin

  Lobular

  • in lobules
  • loss of E-cadherin expression
• What is the most common invasive breast carcinoma?

  Invasive ductal carcinoma (70-80%)
• What happens if invasive carcinoma is central in the breast?

  Nipple retraction
• What happens if lymphatics are involved/blocked in breast invasive carcinoma?

  Peau d'orange
• What is adenocarcinoma?

  Gland forming/mucin forming tumour
• What does invasive carcinoma look like on a mammogram?

  Radiodense mass

  
• What are the current available treatments for breast cancer?

  Surgery

  • mastectomy
  • wide local excision
  • sentinel node biopsy

  Radiotherapy

  Chemotherapy

  • endocrine therapy (oestrogen antagonists, Tamoxifen)
  • tissue-targeted therapy (Trastuzumab)
• Breast cancer screening

  Women 50-70

  Every 3 yrs

  Mammogram
• How is breast cancer histologically graded?

  Bloom Richardson System

  • Tubule formation (1-3)
  • Nuclear pleomorphism (1-3)
  • Mitotic activity (1-3)

  3-5 Grade 1 (well differentiated)

  6-7 Grade 2 (moderately differentiated)

  8-9 Grade 3 (poorly differentiated)
• What is the treatment for hormonal receptor positive breast cancer?

  Anti-oestrogen therapy

  E.g. Tamoxifen
• What is the treatment for HER2 positive breast cancer?

  Herceptin (Trastuzumab)