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LC 02 > Normal breast and Benign disease > Flashcards

Normal breast and Benign disease Flashcards

1
Q

Where does the majority of the breast cancer spread to?

Where do cancers that arise on the medial aspect of the breast spread to?

A

Axillary node

Mediastinal LNs

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2
Q

functional unit of the breast

- what does it branch into?

A

terminal duct unit (smallest branch)

  • stops branching into more ducts, but ends up in a cluster of small tubules (acini) and becomes the terminal duct lobular unit
  • area where most of the changes occur that can malignant or premalignant
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3
Q

What area of the breast does the majority of malignant or premalignant changes occur?

A

Terminal duct lobular unit

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4
Q

The entire ductal system is lined by?

A

Two cell layers

  1. Outer: myoepithelial layer - contractile properties important in propelling milk in lumen, and supports inner layer
    - in case of malignancy, myoepithelial layer is lost
  2. Inner: epithelial layer - production of milk - single cuboidal epithelium
  • any change in two cell layer is pathological
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5
Q

Difference between stroma lining the terminal duct lobular unit and the stroma between the lobules

A 
INTRAlobular stroma:
specialized stroma (also fibrous) that is hormone responsive

INTERlobular stroma:
regular fibrous tissue liek any where else in body

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6
Q

Diff between male and female breast?

A

Same until puberty

  • then females develop lobules (+ TDLU)
  • both have ducts and stroma
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7
Q

At puberty, what stimulates the lobules to grow?

A

E + P

- formation of actual lobules occur

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8
Q

During the menstrual cycle, what happens to breast development?

A

Increased size/nodularity of lobules

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9
Q

What happens to breasts during pregnancy?

A

Maximum stimulation with hormones:
1. epithelial vacuolization
- LOTS more acini
Entire lobule increases in size

  1. secretion in lumina
    - Epithelial cells start increasing milk prod.
    - Continues to be in this state during lactation and regresses when finished
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10
Q

What happens to breast tissue during menopause?

A

Involution of TDLUs
Duct system remains
Decrease in interlobular stroma
More fatty tissue comes in

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11
Q

Sites of ectopic breast tissue

A

Usually along midline (during development of fetus)

- most prominant is in the axilla

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12
Q

Juvenile hypertrophy

A

doesnt stay in nl range

- results in really large breasts –> discomfort

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13
Q

In gynecomastia, what proliferates?

A

mostly the stroma

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14
Q

Inflammatory lesions

A
  1. acute mastitis
  2. chronic mastitis
  3. periductal mastitis
  4. fat necrosis
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15
Q

Acute mastitis

A

young female - common in lactating breast

Cracked or inflammed nipple allows entry of staph and grows in milk in ducts
–> neutrophils come in –>
abscess forms

  • can resemble cancer
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16
Q

Chronic mastitis

A 
Perimenopausal women
Nonbacterial inflammation due to duct obstruction
-->
Dilation of duct (duct ectasia)
PLasma cell mastitis
Granulomatous mastitis
Healing by fibrosis
17
Q

Periductal mastitis

aka recurrent subareolar abscess, squamous metaplasia of lactiferous ducts, Zuska disease

A

recurrent subareolar abcess

Painful erythematous subareolar mass

  • 90% are smokers
  • instead of having the double layered cuboidal epithelium, the outer squamous cells advance into the ducts
18
Q

Fat necrosis

  • Benign or malignant?
  • Cause?
  • Microscopic
A

Benign
Caused by ischemia or trauma
Ill defined palpable mass - mimics carcinoma

Microscopic:

early: necrotic fat cells, neutrophils
later: macrophages, glycoproteins, fibrosis Ca2+

19
Q

Benign neoplasms o the breast

A
  1. Fibroadenoma (most common
  2. Lactating adenoma
  3. Phyllodes tumor
  4. (Intraductal) Papillloma
20
Q

Fibroadenoma

A

derived from TDLU

  • very well circumscribed
  • mobile
  • terminal ducts become squished by fibrous tissue
  • NOT proliferating
21
Q

Lactating adenoma

A

presents in pregnancy or lactation
- assoc. w/ rapid increase in size during pregnancy

soft circumscribed mass

Small tubular structure with lactational changes

22
Q

Phyllodes tumor

A

large fleshy tumors
“leaflike projections” into cystic spaces
Spectrum: benign –> high grade

Most common in 5th decade
- some can become malignant

23
Q

Which if the benign breast tumors can become malignant?

A

Phyllodes tumor

24
Q

Intraductal papilloma

A

benign, 1 cm, subareolar (beneath areola) - papillary mass in large duct

Bloody nipple discharge (rule out carcinoma)

25
Q

Fibrocystic change

  • Cause
  • Menopause FX
  • Painful?
  • Premalignant?
  • Types
A

Idiopathic,

Most common disorder/change in breasts

Decreases progressively after menopause.

Asymptomatic, pain, nodularity
Can be innocuous to pre-malignant
can have:
1. cysts
2. ductal hyperplasia
3. apocrine metaplasia
(NO CHRONIC MASTITIS)
26
Q

3 types of fibrocystic change

A
  1. Nonproliferative FCC
    - cyst/fibrosis
    - epith hyperplasia ABSENT
  2. Proliferative FCC
    - cyst/fibrosis
    - epith hyperplasia present
  3. Sclerosing adenosis
    - marked fibrosis –> compress/distorts lumens of acini/ducts
    - hard rubbery like Ca
27
Q

Two types of proliferative fibrocystic disease (has epithelial hyperplasia)

A
  1. lobular hyperplasia (acinar epithelium)
    - atypical lobular hyperplasia
    - LCIS (lobular Ca in situ)
  2. Ductal hyperplasia (terminal duct)
    - Usual hyperplasia
    - atypical ductal hyperplasia
    - DCIS (Ductal Ca in situ)
28
Q

Lobular carcinoma in situ (LCIS)

A

increased risk of breast cancer on both sides

- both lobular and ductal carcinoma

29
Q

Breast pathology with minimal/no risk of breast carcinoma

A
  1. Fibroadenoma W/O complex feat
  2. cysts
  3. duct ectasia
  4. apocrine metaplasia
  5. mild hyperplasia
30
Q

Breast pathology with slight risk of breast carcinoma (1.5-2x)

A
  1. Fibroadenoma WITH complex feature
  2. (Intraductal) papilloma
  3. Sclerosing adenosis
  4. Moderate–florid Epithelial Hyperplasia
31
Q

Breast pathology with moderate risk of breast carcinoma (4-5x)

A

Atypical hyperplasia

  1. ALH (atypical lobular hyperplasia )
  2. ADH (atypical ductal hyperplasia)
32
Q

Breast pathology with significant risk of breast carcinoma (8-10x)

A
  1. DCIS
    - risk of invasive ductal ca
  2. LCIS
    - risk of both ductal and lobular ca

*risk is equal for both breasts and risk may be either ductal or lobular

33
Q

Terminal duct lobular unit can result in?

A

Where majority of more sig changes occur

  1. Cyst
  2. Sclerosing adenosis
  3. Small duct (intraductal) papilloma
  4. Hyperplasia
  5. Atypical hyperplasia
  6. Carcinoma
34
Q

Lobular stroma can give rise to?

A
  1. fibroadenoma

2. phyllodes tumor

35
Q

Bloody nipple discharge is associated with which? Carcinoma or papilloma?

A

Either carcinoma or papilloma

36
Q

Most common benign neoplasm of the breast

A

fibroadenoma

37
Q

Fluid filled, blue domed- cyst arise from which area of the breasst?

A

Cysts (proliferative breast disease/FCC)

Arise in TDLU

38
Q

How is sclerosing adenosis assoc with breast cancer?

A

It may be mistaken for cancer!

Almost always assoc with fibrocystic change

Diffuse microcalcification

Proliferated ductules may be compressed and deformed producing whorls and cords that mimic infiltrating carcinoma

39
Q

Lobular hyperplasia has 2 types:
1. Atypical lobular hyperplasia (ALH)
2. Lobular carcinoma in situ (LCIS)
How are they different?

A

Both are assoc with increase in # of cells in lobules (acinar epithelium)

  1. Atypical lobular hyperplasia (ALH)
    - 50% of lobules are filled and distended with epi cell proliferation

LC 02 (15 decks)

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