Breast

Question 1

When is fibrocystic change most common?

Answer 1

premenopausal females

- 20 -50 years old

Question 2

What are 2 major subtypes of fibrocystic change?

- What are the features of each?

Answer 2

Sclerosing adenosis
- Acini and stromal fibrosis, associated w. calcifications

Epithelial hyperplasia
- Cells in terminal ductal or lobular epithelium

Question 3

What subtype of fibrocystic change disease is more likely to result in cancer?

Answer 3

Epithelial hyperplasia (incr risk of carcinoma w. atypical cells)
- Sclerosing adenosis, slight incr risk

Question 4

What are the 2 types of inflammatory benign breast diseases?

Answer 4

• Fat necrosis

- Lactational mastitis

Question 5

What will fat necrosis show on mammography and biopsy?

Answer 5

Mammography - calcified oil cyst

Biopsy - Necrotic fat and giant cells

Giant oily block of cheese

Question 6

What are the the benign tumours which affect the breast?

Answer 6

• Fibroadenoma
• Intraductal papilloma
• Phyllodes tumour

Question 7

What ducts are affected in Intraductal papilloma, mastitis/abcess, paget disease?

Answer 7

Lactiferous duct and Major duct (distal)

Question 8

DCIS + carcinoma, LCIS + carcinoma and fibrocystic change affect what ducts?

Answer 8

Terminal duct and lobular unit (proximal)

Question 9

What breast diseases affect the stroma?

Answer 9

• Fibroadenoma
• Phyllodes tumor

Sclerosing adenosis affects acini and stroma

Question 10

When is fibroadenoma most common?

Answer 10

< 35 years old

Question 11

What bacteria causes lactational mastitis?

Answer 11

S. aureus - come thru cracks in nipple

Question 12

What percentage of those with fat necrosis report trauma?

Answer 12

50%

Question 13

Who is most commonly affected by fibroadenoma?

Answer 13

< 35years old

Question 14

Describe the features of a fibroadenoma presentation

Answer 14

Small, well-defined, mobile mass in < 35 year old female

- Increased size and tenderness with incr estrogen

Question 15

What benign tumours are associated with cancer what is less so?

Answer 15

• Fibroadenoma = not increased risk
• Intraductal papilloma = slight increase
• Phyllodes tumour = Some may become malignant

Question 16

What is fibroadenoma (benign tumour) composed of?

Answer 16

Fibrous tissue and glands

Question 17

What is the most common cause of nipple discharge serous or bloody?

Answer 17

Intraductal papilloma

Question 18

Describe Intraductal papilloma (benign tumor)

Answer 18

Small fibroepithelial tumour w. lactiferous ducts typically beneath areola

Question 19

Describe Phyllodes tumour (histo)

Answer 19

Large mass of connective tissue (stroma) and cysts with ‘leaf-like’ lobulations

Question 20

Who is most commonly affected by Phyllodes tumour?

Answer 20

Woman in 40s

Question 21

What quarter of the breast is most commonly affected by breast cancer?

Answer 21

Upper outer

Question 22

What are the receptors which can be amplified/overexpressed in breast cancer?

Answer 22

• Estrogen receptor
• Progesterone receptor
• c-erB2, HER2 - an Epidermal Growth Factor Receptor (EGFR)

Question 23

What type of breast cancer is most aggressive in terms of receptors?

Answer 23

Triple negative

Question 24

How is DCIS usually detected?

Answer 24

Macrocalcifications on mammography

- Usually does not produce a mass

Question 25

What is Comedocarcinoma, what is it a subtype of? What is seen on histology?

Answer 25

A subtype of DCIS

- Cells have high-grade nuclei w. extensive central necrosis and dystrophic calcification

Question 26

What is seen on histology in DCIS?

Answer 26

Cells filling ductal lumen, neoplastic cells that engorge blood vessel
- Arises from ductal atypia

Question 27

What is the most common type of invasive breast cancer?

Answer 27

Invasive ductal carcinoma

Question 28

What is the pathophysiology of Paget’s disease?

Answer 28

Extension of underlying DCIS/invasive breast cancer up to lactiferous duct ands and into contigous skin of nipple from terminal duct/lobular unit

Question 29

What will Paget’s disease look like?

Answer 29

Eczematous patches over nipple and areolar skin

Question 30

Lobular carcinomas / LCIS lack what molecule?

Answer 30

E-cadherin

Question 31

What does a lack of E-cadherin result in in histology in Lobular carcinomas / LCIS?

Answer 31

Orderly row of cells ‘single file’ and no duct formation

• Lines of cells
• Often bilateral w. multiple lesions in the same location

Question 32

What response do invasive lobular carcinoma lack?

Answer 32

Desmoplastic response

Question 33

What can a medullary carcinoma mimic?

Answer 33

A well-circumscribed tumour can mimic fibroadenoma

Question 34

What will be seen on histology in medullary carcinoma?

Answer 34

Large, anaplastic cells growing in sheets w. associated lymphocytes and plasma cells

Question 35

Describe Inflammatory breast cancer

Answer 35

Dermal lymphatic space invasion -> breast pain w. warm, swollen, erythematous skin around exaggerated hair follicles (peau d’orange’)

Question 36

What type of breast cancer can lack a palpable mass?

Answer 36

Inflammatory

Question 37

Name the ducts of the breast from the nipple to the lobular units

Answer 37

Lactiferous duct -> Major duct -> Terminal duct

-> Lobular unit (surrounded by stroma)

Question 38

What is a stereotypical presentation of fibrocystic change disease?

Answer 38

Premenopausal woman 20-50

- Premenstrual breast pain or lumps

Question 39

Describe invasive ductal carcinoma?

Answer 39

• Firm, fibrous “rock-hard” mass with sharp margins and - Small, glandular, duct-like cells in desmoplastic stroma

Question 40

Differences between invasive ductal and invasive lobular?

Answer 40

• Lobular does not have ducts
• Lobular has decreased E-cadherin, single-file orderly row of cells
• Lobular lacks desmoplastic response