Breast Pathology Flashcards
(45 cards)
T/F: The breast is an essential organ
FALSE
The breast is non-essential for survival - major function = nutritional support of the infant
Describe the major changes the breast undergoes through life
-Expansion after menarche
-Remodeling during adulthood, especially during and after pregnancy
-Involution and regression
List the breast disease symptoms
-Pain
-Inflammation
-Nipple discharge
-Lumpiness
-Palpable masses
-Gynecomastia
Describe when the symptom of pain would be present in breast disease
Pain (mastalgia or mastodynia) - common to menses
-When localized usually due to a ruptured cyst of trauma to adipose (fat necrosis)
-Almost al painful masses are benign (10% of cancers cause pain)
Describe when the symptom of inflammation would be present in breast disease
Edema and Erythema
-Rare, most often caused by infection typically during lactation/breast-feeding
*one exception = inflammatory breast carcinoma
Describe when the symptom of nipple discharge would be present in breast disease
-Normal when small amount and bilateral
-Common benign lesion: Papilloma arising in large ducts below the nipple
-Spontaneous, unilateral and bloody discharge is concerning for malignancy
Describe when the symptom of lumpiness would be present in breast disease
Lumpiness (diffuse nodularity)
-Usually normal glandular tissue
-Imaging used to detect if there is a discrete mass
Describe when the symptom of palpable masses would be present in breast disease
-Arise from stromal or epithelial cell proliferation
-Generally detected when 2-3cm in size
- ~95% are benign
-Round to oval, circumscribed
-While malignancies generally have irregular borders some are circumscribed - all palpable masses require evaluation
Describe when the symptom of gynecomastia would be present in breast disease
-Breast enlargement in males (the only common breast symptom in males)
-Imbalance between estrogens and androgens causes an increase in stromal and and epithelial cells
Most symptomatic breast lesions (>90%) are _____
benign
What percentage of women with cancer have symptoms?
45%
With increasing age, symptoms are associated with increased likelihood malignancy. Describe this for both nipple discharge and for palpable mass
Nipple discharge:
- <60yrs = 7% due to cancer
- >60yrs = 30% due to cancer
Palpable mass
- <40yrs = 10% due to cancer
- >50yrs = 60% due to cancer
Describe Inflammatory Lesions
-Often benign, but because they are rare, always should rule out inflammatory carcinoma
-Symptoms: pain, erythema, edea
Mastitis
-Inflammatory lesion
-Bacterial infection in/through the nipple
-Caused by Staphyloccocus aureus most often
Traumatic fat necrosis
-Inflammatory lesions
-History of trauma to breast
-Small, localized tender lesion that over time scars with calcification, creating a palpable, firm lesion
Benign epithelial lesions
Most are incidental findings by mammography; some have risk for cancer development
Nonproliferative disease: (“fibrocystic change/disease”)
-Most common benign epithelial lesion; no increased risk of breast cancer
-Ducts keep single layer but are dilated (adenosis) forming variably sized brown/blue cysts and increased fibrous stroma
-Apocrine secretions may create microcalcifications (detected by mammography)
-Rupture induces chronic inflammation and fibrous producing palpable nodularity
Benign epithelial lesions - proliferative disease without atypia
Slightly increased risk of cancer (1.5-2x) - “ductal hyperplasia”
Benign epithelial lesions - proliferative disease with atypia
(4-5x increased risk). Can occur within the duct (atypical ductal hyperplasia) or the lobule (atypical lobular hyperplasia)
Describe the extent of breast cancer
-Most common malignancy of women (excluding nonmelanoma skin cancer)
-In US: incidence stable; 2nd leading cancer-related cause of death behind lung cancer in women
-Worldwide: incidence and mortality increasing
- 1/8 lifetime risk to get it; 25% die of disease
- >50yrs (75% of cases); <40yrs (5%)
List the risk factors for breast cancer
-Age
-Gender
-Family history
-Geographic variations
-Race/Ethnicity
-Ionizing radiation
-Reproductive history
Describe how age contributes to the risk of breast cancer
risk increases after 30, plateaus at menopause
Describe how gender contributes to the risk of breast cancer
1% incidence in men
Describe how family history contributes to the risk of breast cancer
-Greater risk = multiple affected first-degree relatives with early onset (<45yrs) breast cancer
-5-10% are related to specific inherited mutations which can lead to lifetime risk >90%
