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Flashcards in 3 Benign breast disease Deck (49):
1

What does fibrocystic change of the breast mean?

Describes fibrosis and cysts with reactive and degenerative changes that occur in the breast of older women

2

What is Atypical Epithelial Hyperplasia?

When epithelial hyperplasia becomes multilayered, with atypical nuclear change

3

What is the most common inflammatory disease of the breast? What is it is caused by?

Acute mastitis.
Caused by purulent bacteria such as Staph and Strept

4

How does bacteria invade the breast in acute mastitis?

Thru the dilated milk ducts and thru skin lacerations or injuries during suckling

5

How does stagnant milk affect acute mastitis?

Provides growth medium for the bacteria

6

Which inflammatory cells infiltrate the entire edematous breast in acute mastitis?

PMNs

7

What is the cause of chronic mastitis?

It is unknown

8

What can chronic mastitis mimic b/c it produces small lumps?

Cancer, so a biopsy is needed to rule out

9

When extensive necrosis occurs from acute mastitis, what tissue may replace the destroyed breast tissue?

Fibrous scar tissue, nipple may retract and can be mistaken for carcinoma of the breast

10

What is fat necrosis of the breast?

Grossly, there is hemorrhage with central fat necrosis which later forms a nodule of gray-white tissue with foci of chalk-white debris

11

Where does fat necrosis of the breast occur?

Tends to occur in one breast as a solitary, sharply localized process in one breast. Almost all patients give a prior history of trauma, prior surgical intervention, or radiation therapy

12

What is a Fibrocystic change of the breast?

Fibrosis and cysts with reactive and degenerative changes that occur in the breast of older women

13

What does Fibrocystic change of the breast produce?

Palpable lumps in the breast substance, and histologic signs are found in approximately 50% of all women whose breasts are examined in autopsy or biopsy

14

When does Fibrocystic change of the breast occur?

Does not occur before puberty, and is unusual to be diagnosed with a clinical onset in postmenopausal women

15

What percentage of women b/w 20-50 years of age have symptoms pertaining to Fibrocystic change of the breast?

Only 10-15% have symptoms it is estimated

16

T/F Women who have symptoms related to Fibrocystic change of the breast show improvement after menopause

T

17

What hormones are related to the pathogenesis of Fibrocystic change of the breast?

Sex hormones - estrogen, progesterone, which stimulate the proliferation of cells in the excretory ducts of the breast and the intralobular stroma

18

What is the etiology of Fibrocystic change of the breast?

Imbalances in estrogen/progestrone that produce changes not only in the ducts and lobules but also in the stroma

19

What are some of the changes included in Fibrocystic change of the breast?

Dense fibrosis, cystic dilation of ducts, and various ductal proliferative changes

20

What is the most common feature of Fibrocystic change of the breast?

Fibrosis

21

What is the normal loose intralobular CT replaced with in Fibrocystic change of the breast?

Dense CT rich in collagen, but unresponsive to hormones

22

Why does the ductal epithelium continue to proliferate in Fibrocystic change of the breast?

B/c it retains its responsiveness to hormones

23

How may cysts form in Fibrocystic change of the breast?

The dilated ducts may become entrapped in the dense ct stroma, leading to formation of cysts

24

What are the most common alterations in Fibrocystic change of the breast? Besides this, what is also always present?

Formation of Blue-Domed cysts.
Epithelial hyperplasia is always present

25

What is the term for epithelial hyperplasia that becomes multilayered in Fibrocystic change of the breast?

Atypical epithelial hyperplasia

26

What is the only change related to the development of carcinoma in Fibrocystic change of the breast?

evidence of Atypical epithelial hyperplasia

27

What indicates a greater risk of developing carcinoma in Fibrocystic change of the breast? Are any other changes associated with increased risk for carcinoma?

The more severe and atypical the hyperplasia, the greater the risk. All other changes are NOT associated

28

T/F Clinically, fibrocystic changes usually affect both breasts, and b/c the changes are symmetrical, pts may complain mostly of pain, nodularity, and sensitivity on palpation

T

29

What does the fluctuation of small lumps correspond to in Fibrocystic change of the breast?

They would correspond to the fluid filled cysts and are easily palpatable

30

What may mammography reveal in Fibrocystic change of the breast? What is the surest way to establish diagnosis and why?

Condensed areas, cysts, and even areas of calcification.
Calcifications are indistinguishable from those seen in cancer and biopsy is the surest way to establish a definitive diagnosis

31

Does typical fibrocystic change require treatment in Fibrocystic change of the breast?

Not unless premalignant changes from atypical epithelial hyperplasia are found, if found then additional surgical resection is recommended

32

What do most surgeons perform in Fibrocystic change of the breast? What is the prognosis?

An extended lumpectomy - remove the indurated glandular part of the breast parenchyma. Excellent overall

33

What is the most common of benign tumors of the breast?

Fibroadenomas

34

What are the typical characteristics of fibroadenomas?

Typically measure 2-5 cm in diameter.
Well incapsulated spherical nodules, usually well-circumscribed from the breast parenchyma and are freely moveable from the surrounding breast substance

35

What two components make up fibroadenomas?

Fibrous stroma and glandular epithelium

36

What does the fibroblastic component of fibroadenomas resemble?

Normal intralobular stroma enclosing glandular and cystic spaces lined by epithelium

37

Where do fibroadenomas most commonly occur? What demographic?

Most commonly occur in the upper outer quadrant.
In young women

38

T/F Adenomas are well-encapsulated, gray-white tumors that are easily removed w/o consequences

T

39

Do adenomas recur or undergo malignant change?

No, they have an excellent prognosis

40

What is intraductal papilloma?

A neoplastic papillary growth w/in a duct

41

Where are most intraductal papillomas found?

Most are solitary and found w/in the principle lactiferous ducts or sinuses.

42

What is the clinical presentation of intraductal papilloma?

Serous or bloody discharge from the nipple, a small sub-areolar mass and rarely nipple retraction

43

What would be performed to avoid local recurrence of intraductal papilloma?

Complete excision

44

What are multiple papillomas associated with?

Increased risk of papillary carcinomas. Solitary ones are benign.

45

What is gynecomastia?

Male breast enlargement associated with hormonal changes in puberty.

46

What is gynecomastia secondary to?

inordinte proliferation of the excretory ducts and the surrounding CT.

47

What is an additional reason for gynecomastia in adulthood?

Excess estrogens, as from cirrhosis or tumors

48

What does gynecomastia present as clinically?

Fibrous cap of tissue directly under the areolar area

49

What is the likelihood of gynecomastia becoming a carcinoma in males compared to females?

100 times less likely in males than females, are ductal in origin and invades more rapidly