breast histology nl and benign

Question 1

lymphatic drainage of breast

Answer 1

axillary, supraclavicular and mediastinal lymph node

Question 2

cell type of nipple and ducts

Answer 2

The keratinizing squamous epithelium of the overlying skin dips into the orifices at the nipple and then abruptly changes to a double-layered cuboidal epithelium lining the ducts

Question 3

histology of breast stroma

Answer 3

The interlobular stroma consists of dense fibrous connective tissue admixed with adipose tissue. 2. The intralobular stroma envelopes the acini of the lobules and consists of breast-specific hormonally responsive fibroblast-like cells admixed with scattered lymphocytes

Question 4

male breast vs female breast

Answer 4

Male breast contains no tubulues (acini). The breast consists of ductal structures surrounded by a small amount of adipose and fibrous tissue

Question 5

breast structure during childhood

Answer 5

female breast is composed of branching ductal system without the lobular units.

Question 6

breast structure at puberty

Answer 6

E and P stimulate proliferation of glandular tissue. Lactiferous ducts and interlobular duct system are stable. terminal duct lobular units undergo changes with hormone levels. The lobules are quiescent during first half of menstrual cycle, then cell proliferation and number of acini per lobule increases after ovulation. The intralobular stroma also becomes markedly edematous. Upon menstruation, the fall in estrogen and progesterone levels induces the regression of the lobules and the disappearance of the stromal edema.

Question 7

breast structure during pregnancy

Answer 7

by the end of the pregnancy the breast is composed almost entirely of lobules separated by relatively scant stroma .

Question 8

physiology of breast following cessation of lactation and menopause

Answer 8

cessation of lactation: involution in 3 m. Epithelial cells undergo apoptosis, lobules regress/atrophy. menopause: involution of TDLUs, duct system remains, dec interlobular stroma, inc fatty tissue

Question 9

Sites of accessory nipples/ breasts

Answer 9

nipples: along milk lines- from armpit, through nipples along abdomen. Breasts: may be seen in the lower axilla where it may raise a concern for metastatic cancer.

Question 10

Causes of gynecomastia

Answer 10

Absolute or relative increase in estrogen, Idiopathic ? , liver disease, drugs (dilantin, digitalis, marijuana), testicular tumors, metabolic or endocrine disorders

Question 11

gynecomastia histology

Answer 11

ductal epithelial hyperplasia, stromal edema, and loose fibrosis around ducts.

Question 12

who is affected by acute vs chronic mastitis

Answer 12

acute: young women, onset of lactation. Chronic: perimenopausal women

Question 13

acute mastitis pathophys

Answer 13

Cracked or inflammed nipple permits entry of organisms > proliferation of bacteria (staph) in stagnant milk > acute inflammation (neutrophils) > acute abscess formation

Question 14

Acute mastitis treatment and ddx

Answer 14

antibiotics, drainage of pus. Differential diagnosis includes inflammatory breast carcinoma

Question 15

Chronic mastitis pathophys

Answer 15

Duct obstruction by secretions or cells. Dilation of ducts > stasis of secretion and epithelial debris > infiltration by lymphocytes/ plasma cells causes plasma cell mastitis. Duct rupture with release of lipid contents causes infiltration by foamy histiocytes and granulomatous mastitis. Both processes lead to irregular fibrosis and a painless fixed mass that mimicks carcinoma

Question 16

periductal mastitis sx and associations

Answer 16

Women, and sometimes men, present with a painful erythematous subareolar mass that clinically appears to be an infectious process. More than 90% of the afflicted are smokers. This condition is not associated with lactation, a specific reproductive history, or age. May be due to fistula tract under smooth muscle of nipple.

Question 17

fat necrosis- cause, gross appearance, microscopic appearance, differential diagnosis

Answer 17

Cause: ? ischemia, trauma. Gross: ill defined mass. Microscopic: - early: necrotic fat cells, neutrophils - later: macrophages, gc, fibrosis, Calcifications. Diff dx is cancer: hard irregular mass on palpation and mgm.

Question 18

List benign neoplasms of breast

Answer 18

Fibroadenoma, Lactating adenoma, Phyllodes tumor, Papilloma

Question 19

fibroadenoma of breast- gross appearance, origin, histology

Answer 19

Round, sharply demarcated, rubbery, mobile, 2-4cm, usually solitary. Origin: TDLU. Mixture of fibrous tissue & ducts in varying ratio. (Epith:2-cell layer or more)

Question 20

lactating adenoma- when does it occur, gross appearance, microscopic appearance

Answer 20

Presents during pregnancy or lactation. Gross: circumscribed soft mass. Micro: proliferation of small tubular structures with lactational changes

Question 21

Phyllodes tumor- gross appearance, micro appearance, spectrum,

Answer 21

Large fleshy tumors composed of intralobular stroma and ductal epithelium.. Leaf like processes into cystic spaces. Benign epithelium, fibrosarcomatous stroma. Spectrum: benign, low grade, high grade

Question 22

Intraductal papilloma- gross appearance, micro appearance, ddx

Answer 22

Benign, 1cm mass, subareolar. Bloody nipple discharge. Gross: Papillary mass in a large duct. Micro: Delicate papillae, fibrovascular core, 2-cell layer of epithelium. Differential diagnosis: papillary Ca

Question 23

Describe fibrocystic change

Answer 23

group of morphologic changes that often produce palpable lumps and which are characterized by various combinations of cysts, fibrous overgrowth, and epithelial proliferation. Cause is unknown, may be hormonal.

Question 24

Fibrocystic change sx

Answer 24

•Asymptomatic, pain, nodularity. Range: Innocuous to pre-malignant

Question 25

types of fibrocystic change

Answer 25

1. Nonproliferative FCC: cysts/fibrosis. epith. Hyperplasia absent. 2. Proliferative FCC:cysts/fibrosis. epith. Hyperplasia present. 3. Sclerosing adenosis: hard, rubbery like ca.

Question 26

Sclerosing adenosis histology

Answer 26

•Adenosis, marked fibrosis which may compress/distort the lumens of acini and ducts….giving the appearance of solid cords of cells. Diffuse microcalcifications. Proliferation of ductular structures and stroma distort TDLU. Proliferated ductules may be compresed producing whorls and cords.

Question 27

Types of hyperplasia in proliferative fibrocystic disease

Answer 27

Lobular: atypical lobular hyperplasia (50% of lobules). Ductal: Usual hyperplasia ( Mild, Moderate, Florid), Atypical ductal hyperplasia, DCIS ( Ductal Ca in situ)

Question 28

spectrum of ductal hyperplasia

Answer 28

usual hyperplasia > atypical hyperplasia > carcinoma-in-situ

Question 29

ductal hyperplasia- usual type

Answer 29

There is increase in epithelial layer lining, ( more than 2 cell layers) which distends the terminal ducts. The epithelial proliferation may either form papillary tufts projecting into the lumen( mild), proliferate to bridge and create arcades(moderate) or form solid masses which fill and distend the lumen and may have irregular fenestrations ( florid hyperplasia)

Question 30

Atypical ductal hyperplasia

Answer 30

has some of the architectural and cytologic features of carcinoma in situ but lack the complete criteria for that diagnosis

Question 31

Ductal carcinoma in situ

Answer 31

Malignant cells confined within basement membranes of ducts without invasion of surrounding stroma

Question 32

Fibrocystic changes with minimal risk of breast cancer

Answer 32

Cyst, apocrine metaplasia, , fibrosis, Duct ectasia, mild hyperplasia (more than 2 but less than 4 cells thick), Fibroadenoma without complex features

Question 33

Fibrocystic changes with 1.5-2.5X risk of breast cancer

Answer 33

Hyperplasia- moderate or florid, (refers to extensive degrees of epithelial proliferation), Papilloma, sclerosing adenosis, Fibroadenoma with complex features

Question 34

Fibrocystic changes with 4-5X risk of breast cancer

Answer 34

Atypical ductal hyperplasia (ADH), Atypical lobular hyperplasia ( ALH)

Question 35

Fibrocystic changes with 8-10X risk of breast cancer

Answer 35

Ductal Carcinoma in situ (DCIS), Lobular Carcinoma in situ (LCIS) : marker for increased risk of developing invasive carcinoma ; risk is equal for both breasts and subsequent carcinoma may be either ductal or lobular

Question 36

List condtions that affect the terminal duct lobular unit

Answer 36

cyst, sclerosing adenosis, small duct papilloma, hyperplasia, atypical hyperplasia and carcinoma

Question 37

List conditions that affect the lobular stroma

Answer 37

fibroadenoma, phyllodes tumor

Question 38

List conditions that affect the large ducts and lactiferous sinuses

Answer 38

Duct ectasia, abscesses, solitary ductal papilloma, pagets disease

Question 39

List benign conditions that affect the interlobular stroma

Answer 39

fat necrosis, lipoma, fibrous tumor