Breast- Brown Flashcards
(134 cards)
1
Q
Normal
Where does ducal system drain?
A
Through lactiferous sinus
2
Q
Normal
What arise at distal end of ducts?
A
Menarche lobules
3
Q
Normal
Terminal lobular unit=
A
Terminal duct and ductules
4
Q
Normal
Divided into lobules by…
A
6-10 major ducts
5
Q
Normal
Histology
Nipple and areola covered by
A
Stratified squamous epithelium (pigmented in areola)
6
Q
Normal
Histology
Stratified squamous epithelium covers
A
Nipple and areola (pigmented in areola)
7
Q
Normal
Histology
Stratified squamous epithelium changes to…
A
Double layer of cuboidal
8
Q
Normal
Histology
Flattened layer of contractile cells
A
Myoepithelial
9
Q
Normal
Histology
Interlobular strom
A
Fibroconnective tissue admixed with adipose
10
Q
Normal
Histology
Fibroconnective tissue admixed with adipose
A
Interlobular stroma
11
Q
Normal
Histology
Intralobular stroma
A
Loose, myxomatosis stroma and lymphocyte
12
Q
Normal
Histology
Loose myomatous stroma and lymphocyte
A
Intralobular stroma
13
Q
Normal
Histology
Under influence of…
A
Estrogen and progesterone
14
Q
Normal
Histology
When is morphological and functional maturity achieved?
A
Pregnancy
15
Q
Normal
Histology
Mammography can be affected by
A
Hormonal changes
16
Q
Life cycle changes
Unique…
A
Not fully formed at birth
Cyclic change reproductive life
Involution before menopause
17
Q
Life cycle changes
Prepubertal breast
A
Similar in males and females
Large ductal system with minimal lobule formation
18
Q
Life cycle changes
At menarche
A
Terminal ducts give rise to lobules and increased interlobular stroma
19
Q
Life cycle changes
When do terminal ducts give rise to lobules and increased interlobular stroma?
A
At menarche
20
Q
Life cycle changes
Follicular phase
A
Lobules quiescent
21
Q
Life cycle changes
When are lobules quiescent
A
Follicular phase
22
Q
Life cycle changes
Luteal phase
A
Cell proliferation with increased acini/lobule
23
Q
Life cycle changes
Cell proliferation with increased acini/lobule
A
Luteal phase
24
Q
Life cycle changes
Pregnancy
A
Breast assumes complete morphological and functional maturity
25
Life cycle changes
When does breast achieve complete morphological and functional maturity
Pregnancy
26
Life cycle changes
Breast milk provides...
Complete nourishment requirements and provides protection against infection and allergies
27
Life cycle changes
When does involution occur?
Before menopause and after menopause breast resembles male breast
28
Developmental disorders
Persistence of epidermal thickening along milk line
Milk line remnants
29
Developmental disorders
Mastectomy may not remove all breast tissue
Accessory axillary breast tissue
30
Developmental disorders
Congenital inversion of nipple
Nursing difficulties and can be confused with inversion due to carcinoma or inflammation
31
Developmental disorders
Macromastia may cause...
Severe back pain
32
Developmental disorders
Reconstruction or augmentation complication
Formation of capsule with inflammatory response causing cosmetic deformity and difficulty in mammography evaluation
33
Clinical presentation of breast disease
Majority of signs and symptoms are...
Benign
34
Clinical presentation of breast disease
Most common symptoms
Pain (mastalgia, mastodynia)- MC, may be cyclical
Palpable mass (2 cm minimum)
Nipple discharge (most significant are those that are spontaneous and unilateral)
35
Clinical presentation of breast disease
Mammographic screening
Principle signs
Densities- most neoplasms grow as solid masses
Calcifications- ass. With malignancy are usually small, irregular, numerous and clustered or linear and branching
36
Mammary duct ectasia
Common pt
5th or 6th decade in multifarious woman
37
Mammary duct ectasia
Presentation
Poorly defined mass, skin retraction, cheesy discharge
Pain and erythema uncommon
38
Mammary duct ectasia
Morphology
Ductal dilation
Inspissation of secretion
Marked periductal and interstitial chronic granulomatous inflammation
Squamous metaplasia is not a feature
39
Fat Necrosis
Hx
Sharply localized
Hx of trauma, prior surgical intervention, radiation therapy
40
Fat necrosis
Morphology- gross
Early
Hemorrhage
41
Fat necrosis
Morphology-gross
Later
Lequifactive necrosis: ill defined nodule of firm tissue with Fock of chalky white or hemorrhage
42
Fat necrosis
Histology
Early
Central necrotic fat cells surround by lipid laden macrophages and intense neutrophilic infiltrate
43
Fat necrosis
Histology
Late
Walled off by fibroblasts
Foreign body giant cells
Calcium salts
Blood pigment
44
Benign epithelial lesions
3 groups
Non proliferative
Proliferative
Atypical hyperplasia
45
Benign Epithelial Lesions
Non-proliferative Breast Changes
Pathogenesis
Due to hormonal imbalance; inc estrogen or dec progesterone
46
Benign Epithelial Lesions
Non-proliferative Breast Changes
Incidence
Unusual before adolescence
Peaks around menopause
47
Proliferation
Define
Alterations with inc risk of cancer
48
Benign Epithelial Lesions
Non-proliferative Breast Changes
Morphology
3 patterns
Cyst formation of ting with apocrine metaplasia
Fibrosis
Adnosis
49
Non-proliferative Breast Changes
Cysts
Appearance
Unopened looks like "blue dome cyst"
50
Non-proliferative Breast Changes
Cysts
Clinically
Palpable mass
51
Non-proliferative Breast Changes
Cysts
Seen...
Usually evident grossly
52
Non-proliferative Breast Changes
Cysts
Presentation
Can be multifocal and bilateral
53
Non-proliferative Breast Changes
Cysts
Pathogenesis
Secretory products can calcify
54
Non-proliferative Breast Changes
Cysts
Lining cells have abundant eosinophilic cytoplasm resembling sweat glands
Apocrine metaplasia
55
Non-proliferative Breast Changes
Cysts
Apocrine metaplasia
Lining cells have abundant eosinophilic cytoplasm resembling sweat glands
Virtually always benign
56
Non-proliferative Breast Changes
Cysts
Larger cysts...
May have atrophic lining from pressure
57
Non-proliferative Breast Changes
Fibrosis
Patogenesis
From rupture of cyst and release of contents resulting in inflammation
58
Non-proliferative Breast Changes
Adenosis
Inc in number of acinar units per lobule
If lumens enlarged called blunt duct adenosis
Calcifications can be seen
59
Non-proliferative Breast Changes
Lactational adenomas
Palpable masses in pregnant or lactating women
Exaggerated response to hormones
60
Non-proliferative Breast Changes
Clinical significance
Without proliferative changes no inc risk
Important because form palpable masses, calcification or nipple discharge
61
Proliferative Breast Disease Without Atypia
Finding
Rarely palpable
Usually mammographic density, calcification or incidental finding
62
Proliferative Breast Disease Without Atypia
Characterized by
Proliferation of ductal epithelium and/or stroma without cellular abnormalities suggestive of malignancy
63
Proliferative Breast Disease Without Atypia
Types
Epithelial hyperplasia (moderate or florid)
Sclerosing adenosis
Complex Sclerosing Lesion (Radial Scar)
Papillomas
Fibroadenomas
64
Proliferative Breast Disease Without Atypia
Epithelial hyperplasia
More than 2 cell layers is hyperplasia
More than 4 is moderate or florid
Forms irregular lumens
65
Proliferative Breast Disease Without Atypia
Sclerosing adenosis
Number of acini inc x 2
Normal lobular arrangement
Compressed in central region and dilated at periphery
Prominent myoepithelial cells
Mimic carcinoma
Frequent calcifications
66
Proliferative Breast Disease Without Atypia
Complex Sclerosing Lesion
Stellate with central nidus of entrapped glands
Can mimic carcinoma grossly and mammographically
67
Proliferative Breast Disease Without Atypia
Papillomas
Multiple branching fibrovascular cores lined by ductal and myoepithelial cells
Large duct papillomas are usually single and situated in lactiferous sinus
Small duct papillomas are deeper within ductal system (more clearly ass. With inc risk of carcinoma)
68
Proliferative Breast Disease With Atypia
Atypical hyperplasia resembles...
Carcinoma in situ but lacks features for diagnosis
69
Proliferative Breast Disease With Atypia
Atypical ductal hyperplasia
Characteristically limited in extent
Cells not completely monomorphic and fail to completely fill ductal space
70
Proliferative Breast Disease With Atypia
Atypical lobular hyperplasia
Do not fill or distend mor than 50% of acini
71
Proliferative Breast Disease With Atypia
Types
Atypical hyperplasia
Atypical ductal hyperplasia
Atypical lobular hyperplasia
72
Proliferative Breast Disease With Atypia
Clinical significance
Risk of cancer
Non-proliferative- no inc risk
Proliferative- mild inc
Proliferative with atypia- mod inc risk
All modified by menopausal status, family hx and time since biopsy
73
MC malignancy of breast
Carcinoma of the Breast
| Epithelial=carcinoma
74
MC non-skin malignancy in women
Carcinoma of the Breast
75
Carcinoma of the Breast
Risk factors
Age
Age at menarche- younger than 11 inc risk
1st live birth-under 20 less risk than no kids of >35
1st degree relative with breast cancer
Breast biopsies
Race-lower in African-American
76
Carcinoma of the Breast
Additional risk
Estrogen: not oral contraceptives
Radiation
Carcinoma of contralateral breast
Geographic: US and Europe higher
Diet:dec with B carotene, alcohol inc
Obesity: dec in obese <40, inc post menopause obesity
Exercise: dec
Breast feeding: longer, greater reduction
77
True or false
Tobacco is ass. With breast cancer
FALSE
78
Carcinoma of the Breast
Tx of women at high risk
Bilateral prophylactic mastectomy
Chemoprevention- tamoxifen
79
Carcinoma of the Breast
Pathogenesis
Sporadic
Risk related to hormone exposure, gender, age at menarche and menopause, reproductive history, breast feeding and exogenous hormones
80
Carcinoma of the Breast
Pathogenesis
Genetic
Family hx of breast cancer in 1st degree relative
81
Carcinoma of the Breast
High penetrating AD genes
BRCA1 and BRCA2
82
BRCA1 and BRCA2
Highly penetrating AD genes that are ass. With breast cancer
83
Carcinoma of the Breast
Mechanisms of carinogenesis
Accumulation of 7 new capabilities inc genetic instability
Heredity can help (i.e. HER-2/neu for self-sufficient growth)
84
Carcinoma of the Breast
Classification
2 divisions
In situ and invasive carcinomas
85
Carcinoma of the Breast
Classification
In situ
Limited by BM to ducts or lobules but may extend to overlying skin as Paget's disease
86
Carcinoma of the Breast
Classification
Carcinomas
Arise from terminal duct lobular unit
87
Carcinoma of the Breast
Carcinoma in situ
Ductal Carcinoma in situ
Malignant cells limited by BM
Myoepithelial cells can be present but decreased
88
Carcinoma of the Breast
Ductal Carcinoma in situ
Architectural subtypes
Comedocarcinoma
Non-comedocarcinoma
89
Carcinoma of the Breast
Carcinoma in situ
Comedocarcinoma
Solid sheets of pleomorphic cells
90
Carcinoma of the Breast
Carcinoma in situ
Non-comedocarcinoma
Nuclear grades from low to high
91
Carcinoma of the Breast
Carcinoma in situ
Non-comedocarcinoma
Types
Cribiform- cookie cutter spaces
Solid
Papillary- fibrovascular cores
Micropapillary- bulbous protrusions
92
Carcinoma of the Breast
Carcinoma in situ
Paget's Disease
Unilateral erythematous eruption with scale crust
Pruritis
Extension of DCIS into surface epithelium
Can have underlying invasive carcinoma
93
Extension of DCIS into surface epithelium
Paget's disease
94
Carcinoma of the Breast
Ductal Carcinoma in situ
Clinical
Seen grossly
Can progress to invasive
Mastectomy curative
Breast conservation possible
Tamoxifen reduces recurrence
95
Carcinoma of the Breast
Lobular Carcinoma in situ
Found...
Always incidental as no calcifications and does not form density
96
Carcinoma of the Breast
Lobular Carcinoma in situ
Common pt
Before menopause
20-40% bilateral
97
Carcinoma of the Breast
Lobular Carcinoma in situ
Cancer risk
Multicentric and bilateral and subsequent neoplasms can occur in both breasts
98
Carcinoma of the Breast
Lobular Carcinoma in situ
Pathogenesis
Both LCIS and invasive lobular carcinoma
Lack 3-cadherin (cell adhesion: reason invasive lobular occurs frequently as single cells
99
Carcinoma of the Breast
Lobular Carcinoma in situ
Histology
Small cells with oval or round nuclei with small nucleoli
Signet ring cells with mucin seen
100
Carcinoma of the Breast
Lobular Carcinoma in situ
Receptors and markers
Express hormone receptors and are negative for over-expression of HER-2/neu
101
Carcinoma of the Breast
Lobular Carcinoma in situ
Clinical
Women with LCIS develop invasive lesions at a frequency similar to DCIS
Ipsilateral breast at more risk
102
Carcinoma of the Breast
Lobular Carcinoma in situ
Tx
Bilateral prophylactic mastectomy
Tamoxifen
103
Invasive Carcinoma
Presentation
If no mammographic screening can present as palpable mass and can already have LN metastasis
104
Invasive Carcinoma
Signs
Can be fixed to chest wall causing dimpling (peau d'orange)
Nipple inversion (central involvement)
105
Invasive Carcinoma
Define "inflammatory" carcinoma
Clinical presentation of carcinoma extensively involving dermal lymphatics (enlarged erythematous breast)
106
Invasive Carcinoma, No Special Type (NST;Invasive Ductal Carcinoma)
Gross
Firm with irregular border
Retracts from cut surface due to fibrosis
Firm to cut
107
MC carcinoma
Invasive Carcinoma, no special type
108
Invasive Carcinoma, No Special Type (NST;Invasive Ductal Carcinoma)
Morphology
2 types
Well differentiated
Poorly differentiated
109
Invasive Carcinoma, No Special Type (NST;Invasive Ductal Carcinoma)
Well differentiated
Maintain tubular glands lined by mildly atypical cells
Express hormone receptors and neg for over-expression of HER2/neu
110
Invasive Carcinoma, No Special Type (NST;Invasive Ductal Carcinoma)
Poorly differentiated
Loss of glands
Anastomosing cords
Pleomorphic atypical cells
Neg for hormone receptors and over-expression of HER2/neu
111
Invasive Lobular Carcinoma
Presentation
Palpable mass or density
Many have diffuse pattern of invasion without prominent desmoplasia (very subtle on mammography)
112
Invasive Lobular Carcinoma
Gross
Firm with irregular margins
113
Invasive Lobular Carcinoma
Morphology
Single infiltrating tumor cells often one cell in width
Desmoplasia not as prominent
Signet ring cells
Concentric rings around normal ducts
114
Invasive Carcinoma, NST
Histology
Induce fibrotic reaction (desmoplasia)
Usually see varying amounts of DCIS
115
Invasive Lobular Carcinoma
Clinical
Same prognosis as invasive ductal
Metastasizes in different pattern than other breast carcinomas
Metastasis: peritoneum, retroperitoneum, leptomeninges, GI tract, ovaries and uterus
116
Mutinous (Colloid) Carcinoma
Well circumscribed
Slow growth
Older women
117
Mutinous (Colloid) Carcinoma
Gross
Soft, gelatinous
118
Mutinous (Colloid) Carcinoma
Morphology
Tumor cells seen as clusters of cells in lakes of mucin
119
Mutinous (Colloid) Carcinoma
Clinical
Diploid
Express hormone receptors
Prognosis better than invasive ductal
120
Invasive Papillary Carcinoma
Rare
Papillary architecture
Prognosis better than invasive ductal
121
Prognostic and Predictive Fators
Major Prognostic factors
Invasive or in situ
Distant metastasis
LN metastasis (sentinel node)
Tumor size
Locally advanced disease (inc skin or muscle)
Inflammatory carcinoma: 3 yr survival 3-10%
Used for staging
122
Prognostic and Predictive Fators
Minor prognostic factors (help determine therapy)
```
Histologic subtype
Tumor grade
Estrogen/progesterone receptors
HER2/neu
Lymphvascular invasion
Proliferative rate
DNA content (diploid=DNA index of 1
```
123
Prognostic and Predictive Fators
Therapy
Local and regional control (surgery)
Postoperative radiation
Systemic control (hormonal/chemo)
Inhibition of growth factors, stromal pro teases, and angiogenesis
124
Stromal Tumors
2 types
Intralobular
Interlobular
125
Stromal Tumors
Intralobular gives rise to...
Breast: specific biphasic tumors fibroadenoma and phylloides
126
Stromal Tumors
Interlobular gives rise to...
Same types of tumors found in CT in other sites (lipomas, angiosarcomas etc.)
127
Stromal Tumors
Fibroadenoma
Composition
Composed of fibrous and glandular tissue
128
Stromal Tumors
MC benign tumor
Fibroadenoma
129
Stromal Tumors
Fibroadenoma
Morphology
Sharply circumscribed nodule, freely moving
Upper outer quadrant
Grayish white with slot like spaces
130
Stromal Tumors
Fibroadenoma
Histology
Delicate fibroblastic stroma enclosing glandular and cystic spaces lined by epithelium
Epithelial spaces may be distorted by stroma
131
Stromal Tumors
Fibroadenoma
Responsive?
Hormonal responsive:
Enlarges late menstrual cycle
Enlargement during pregnancy may lead to infarction
Regresses postmenopausal and may calcify
132
Stromal Tumors
Phylloides Tumor
Presentation
6th decade
Low grade, local
Rare mets
133
Stromal Tumors
Phylloides Tumor
Morphology
Varying size
Leaf-like protrusions
Resemble fibroadenoma but increased cellularity and mitosis
High grade lesions may have Fock of heterozygous mesenchymal differentiation (e.g. Rhabdomyosarcoma)
134
Ass. With seatbelt injury or surgery
MC lesion
Fat necrosis
