Flashcards in 4dEndometrial conditionsBreast pathology Benign breast tumorsCommon breast conditionsMalignant breast tumors Deck (48):
An hour after giving birth, a woman develops abdominal pain, fever, and uterine tenderness. What is the likely causing her pain?
Endometritis (retained material [products of conception or a foreign body such as IUD] promotes infection from vagina or GI bacterial flora)
On laparoscopy, a woman with chronic pelvic pain has many lesions that appear like chocolate cysts in her ovaries. Does she have cancer?
Unlikely (chocolate cysts [endometriomas], classic for endometriosis, are caused by cyclic bleeding of ectopic endometrial tissue)
A woman has been unable to conceive for several years and has severe pain during periods and with sex. What diagnosis should you consider?
Endometriosis, which is nonneoplastic ectopic endometrial tissue (glands/stroma), most commonly found in the peritoneum, pelvis, or ovaries
What processes are thought to lead to the ectopic endometrial implantation in endometriosis?
Retrograde menstrual flow, transportation of endometrial tissue via the lymphatic system, metaplastic transformation of multipotent cells
A 35-year-old woman has dyschezia, dysmenorrhea, and dyspareunia. Her uterus is normal sized. How do you treat her?
Treat with OCPs, NSAIDs, GnRH agonists, progestins, danazol, laparoscopic removal (this is endometriosis)
Biopsy from a patient reveals extension of glandular endometrial tissue into the uterine myometrium. What is the diagnosis?
Adenomyosis, caused by hyperplasia of the endometrial basalis layer
A patient has dysmenorrhea and menorrhagia. She also has a soft, enlarged, and globular uterus. How do you treat her?
Treat with GnRH agonists or hysterectomy (this is likely adenomyosis)
Biopsy from a patient shows a collection of endometrial tissues that is well-circumscribed within the uterine wall. What is the diagnosis?
Polyp (may also contain smooth muscle cells)
Polyps can grow and extend into the ____.
What is the most common gynecologic malignancy?
A postmenopausal woman presents with vaginal bleeding. What two conditions should immediately come to mind?
Endometrial hyperplasia or the more worrisome endometrial carcinoma
Name four risk factors for endometrial hyperplasia.
Hormone replacement therapy, anovulatory cycles, granulosa cell tumors, and polycystic ovarian syndrome (think: increased estrogen exposure)
A young black woman presents with abnormal uterine bleeding. She has had several miscarriages. What benign neoplasm could be responsible?
Leiomyoma or fibroid (increased incidence in black women, most common tumor in women, and peak occurrence at 20–40 years of age)
Leiomyomas are sensitive to what hormone? What is the clinical significance?
Estrogen, meaning leiomyomas grow with pregnancy and shrink with menopause
A young woman has uterine bleeding and fatigues easily. She is anemic. Exam shows multiple uterine masses. What are you worried about?
Iron deficiency anemia secondary to severe bleeding from leiomyomas
A woman has had leiomyomas for many years. She wants screening, as she is worried about her leiomyomas progressing to cancer. Your reply?
There is no need to screen, as leiomyomas usually do not progress to cancer (specifically, leiomyosarcoma)
Name the most common location for each of the following: intraductal papilloma, fibrocystic change, lobular carcinoma, phyllodes tumor.
Intraductal papilloma = lactiferous sinus, fibrocystic change = major duct, lobular carcinoma = lobules, phyllodes tumor = stroma
Name the most common location for each of the following: breast abscess, tubular carcinoma, Paget disease, invasive ductal carcinoma.
Breast abscess = nipple/lactiferous sinus, tubular carcinoma = terminal duct, Paget disease = nipple, invasive ductal carcinoma = major duct
Name the most common location for each of the following: ductal carcinoma in situ (DCIS), fibroadenoma, mastitis.
DCIS = major duct. fibroadenoma = stroma, mastitis = lactiferous sinus
A woman complains of itchy breast skin and a bloody discharge from her nipples. What is the most commonly affected site?
What is the most common breast tumor among women younger than 35 years?
Fibroadenoma, a benign tumor
A 20-year-old woman has a small, mobile, firm breast mass with well-defined borders. What is the most likely etiology?
Fibroadenoma, the most common tumor in women younger than 35 years
A 24-year-old woman notes a breast mass that grows and is more tender during menstruation. Does she have breast cancer?
Unlikely (the age/description are consistent with a fibroadenoma from increased estrogen levels [e.g., pregnancy or prior to menstruation])
What neoplasm would be likely in a woman with serosanguineous discharge from her nipple but without a palpable breast mass?
Intraductal papilloma, a lactiferous duct tumor often seen below the areola that leads to a slightly increased risk for carcinoma (1.5–2×)
A large, bulky breast mass made up of connective tissue and cysts with leaf-like projections is taken from a 55-year-old woman. Prognosis?
Usually considered benign but may become malignant (this is a phyllodes tumor, most common in fifth decade)
Name four histologic types of proliferative breast disease.
Fibrosis, cystic, sclerosing adenosis, and epithelial hyperplasia
What diagnosis should you suspect in a woman who presents with a painless breast lump following trauma to her chest?
This is likely fat necrosis, a benign process that occurs after trauma (although up to 50% of patients may not recall an injury)
Name five non-drug-related conditions that can cause gynecomastia due to hyperestrogenism in males.
Puberty, old age, testicular tumors, cirrhotic liver disease, and Klinefelter syndrome
A male patient presents with abnormally enlarged breasts. What is this finding called, and which drugs could cause this?
Gynecomastia; Spironolactone, Digoxin, Cimetidine, Alcohol, Ketoconazole ("Some Drugs Create Awesome Knockers")
A woman has multiple painful breast masses bilaterally that fluctuate in size during her menstrual cycle. What is the likely diagnosis?
Proliferative breast disease (most common cause of breast lumps in women between age 25 years & menopause, usually no increased cancer risk)
How does the fibrosis type of proliferative breast disease appear on histopathology?
Hyperplasia of the breast stroma
What is the gross and histologic appearance of cystic-type proliferative breast disease?
Gross = fluid-filled blue-dome cysts, histology = ductal dilation
Which form of proliferative breast disease increases the risk of breast carcinoma? What is its histologic appearance?
Epithelial hyperplasia with atypical cells; increased number of epithelial cell layers in terminal duct lobule (seen in women >30 years old)
Which type of proliferative breast disease has increased acini and intralobular fibrosis on histopathology? Calcifications can be seen.
Sclerosing adenosis (often confused with cancer, associated with an increased risk [1.–2×] of developing cancer)
A breastfeeding woman has nipple tenderness, redness, and drainage. S. aureus is isolated in the fluid. Should she continue breastfeeding?
Yes (this is lactational mastitis)
A woman who is breastfeeding presents with an infection arising from cracks in her nipple. How would you treat her?
Treat with dicloxacillin and continued breast-feeding (this is lactational mastitis)
A woman has a painless lump on her breast. Biopsy shows necrotic fat and giant cells. Mammography shows abnormal calcifications. Diagnosis?
Fat necrosis, which usually results from injury to breast tissue, but up to 50% may not report trauma
A male infant is born and you find he has slightly enlarged breasts bilaterally. What do you do?
Nothing, as this is normal (physiologic) and will resolve with time (gynecomastia is also normal at puberty and old age)
Malignant breast tumors most commonly arise from which part of the breast tissue? When do they most commonly arise?
Terminal duct lobular unit; the commonly arise postmenopausal
Which cellular markers that affect both treatment and prognosis should you test for in a patient with a new diagnosis of breast cancer?
Hormone receptor expression (estrogen, progesterone receptors) and c-erbB2 (HER-2, an epidermal growth factor receptor)
A woman has a malignant breast tumor that is negative for ER, PR, Her2/Neu. This correlates with ____ (more/less) aggressive disease.
More (a triple negative genotype is more aggressive)
A woman is found to have Paget disease on her vulva. What do you tell her about her cancer risk?
You may reassure her (extramammary Paget disease does not suggest underlying malignancy)
What is the single most important prognostic factor in malignant breast cancer? Where are malignant breast cancers most often located?
Axillary lymph node involvement; upper outer quadrant of breast
Name five factors for breast malignancies.
Increased estrogen exposure, obesity, increased total number of menstrual cycles, older age at first live birth, BRCA1 & BRCA2 mutations
Why is obesity a risk factor for breast cancer?
Androstenedione is converted to estrone in adipose tissue, which serves as a major source of estrogen in postmenopausal women
A patient is diagnosed with an invasive ductal carcinoma. What type of infiltration pattern is seen grossly on pathologic analysis?
A "stellate" pattern
An African-American woman was diagnosed with a malignant breast tumor. Risk of which breast cancer genotype is increased for her background?
Tumors that are negative for estrogen receptors, progesterone receptors, and Her2/Neu (triple negative) are more likely to occur