What term refers to a condition where breast tissue, nipple and areola are absent?
What term refers to a condition where the mammary gland tissue is absent but the nipple and areola remain present?
What term refers to the presence of breast glandular tissue but no nipple or areola?
What is a supernumerary nipple and where does it arise?
It’s an additional nipple that may occur along the milk line.
What is polymastia?
Supernumerary breast tissue or ectopic breast tissue, usually on the milk line.
What usually causes an inverted nipple?
Fibrous bands of tissue that tether the nipple in an inverted position. 90% are bilateral.
When is galactorrhea most disconcerting?
D/c is unilateral, bloody or associated with breast mass. It may indicate malignancy.
Inflammation of the parenchyma of the mammary gland during lactation is often termed what?
What is a common myth about mastitis?
The it is an acute infection. It is rarely associated with an infection (although this is possible if the nipple is cracked in which cased it is usually caused by staph aureus or strep epidermidis)
What condition is characterized by keratinizing squamous epithelium in the duct system of the nipple causing pain in the sub-areolar area?
Peri-ductal mastitis (90% of pts are smokers)
What condition is characterized by dilatations of the sub-areolar ducts and usually occurs in 5th or 6th decade of life to multiparous women?
Mammary duct ectasia
What is the single most common disorder of the breast and accounts for more than half of all surgical operations that are performed on the female breast?
Fibrocystic breast disease
How is fibrocystic breast disease diagnosed?
It’s too dense for mammography.
Usually, clinical diagnosis from history and sxs
Definitive diagnosis is by biopsy or aspiration
What are the microscopic findings of fibrocystic breast disease?
Sclerosing ductal epithelium proliferation
Multi-layering of the ductal cells or ingrowth of the cells towards the center of the duct
What does fat necrosis of breast tissue look like microscopically?
Irregular fatty spaces that are surrounded by foamy histiocytes and multinucleated giant cells
What condition is characterized by a single hard mass or multiple hard masses that are made up of collagenized stroma surrounding atrophic ducts and lobules?
What are the microscopic findings in lymphocytic mastopathy?
A thickening and fibrosis of stromal tissue and lymphocytic infiltrates that surrounds the epithelium and blood vessels
Who typically gets lymphocytic mastopathy?
Women with type 1 diabetes mellitus or autoimmune thyroiditis
What is the difference between Adenosis and Adenoma?
Adenosis is an increased number of glandular components
Adenoma is a benign lesion with more glandular tissue involved and is more organized
What is the most common benign tumor of the breast?
What tumor is characteristically a well circumscribed mass with a prominent fibrotic capsule?
How do fibroadenomas respond to hormones?
They are responsive to hormones:
Increase in size during pregnancy and late luteal phase of menses
Regress after menopause
What is a lactating adenoma
A fibroadenoma. A localized focus of hyperplastic cells seen in breast tissue during pregnancy.
Marked cytoplasmic vacuolization seen in the hyperplastic lobules.
What are the two types of intraductal papillomas and how are they different?
Solitary - originates in the large ducts and is located centrally beneath the nipple
Multiple - located in the terminal ducts at the periphery of the breast
Microscopically what condition is characterized by the presence of myoepithelial cells and multilayer ductal cells becoming flattened with a heterochromatic nucleus next to the luminal surface?
Where do most breast cancers originate and how are they classified?
What type of receptors are overexpressed in 70% of breast cancer patients?
Estrogen, which stimulates proliferation of mammary cells which increases cell division and DNA replication > greater chance of mutations
What gene mutations account for 30-40% of inherited breast cancers?
BRCA1 and BRCA2 which are tumor suppressor genes
What other gene is a proto-oncogene found over-expressed in breast cancer?
What are the three main types of breast cancer?
Nipple (Paget’s disease of breast/nipple)
What is the most common type of breast cancer?
Ductal carcinoma (infiltrating)
Infiltrating ductal carcinoma has a central white area that is hard and gritty because the neoplasm is producing a desmoplastic reaction with lots of collagen. What is this called?
What is the second most common histologic type of breast cancer?
What characterizes the histologic appearance of lobular carcinoma?
The presence of small homogenous cells that invade the stroma often seen in a “single file pattern”. “Signet ring” appearance has a worse prognosis.
What condition is characterized by eczematous changes overlying the nipple and areola, or in worse conditions, ulceration/destruction?
Paget’s disease (less common than ductal or lobular)
What are Paget cells?
They are derived from glandular epithelium. They are large round cells with pale cytoplasm and pleomorphic nuclei and are seen within the epidermis
What is notable about inflammatory breast cancer?
It often presents without a palpable lump on breast exam. It is especially aggressive.