breast Flashcards
(32 cards)
intraductal papilloma presentation
buzzwords: bloody nipple discharge, premenopausal woman, myoepithelial cells still present
papillary growth w/in lactiferous ducts can bleed
where are these axillary nodes:
level I
level II
level III
rotters
level I - lateral to pec minor
level II - deep to pec minor
level III - medial to pec minor
rotter’s nodes - interpectoral
risk factors for breast cancer
- increased estrogen exposure(obesity)
- increased # of menstrual cycles
- bein older when you have ya first baby
- african american - increased risk for triple negative
- BRCA1/2
Ki-67 index
nuclear marker for proliferation in breast cancer
invasive lobular carcinoma
5-10% of all breast cancers
Presentation:
- Hard to see, even on imaging and grossly – sneaky bastard
- Usually expresses hormonal receptors so pretty easy to treat
- orderly rows of malignant cells(indian file)
- bilateral w/multiple lesions in same location
Mets to: CSF, BM, GU tract, peritoneum
loss of e-cadherin means they wont be formin no ducts! discohesive.
periductal mastitis
inflammation of subareolar ducts
SMOKERS – causes relative vitamin A deficiency; lactiferous ducts cant start to become squamous tissue due to lack of vit. A; keratin plugs up lactiferous ducts causing inflammation
buzzwords: smoker, subareolar mass, nipple retraction
difference in chemotherapy benefit for breast cancer based on age
young people benefit by a greater margin than old people who are indicated for chemo
acute mastitis
bacterial breast infection(s. aureus mostly)
breast-feeding causes fissures, allows bacteria in
presents as mother with erythematous breast w/purulent discharge – drain and give dicloxacillin!
tubular invasive ductal carcinoma presentation
well formed tubules w/low-grade nuclei
LACKS MYOEPITHELIAL CELLS
young patient
ER/PR+; good prognosis
tamoxifen
anti-estrogen; blocks estrogen binding to ER+ cells
also called selective estrogen receptor modulator(SERM)
staple treatment for premenopausal patients w/early stage disease
partial agonist @ endometrium: increased cancer risk
antagonist @ breast: anti-ER+ tumor effect
mammary duct ectasia
inflammation w/dilation of subareolar(lactiferous) duct
usually seen in multiparous, POSTmenopausal woman
buzzwords: green-brown nipple discharge, periareolar mass(can mimic breast canceR)
phyllodes tumor presentation
fibroadenoma-like tumor w/excess fibrous tissue – causes leaf-like projections; can be malignant(low-grade)
more common in post-menopausal women
fibroadenoma presentation
buzzwords: small, mobile, firm mass, well-circumscribed, young
benign tumor of fibrous tissue and glands in premenopausal women; no malignant potential; no increased risk; can be left alone
estrogen sensitive - gets bigger w/more estrogen; regress after menopause
mucinous invasive ductal carcinoma
old lady(70-80)
tumor is filled w/mucous - rather indolent
estrogen/progesterone +
adenosis
increased acinii in lobules
non-malignant causes of breast calcifications
fat necrosis – saponification
sclerosing adenosis – seen in association with fibrocystic breast changes
inflammatory subtype of invasive ductal carcinoma
invasion of dermal lymphatics by malignant cells
peau d’orange(breast skin looks like an orange)
bad prognosis – looks very similar to acute mastitis(erythematous, swollen breast)
- keep inflammatory invasive ductal carcinoma in back of mind when seeing this presenation
proliferative breast diseases and their cancer risk
- *fibrocystic changes -** enlarged, cystic glands w/hyperplasia of fibrous breast stroma
- no risk
sclerosing adenosis - excess glands that increase in fibrous tissue – can calcify!
- 2x increased risk
epithelial/ductal hyperplasia - increased # of ductal cells – more than 2 layers in duct
- 2x increased risk
atypical hyperplasia
- 5x increased risk
these risks are all bilateral increases in risk!
medullary sub-type of invasive ductal carcinoma
high grade malignant cells w/lymphocytic infiltrate
good prognosis
assn. w/BRCA mutation; ER-/PR-
invasive ductal carcinoma presentation
“rock-hard” mass; poorly defined edges
duct-like cells - cells havent lost e-cadherin like invasive lobular
worst and most invasive
most common(76% of all breast cancers)
how is DCIS often picked up on mammography?
microcalcifications in the ducts!
HER2 mutation is _____prognostic and ________predictive
poor prognostic, but positive predictive
HER 2 lets you use trastuzumab or pertuzumab so positive predictive! natural course would be worse though so poor prognostic
fibroscystic changes presentation
buzzwords: premenopausal, “lumpy” breast, blue dome cysts
hormone mediated change in breasts involving cystic ducts and increased fibrous change around them
aromatase inhibitors
prevents formation of estrogens
staple treatment for postmenopausal patients – prolly cause they dont need estrogen for periods and stuff as much as pre-meno’s
reduced risk of second primary BC
