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USMLE Pathoma > Block 3 Breast > Flashcards

Block 3 Breast Flashcards

1
Q

What is acute mastitis?

A

Bacterial infection of the breast by S. aureus. It is associated with feeding, which causes fissures in the nipple giving bacteria a route to cause infection

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2
Q

Bacterial infection of the breast by S. aureus. It is associated with feeding, which causes fissures in the nipple giving bacteria a route to cause infection

It presents as:
1) Erythematous breast with nipple discharge

Complication:
It can progress to form an abscess

Rx: Continue to drain (feedings) & antibiotics (dicloxacillin)

A

acute mastitis

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3
Q

Acute infection of the breast with gram +ve cocci, causing erythematous breast tissue & nipple discharge

A

acute mastitis

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4
Q

What is periductal mastitis?

A

It is inflammation of the subareolar ducts. It is usually seen in smokers due to them having a relative vitamin A deficiency which causes metaplasia in the lactiferous ducts resulting in blockage & inflammation

Presents with:
1) A subareolar mass with nipple retraction

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5
Q

It is inflammation of the subareolar ducts. It is usually seen in smokers due to them having a relative vitamin A deficiency which causes metaplasia in the lactiferous ducts resulting in blockage & inflammation

Presents with:
1) A subareolar mass with nipple retraction

A

periductal mastitis

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6
Q

1) A subareolar mass with nipple retraction, involves metaplasia of squamous cells lining the lactiferous ducts

A

periductal mastitis

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7
Q

What is mammary duct ectasia?

A

Rare inflammation with dilation (ectasia) of the subareolar ducts that is seen in multiparous postmenopausal women

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8
Q

Rare inflammation with dilation (ectasia) of the subareolar ducts that is seen in multiparous postmenopausal women

It presents as a:
1) Peri areolar mass with green/brown nipple discharge

Biopsy shows:
Chronic inflammation with plasma cells

A

mammary duct ectasia

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9
Q

A postmenopausal woman with a brownish peri areolar mass with nipple discharge

A

mammary duct ectasia

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10
Q

What is fat necrosis of the breast?

A

It is usually caused by trauma (needle biopsy etc) that presents as a mass on physical exam & abnormal calcification on mammography

Biopsy reveals:
Necrotic fat that is associated with calcification & giant cells

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11
Q

It is usually caused by trauma (needle biopsy etc) that presents as a mass on physical exam & abnormal calcification on mammography

Biopsy reveals:
Necrotic fat that is associated with calcification & giant cells

A

fat necrosis of the breast

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12
Q

Biopsy reveals:
Necrotic fat that is associated with calcification & giant cells

A

fat necrosis of the breast

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13
Q

What is fibrocystic change of the breast?

A

The development of fibrosis & cysts in the upper & outer quadrant of the breast that give it a lump bumpy texture. It usually occurs in premenopausal women & tends to be benign, though certain fibrotic changes are associated with invasive carcinoma

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14
Q

The development of fibrosis & cysts in the upper & outer quadrant of the breast that give it a lump bumpy texture. It usually occurs in premenopausal women & tends to be benign, though certain fibrotic changes are associated with invasive carcinoma

A

fibrocystic change of the breast

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15
Q

Which types of fibrocystic changes of the breast are NOT associated with invasive carcinoma

A

Fibrosis, Cysts, & Apocrine metaplasia

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16
Q

Which types of fibrocystic changes of the breast are associated with twice the risk of developing invasive carcinoma?

A

Ductal hyperplasia & sclerosing adenosis

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17
Q

Ductal hyperplasia & sclerosing adenosis are all fibrocystic changes of the breast that are associated with what?

A

twice the risk of developing invasive carcinoma

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18
Q

Which types of fibrocystic changes of the breast are associated with five times the risk of developing invasive carcinoma?

A

Atypical hyperplasia

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19
Q

Atypical hyperplasia is a fibrocystic change of the breast that are associated with what?

A

five times the risk of developing invasive carcinoma

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20
Q

What is an Intraductal papilloma?

A

It is papillary growth in the large ducts.

It presents as:
1) A bloody nipple discharge in premenopausal women

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21
Q

It is papillary growth in the large ducts.

It presents as:
1) A bloody nipple discharge in premenopausal women

A

Intraductal papilloma

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22
Q

What is a papillary carcinoma?

A

It is fibrovascular projections lined with epithelial cells without any underlying myoepithelium.

It presents as:
1) bloody nipple discharge

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23
Q

It is fibrovascular projections lined with epithelial cells without any underlying myoepithelium.

It presents as:
1) bloody nipple discharge

Complication:
It has a risk of progressing to papillary carcinoma

A

papillary carcinoma

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24
Q

What is a fibroadenoma?

A

The most common benign breast tumor that is made of fibrous tissue & glands. It is usually seen in premenopausal as a well circumscribed mobile marble-like mass. It is estrogen sensitive so it grows during pregnancy & can be painful during menstruation

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25
Q

The most common benign breast tumor that is made of fibrous tissue & glands.

It is usually seen in premenopausal as a well circumscribed mobile marble-like mass.

It is estrogen sensitive so it grows during pregnancy & can be painful during menstruation

A

fibroadenoma

26
Q

a well circumscribed mobile marble-like mass that is benign & sensitive to estrogen

A

fibroadenoma

27
Q

What is a phyllodes tumor?

A

A tumor that resembles a fibroadenoma except there is overgrowth of the fibrous component, with leaf-like projections giving it the potential to be malignant. It is usually seen in postmenopausal women.

28
Q

A tumor that resembles a fibroadenoma except there is overgrowth of the fibrous component. It is usually seen in postmenopausal women.

Biopsy shows:
Lead-like projections

Complication is that it can be malignant

A

phyllodes tumor

29
Q

Fibrous tumor with leaf-like projections in a postmenopausal woman, it may be malignant

A

Phyllodes tumor

30
Q

What is Ductal Carcinoma In Situ?

A

A malignant proliferation of ductal cells that does NOT invade the basement membrane. It can be seen as calcification on mammography (not a mass) & it can be a Comedo type or Paget’s disease associated with DCIS

31
Q

A malignant proliferation of ductal cells that does NOT invade the basement membrane. It can be seen as calcification on mammography (not a mass).

Subtypes:

1) Comedo type
Has high-grade cells with necrosis & dystrophic calcification in the center of ducts

2) Paget’s ass
The cancer extends upwards into the ducts & involves the nipple skin, presenting as nipple erythema & ulceration

A

Ductal Carcinoma In Situ

32
Q

What is Paget’s disease that is associated with Ductal Cell In Situ?

A

The DCIS extends upwards into the ducts & involves the nipple skin, presenting as nipple erythema & ulceration.

33
Q

What is Comedo subtype of Ductal Cell In Situ?

A

A cancer of the breast with high-grade cells with necrosis & dystrophic calcification in the center of ducts

34
Q

What is Invasive Ductal Carcinoma?

A

The most common type of invasive breast cancer. It classically forms duct-like structure in the breast

35
Q

The most common type of invasive breast cancer. It classically forms duct-like structure in the breast

It presents as:
1) A mass 2/+cm on clinical exam
2) A mass 1/+cm on mammography
3) Skin dimpling & Nipple retraction in advanced stages

Biopsy shows:
Duct-like structures in desmoplastic stroma

Sub types include:
1) Tubular carcinoma
2) Mucinous carcinoma
3) Medullary carcinoma
4) Inflammatory carcinoma

A

Invasive Ductal Carcinoma

36
Q

What is Tubular carcinoma?

A

A subtype of invasive breast carcinoma that presents as well differentiated tubules that lack myoepithelial cells

It has a good prognosis

37
Q

A subtype of invasive breast carcinoma that presents as well differentiated tubules that lack myoepithelial cells

It has a good prognosis

A

Tubular carcinoma

38
Q

What is Mucinous carcinoma?

A

A subtype of invasive breast carcinoma that presents as an abundance of extracellular mucin “tumor in a pool of mucus app” It is usually seen in older women (~70yrs)

It has a good prognosis

39
Q

A subtype of invasive breast carcinoma that presents as an abundance of extracellular mucin “tumor in a pool of mucus app” It is usually seen in older women (~70yrs)

It has a good prognosis

A

Mucinous carcinoma

40
Q

What is a Medullary carcinoma?

A

A subtype of invasive breast carcinoma that presents as large high-grade cells that grow in sheets. It is associated with lymphocytes & plasma cells & people who carry the BRCA1 gene are at higher risk

Biopsy shows:
A well circumscribed mass that can mimic an fibroadenoma on mammography

It has a good prognosis

41
Q

A subtype of invasive breast carcinoma that presents as large high-grade cells that grow in sheets. It is associated with lymphocytes & plasma cells & people who carry the BRCA1 gene are at higher risk

Biopsy shows:
A well circumscribed mass that can mimic an fibroadenoma on mammography

It has a good prognosis

A

Medullary carcinoma

42
Q

What is an inflammatory carcinoma?

A

A carcinoma in the dermal lymphatics that causes blockages. This causes it to classically present as an inflamed & swollen breast with NO discrete mass

It has a poor prognosis

43
Q

A carcinoma in the dermal lymphatics that causes blockages. This causes it to classically present as an inflamed & swollen breast with NO discrete mass

It has a poor prognosis

A

inflammatory carcinoma

44
Q

What is Lobular Carcinoma In Situ (LCIS)?

A

Malignant proliferation of cells in the lobules that do NOT invade the basement membrane. There is NO mass or calcification, instead it is multifocal & bilateral & can be identifies via biopsy

45
Q

Malignant proliferation of cells in the lobules that do NOT invade the basement membrane. There is NO mass or calcification, instead it is multifocal & bilateral & can be identifies via biopsy

Biopsy shows:
1) Dyscohesive cells that LACK E-cadherin adhesion proteins

Rx. Tamoxifen & follow up

Complication a low risk of progressing to invasive carcinoma

A

Lobular Carcinoma In Situ (LCIS)

46
Q

Biopsy shows:
1) Dyscohesive cells that LACK E-cadherin adhesion proteins

A

Lobular Carcinoma In Situ (LCIS)

47
Q

What are the biopsy findings you would expect to seen in a patient with Lobular Carcinoma In Situ (LCIS)?

A

Biopsy shows:
1) Dyscohesive cells that LACK E-cadherin adhesion protein

48
Q

What is Invasive Lobular Carcinoma of the breast?

A

An invasive carcinoma that grows in a single-file pattern. It’s cells exhibit signet ring morphology & it CANNOT form ducts because it’s cells lack E-Cadherin

49
Q

An invasive carcinoma that grows in a single-file pattern. It’s cells exhibit signet ring morphology & it CANNOT form ducts because it’s cells lack E-Cadherin

A

Invasive Lobular Carcinoma of the breast

50
Q

For TNM staging of breast cancer spread to which LN is most useful as a prognostic factor & how do you assess it?

A

Axillary LN is best to determine the prognosis of breast cancer, to assess it you need to biopsy the sentinel LN

51
Q

Estrogen & progesterone receptor +ve breast cancers response to which type of therapy?

A

Antiestrogen agents (nucleus) like Tamoxifen

52
Q

HER2/neu receptor +ve breast cancers response to which type of therapy?

A

Antibodies against HER2 receptors (cell surface) like Trastuzumab (Herceptin)

53
Q

What does having a triple -ve mean & who is most at risk?

A

-ve for ER, PR, & HER2/neu receptors it’s associated with a very poor prognosis & it is more common in African American women

54
Q

What is Hereditary Breast cancer?

A

It is associated with a family history of breast cancer. The patient usually has:
1) Multiple first-degree relatives with breast cancer
2) A tumor in the early stage (premenopausal)
3) Multiple tumors in a single patient

Highest risk:
BRCA1 female ovarian & breast cancers
BRCA2 male breast cancer

55
Q

It is associated with a family history of breast cancer. The patient usually has:
1) Multiple first-degree relatives with breast cancer
2) A tumor in the early stage (premenopausal)
3) Multiple tumors in a single patient

Highest risk:
BRCA1 female ovarian & breast cancers
BRCA2 male breast cancer

A

Hereditary Breast cancer

56
Q

BRCA1

A

female ovarian & breast cancers

57
Q

BRCA2

A

male breast cancer

58
Q

It is associated with a family history of breast cancer. The patient usually has:
1) Multiple first-degree relatives with breast cancer
2) A tumor in the early stage (premenopausal)
3) Multiple tumors in a single patient

A

Hereditary Breast cancer

59
Q

What is male breast cancer?

A

A rare cancer that is associated with BRCA2 or Klinefelter syndrome. It presents in older men as a subareolar mass that may have nipple discharge

60
Q

A rare cancer that is associated with BRCA2 or Klinefelter syndrome. It presents in older men as a subareolar mass that may have nipple discharge

The most common subtype is Invasive ductal carcinoma

A

male breast cancer

61
Q

What is the most common subtype of male breast cancer?

A

The most common subtype is Invasive ductal carcinoma

62
Q

What are the conditions associated with male breast cancer?

A

BRCA2 or Klinefelter syndrome

USMLE Pathoma (20 decks)

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