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Breast Flashcards

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1
Q

Most common type of fibrocystic lesions

A

Nonproliferative changes

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2
Q 
Brown to blue dome cysts  filled with watery turbid fluid
May calcify
Apocrine metaplasia (polygonal abundant granular eosinophilic cytoplasm and small round deeply chromatic nuclei)
A

Fibrocystic changes

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3
Q

Presence of more than normal 2 cell layers of the ducts and lobules of breast (ie luminal overlying myoepithelial cell)

A

Epithelial hyperplasia

Proliferative fibrocystic change

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4
Q 
Small gland fenestrations
Ductal papillomatosis (small papillary excrescences into duct lumen)
Micrpcalcifications 
Atypical ductal hyperplasia occasionally
Atypical lobular hyperplasia
A

Epithelial hyperplasia

Proliferative fibrocystic change

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5
Q

Mimics carcinoma
Hard😟, rubbery
Proliferation of luminal space (adenosis) lined by epithelial cells and myoepithelial cells small glands within fibrous stroma
Stromal fibrosis compresses epithelium and lumen of ducts
Double layered epithelium

A

Sclerosing adenosis

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6
Q

Fibrosis, cystic change, apocrine metaplasia, mild hyperplasia

A

Minimal or no inc risk of breast carcinoma

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7
Q

Moderate to florid hyperplasia without atypia
Ductal papillomatosis
Sclerosing adenosis

A

Slightly inc risk 1.5-2 fold

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8
Q

Atypical hyperplasia whether ductular or lobular

A

Significantly inc risk 5 fold

Prolif fibrocystic change are bilateral multifocal asoc with inc risk of carcinoma

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9
Q

Nonbacterial chronic inflammation of breast assoc with inspissation of breast secretions in main excretory ducts

A

Mammary duct ectasia

Plasma cell mastitis

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10
Q

Most distinguishing feature of breast inflammatory change is

A

lymphoplasmacytic infiltrate and granulomas in periductal stroma

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11
Q

inoccuous lesion with central focus of necrotic fat surrounded by neutrophil and lipid laden mac with giant cells

A

Fat necrosis

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12
Q

Most common benign neoplasm of breast
Premenopausal women in 20s and 30s
Biphasic with fibroblastic stroma and epithelium lined glands the former of which is neoplastic

Well circumscribed, mobile, marble-like mass

Related to inc

A

Fibroadenoma

estrogen

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13
Q

Fibroadenoma-like tumor with overgrowth of fibrous component
Biphasic
Stromal element forming epithelium leaflike projections
Cleft like spaces with spindle stroma
Arises de novo
Leaf-like projections
Most commonly seen in postmenopausal women
Benign, localized but may be malignant

A

Phyllodes tumor
Cystosarcoma phyllodes

Tx: wide excision or mastectomy

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14
Q

Benign neoplastic papillary growth in lactiferous ducts
Fibrovascular core lined with eithelial and myoepithelial cells
Serous bloody nipple discharge
Small subareolar tumor
Nipple retraction
Delicate branching growths within dilated duct
Multiple papillae with a double layrred core covered by epithelial cell and outer luminal of myoepithelial cell

A

Intraductal papilloma

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15
Q

Most common location of breast tumors

A

Upper outer quadrant 50%

Central portion 20%

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16
Q

high grade nuclei with extensive necrosis extruding from transected
ducts on application of gentle pressure
dystrophic calcification inside cells

A

Comedo DCIS

other types:
cribriform
solid
micropapillary
papillary
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17
Q

Frequently assoc with DCIS

A

Calcification

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18
Q

Extension of DCIS up lactiferous ducts into contiguous skin of nipple unilateral crusting exudate over the nipple and areolar skin

A

Paget disease of nipple

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19
Q

Malignant proliferation of cells in lobules
Monomorphic bland, round nuclei occuring loosely in cohesive clusters within lobules
No invasion of BM
Mucin vacuoles forming signet rings
Dyscohesive cells lacking e-cadherin
Multifocal and bilateral (20-40%)
Premenopausal (80-90)
Subsequent invasive carcinomas arise in either breast
A marker of inc risk of carcinoma in both invasive ductal and lobular breasts and direct precursor of some cancers

A

LCIS

Tx: Tamoxifen and close follow up

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20
Q

Rf for Breast CA

A

Estrogen exposure
Long menarche and menopause
Atypical proliferative lesions
Family hx of breast cancer in a first degree

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21
Q

10% of all breast CA are inherited mutations in

A

BRCA1

BRCA2

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22
Q

Estrogen receptor expressing tumors respond to

A

Tamoxifen

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23
Q

HER2/NEU overexpressing tumors respond to

A

Trastuzumab/Herceptin

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24
Q

Clinically enlarged swollen erythematous breast without palpable mass
Poorly differentiated and infiltrative
Involves dermal lymphatic spaces with blockage of channels leading to edema
Minimal to absent inflammation

A

Inflammatory carcinoma

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25
Rare carcinoma 1% Sheets of large anaplastic cells with pushing borders Pronounced lymphoplasmacytic infiltrate Inc frequency in BRCA1 mutation Lack estrogen and progesterone receptors, do not express HER2/Neu Triple negative
Medullary carcinoma
26
Rare subtype Producing abundant quantities of extracellular mucin dissecting into surrounding stroma Soft gelatinous Express hormone receptors
Colloid mucinous carcinoma
27
Palpable masses with well formed tubules low grade nuclei Prognosis is excellent Express hormone receptor and do not show HER2/Neu
Tubular carcinoma
28
Enlargement of male breast from Excess estrogen Due to cirrhosis and inability of liver to metabolize estrogen Klinefelter’s, anabolic, pharma agent Inc CT and epithelial hyperplasia of ducts Lobules formation rare Button like subareolar swelling develops in both breasts
Gynecomastia
29
``` Rare in men Subareolar mass under nipple Nipple discharge Invasive ductal Diagnosed at advance age Tumor infiltrates skin and thoracic wall rapidly Resemble invasive carcinomas BRCA2 and Klinefelter Syndrome ```
Male breast Carcinoma
30
Highest density of ductal system in males in females
Subareolar area Upper outer quadrant Each ductal system occupies more than one quadrant
31
Mammograms in young women are typically
radiodense or white in appearance | mass forming lesions or calcifications (radiodense) detection is difficult
32
Density of a young woman’s breast stems from predominance of
fibrous interlobular stroma | paucity of adipose
33
Drugs that cause galactorrhea
``` Digitalis Anti-psychotics Anti-depressants TCAs Estrogen/birth control pills D2 antagonist Reserpine Methyldopa ```
34
Reserpine SE
Psychosis
35
Squamous metaplasia of lactiferous ducts Recurrent Subareolar mass with nipple retraction Inflammation of subareolar ducts Associated with smokers 90% and Vit A deficiency
Zuska disease | Periductal mastitis/abscess
36
Periductal mastitis/abscess | Key feature:
Keratinizing squamous metaplasia of nipple ducts Intense chronic inflammation with granulation tissue and fibrosis Tx: enbloc removal Complication: fistula
37
Squamous metaplasia is produced because of these 2 risk factors
Lack of vitamin A for highly specialized epithelium | Smoking (dec Vit A)
38
Inflammation and dilation of subareolar ducts Clasically arises from multiparous postmenopausal women Lacks squamous metaplasia of nipple ducts End of spectrum: Fibrosis = skin and nipple retraction
Mammary duct ectasia
39
Gross appearance of fibrocystic change
Bluedome appearance
40
``` Proliferative disease without atypia Moderate or florid hyperplasia Sclerosing adenosis Papilloma Complex sclerosing Lesion radial scar Fibroadenoma with simple features ```
5-7% risk | Mild increase
41
Proliferative change with atypia
Moderate inc risk
42
Risk reduction of breast ca may be done by
Prophylactic mastectomy | Giving of estrogen antagonist like tamoxifen
43
Tamoxifen inc risk for
Endometrial ca
44
Modified apocrine sweat glands Embryologically derived from skin 6-10 major duct system (12-20 lobules)
Breast
45
Order of duct branching
Lactiferous sinus -> ducts branch -> terminal duct -> cluster of acini/lobules
46
Functional unit of breast
Terminal ductal lobular unit
47
2 cell types lining ducts and lobules 2 types of stroma Histology
``` Myoepithelial cells (contractile) Luminal epithelial cells ``` Interlobular stroma Interlobulat stroma: hormonally responsive Keratinizing stratified squamous epithelium (skin) changing to double layered cuboidal epithelium lining ducts and lobules (TDLU)
48
Covered by stratified squamous epithelium | Pigmented and supported by smooth muscle
NAC
49
``` function in nipple lubrication becoming prominent during pregnancy ```
Areolar glands of Montgomery
50
Other conditions that promote calcification on mammography
fat necrosis | sclerosing adenosis
51
Swollen Erythrma Pea d orange Frequently mistaken for mastitis
Inflammatory breast cancer
52
Invasive lobular carcinoma | histological landmark due to loss of e cadherin
Indian file pattern
53
Her2 /neu
ERB | CD340
54
Milk production outside of lactation Not a symptom of breast cancer Causes: Nipple stimulation Prolactinoma of anterior pituitary (most common) Drugs
Galactorrhea
55
Congenital nipple inversion may be corrected
with pregnancy
56
Acute mastitis most common etiologic agents
Staph aureus | Streptococcus (diffuse)
57
Usually related to trauma or prior surgery Mass on PE Calcifications on mammography
Fat necrosis
58
Fat necrosis biopsy:
Necrotic fat with associated calcifications and giant cells Saponification Ill defined nodules with hemorrhage
59
Development of fibrosis and cyst Most common change in premenopausal women (25-40) Unopposed estrogen stimulation Clinically a lumpy breast on the upper outer quadrant Decreased risk by:
Fibrocystic change OCP use
60
Cysts with apocrine metaplasia (no inc risk) Fibrosis: rupture of cyst leading to secretory material released into stroma -> inflammation and fibrosis (no increased risk) Sclerosing adenosis 2x Inc number of acini per lobule Often are calcified Ductal hyperplasia 2x Atypical hyperplasia 5x
Fibrocystic change -> benign
61
Hallmark of intraductal papilloma
Bloody nipple discharge in a premenopausal
62
Intraductal papilloma must be differentiated from papillary carcinoma by checking presence of
``` Myoepithelial cells (intraductal) Postmenopausal women (papillary) ```
63
Characterized by proliferation of ductal epithelium and or stroma without cytologic or architectural features suggestive of carcinoma
Proliferative breast disease without atypia Morphology: epithelial hyperplasia: >2 layers sclerosing adenosis: inc lobules with fibrosis complex sclerosing adenosis: with epithelial hyperplasia sclerosing adenosis papilloma: within dilated duct, fibrovascular core
64
``` Most common carcinoma by indicdence 2nd most common by mortality Risk factors most commonly related to estrogen exposure: female age early menarche/late menopause obesity atypical hyoerplasia prior biopsy 5x 1st degree relative with breast cancer ```
Breast cancer
65
Means to detect small, nonpalpable, asymptomatic breast carcinomas Sensitivity and specificity increases with age (radiodense fibrous tissue gradually replaced with radioluscent fatty tissue)
Mammographic screening
66
Routine screening not recommended | 10% chance of mammographic lesion being malignant
Age 40-49
67
Screened every 2-3 years | 25% chance of mammographic lesion being malignant
Age 50-74
68
Mammographic signs of CA
densities and calcifications
69
Neoplastic proliferation that is limited to ducts and lobules by an intact basement membrane
CA in situ
70
Tumor cells penetrate through basement membrane and invade the stroma have potential to invade vasculature and metastasize
Invasive or infiltrative CA
71
95% of breast carcinomas are?
adenocarcinoma
72
Malignant proliferation of cells in ducts No invasion of the basement membrane Detected as calcification on mammography
DCIS Tx: Mastectomy 95%
73
Clasically forms duct like structures Most common type of invasive carcinoma Presents as palpable mass by physical exam and as calcifications on mammography Advance tumors may result to skin dimpling and nipple retractions Biopsy:
Invasive ductal carcinoma Duct like structures in desmoplastic stroma ``` Special subtypes Tubular Mucinous Medullary Papillary Metaplastic Inflammatory ```
74
Most important prognostic factor
Metastasis
75
Most useful factor
Spread to axillary lymph nodes
76
Used to assess biopsy
Sentinal lymph node biopsy
77
Most important predictive factors
ER PR HER-2-NEU Amplification
78
Predict response to antiestrogenic agents (Tamoxifen)
ER | PR
79
Associated with response to trastuzumab Cell surface growth factor receptor Poorer survival Poor prognosis?
Her-2-Neu Amplification Triple negative
80
10% of breast cancer Multipel first degree relatives with breast cancer Tumors at premenopausal age Multiple tumors BRCA1 and BRCA2 BRCA 1: BRCA 2:
Hereditary breast cancer Breast and ovarian Breast cancer in males Tx: if with genetic propensity, prophylactic mastectomy

Pathology (24 decks)

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