Breast

Question 1

What are the most important breast diseases in various age groups?

Answer 1

15-35: fibroadenoma

25-55: fibrocystic changes

> 45: breast cancer

Question 2

What is acute mastitis, and when does it usually occur?

Answer 2

Typically occurs during lactation. It may present at diffuse swelling, multiple nodules, or large abcess.

staph and strep

Question 3

How do hormones affect breasts in women and men?

Answer 3

Epithelial cells lining the ducts and acini, and intralobular connective tissue respond to sex hormones.

Lack of estrogen >> atrophy

Enlarge during puberty

Question 4

What is gynecomastia?

Answer 4

Usually occurs due to excess estrogens

Question 5

How common is fibrocystic change of the breast and how does it present clinically?

Answer 5

Affects 50% of women

Affects 10-15% clinically

*Usually affects both breasts, may have one-sided pain, nodularity, sensitivity. *

Question 6

What are the pathologic features of fibrocystic breast change?

Answer 6

Fibrosis: loose intralobular connective tissue is replaced by dense connective tissu, rich in collagen but unresponsive to hormones.

Dilated ducts: entrapped in connective tissue strands and form cysts >> interruption of blood supply >> degenerative changes, necrosis, calcification

Proliferative breast disease: epithelium proliferates >> sclerosis adenosis

Question 7

What is fibroadenoma, and how does it present clinically?

Answer 7

Most common benign tumor

• 2-5 cm
• encapsulated, round, lobulated
• 2 components: fibrous stroma and glandular epithelium

Question 8

What are the risk factors for breast cancer?

Answer 8

• Female
• >45
• Whites (esp jews)
• Mother/sister with breast cancer
• early menarch
• late menopause
• no children
• late age at 1st pregnancy

Question 9

What is the most common microscopic type of breast cancer?

Answer 9

80% are invasive ductal carcinoma
Most occur in the upper lateral quadrant

Macro: tumor appears grayish white because of abundance of CT between tumor cells

Micro: strands of cancer cells surrounded by abundant collagenous connective tissue

Question 10

Correlate the macroscopic and microsocopic pathology of infiltrating duct carcinoma.

Answer 10

Form a strong desmoplastic reaction = dense connective tissue

Question 11

How does breast cancer metastasize?

Answer 11

Via lymphatics

most = axillary area

Common distant sites = lungs, liver, bones, brain, adrenals

Question 12

How is breast cancer usually diagnosed?

Answer 12

Mammography = noninvasive, painless procedure with x-ray. FNA requires local anesthesia. Surgical biopsy is performed in OR under general anesthesia.

Question 13

What are the diagnosis and survival rates of breast carcnoma diagnosed in various clinical stages of the disease?

Answer 13

Stage 0: 92%

Stage I: 87%

Stage II: 75%

Stage III: 45%

Stage IV: 13%