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Flashcards in Breast Deck (29):
1

Breast in embryologically derived from_____

The skin. It is a modified sweat gland

2

Milk Line

Line from axilla to the vulva along which breast tissue can develop anywhere on that line

3

2 layers of epithelium in Lobulues and Ducts

Luminal Cell layer - inncer cell layer, milk production in lobules
Myoepthelial Cell Layer - Outer cell layer, contractile to propel milk to nipple

4

Indications that Breast tissue is hormone sensitive

1) After menarche see increase in estrogen and porgesterone and a corresponding increase in breast size and lobule formation
2) Breast are tender during menstrual cycle
3) During pregnancy undergo hyperplasia (E and P from corpus luteum, P from placenta, E from fetus and placenta workign together)
4) After menopasue breast tissue udnergoes atrohpy

5

Breast tissue is highest in which quandrant

upper outer quandrant

6

Galactorrhea

Milk production outside of lactation. Causes include nipple stimulation, prolactinoma of anterior pituitary, and drugs

7

Acute Mastitis

Bacterial infection of breast (staphylococcus aureus). Gain entry to breast usually after breast feeding. Breast is erythematous and purulent nipple discharge (can eventually get abscess formation. Encourage to continue breast feeding to treat in addition to antibiotic (dicloxacillin)

8

Periductal Mastitis

Inflamation of subareolar ducts. Usually seen in smokers since they get a Vitamin A deficiency that leads to squamous metaplasia of lactiferous ducts that can block and inflame the duct with their keratin.
See subareolar mass with nipple retraction

9

Mammary Duct Ectasia

Inflammation with dilation (ectasia) of subareolar ducts. Presents as sub areolar mass with GREEN BROWN NIPPLE DISCHARGE. Plasma cells on biopsy. See in multiparous, postmenopausal women

10

Fat Necrosis of Breast

Mass on physical exam or abnormal calcifications on mammography. Necrosis usually occurs due to trauma to the fat

11

Fibrocystic Change
(Fibrosis, cysts, apocrine metaplasia)
Ductal hyperplasia
Sclerosing Adneosis
Atypical hyperplasia

Development of fibrosis and cysts in the breast and is hormone mediated.
Presents as vague irregularity of the breast tissue (lumpy breast)
Cysts have a blue-dome like appearance on gross exam.
Benign but some are related to increased risk for invasive carcinoma in both breasts
Fibrosis, cysts, apocrine metaplasia - no increased risk
Ductal hyperplasia, Sclerosing Adneosis - 2 x risk
Atypical hyperplasia - 5 x risk

12

Intraductal Papillmoa (papilloma vs papillary carcinoma)

Papillary growth usually into a large duct. Characterized by by fibrovascular projection into duct. Classically presents as bloody nipple discharge.
Papilloma - fibrovascular projection lined by both epithelial and myoepthelial cells.
Papillary carcinoma - projection covered by ONLY epithelial cells, NO myoepithelial

13

Fibroadenoma

Tumor of fibrous tissue and glands. Most common benign neoplasm seen in premenopausal women. Well circumscribed, mobile, marble like mass that is estrogen senstive. No increased risk of carcinoma

14

Phyllodes Tumor

Fibroadenoma like tumor with overgrowth of the fibrous component, LEAF LIKE projections on biopsy. Seen in postmenopausal typically and some can be malignant

15

Risks for breast cancer

Female
Old age
Early menarche/late menopause/lack of pregnancy
Obesity
Atypical Hyperplase (usually driven by excess estrogen)
Hereditary (1st degree relatives with breast cancer = mother, sister, daughter)

16

Ductal Carcinoma in Situ (comedo type)

Malignant proliferation of cells in ducts with no invasion of basement membrane. Often detected as calcification in mammography (no mass). Need to biopsy since fat necrosis and fibrocystic changes can also display calcification. If it extends up the duct to involve the skin get paget disease (nipple ulceration and erythema)
Comedo type = high grade cells with necrosis and dystrophic calcification in center of ducts (since lack vasculature)

17

Paget Disease

Sign of DCIS> See nipple ulceration and erythema

18

Invasive Ductal Carcinoma

Invasive carcinoma that classically forms duct like structures. Most common breast cancer. Presents as 2cm mass or 1cm calcification. Advanced tumor can cause dimpling of the skin or retraction of the nipple.
includes the subtypes: tubular carcinoma, mucinous carcinoma, medullary carcinoma and inflammatroy carcinoma

19

Tubular Carcinoma.

IDC characterized by well differentiated tubules that lack myoepithelial cells. Good prognosis

20

Mucinous Carcinoma

IDC characterized by abundant extracellular mucin (tumor cells float in mucous pool) good prognosis and occurs in old women (70)

21

Medullary Carcinoma

IDC characterized by large, high grade cells growing in sheets with associated lymphocytes and plasma cells. Well circumscribed mass that can mimic fibroadenoma. Higher incidence in BRCA1. Good prognosis

22

Inflammatory Carcinoma

IDC characterized by carcinoma in dermal lymphatics. Presents as inflammed swollen breast with no discrete mass. Often mistaken for acute mastitis but doesnt improve with antibiotics or breast feeding. Poor prognosis

23

Lobular Carcinoma in Situ

Malignant proliferation of cells in lobules with no invasion of the basement membrane. No mass or calcifications so incidentally found on biopsy. See dyscohesive cells since they lack E-cadherin to bind them together. Often multifocal and bilateral. Treat with tamoxifen to reduce risk of subsequent cancer but low chance of developing into ILC

24

Invasive Lobular Carcinoma

Invasive carcinoma that typically grows in single-file pattern (dont form ducts because they lack e-cadherin to hold them together.

25

Prognostic Factors for Breast cancer

TNM
Metastasis is most important prognostic. Mets mean bad prognosis but most people dont presents with mets
N= nodes = spread to axillary lymph nodes is most useful prognostic factor (do sentinel lymph node biopsy)

26

Predictive Factors for Treatment

Estrogen Receptor (ER) and Progesterone Receptor (PR) and HER2/neu gene amplification (overexpression) status
ER and PR positive then treat with tamoxifen/antiestrogenic agents. Both receptors are located in the nucleus
HER2/neu amplification then treat with trastuzumab (antibody to HER2 receptor on cell surface)

27

Triple Negative Cancers

Negative for ER, PR, and HER2/neu have poor prognosis. More common if African American women

28

Hereditary Breast Cancer

BRCA1 = increased risk for breast (medullary carcinoma) and ovarian (serous carcinoma of ovary and fallopian tube) carcinomas
BRCA2 = increased risk for breast cancer for males.
Can choose to do a bilateraly mastectomy but this only decreases risk not make it zero since breast tissue can hide axilla or subcutaneous tissue of chest wall

29

Male breast cancer

Very rare but presents as subareolar mass with nipple discharge. Most common is invasive ductal carcinoma
BRCA2 and Klinefelter (XXY) at increased risk