Breast Pathology

Question 1

Key Features: Central necrosis Precancerous lesion Confined to ducts & lobules

Answer 1

Ductal Carcinoma in Situ (DCIS) non-invasive

Image: ducts (black arrows) distended by pleomorphic cells with prominent central necrosis without extension

Question 2

Key Features: Eczematous nipple lesion Extension of DCIS into ducts

Answer 2

Paget’s disease (manifestation of ductal carcinoma)

Question 3

Key Features: Most common type Nests & cords of cells Firm, Rock hard mass

Answer 3

Invasive Ductal Carcinoma *stellate infiltration = worse prognosis

Question 4

Painless breast mass

Small cells in single file (orderly row)

↓ E-cadherin expression

Mammary stroma invasion

Answer 4

Invasive Lobular carcinoma *Lines of cells = Lobular

Question 5

Enlarged, hard lymph nodes Usually lacks palpable mass Peau d’orange Dermal lymphatic invasion Poor prognosis (Undiff)

Answer 5

Inflammatory Breast Cancer (Invasive) High Yield

Question 6

presents with painful, diffuse breast induration, erythema, and peau d’orange (orange peel or dimpled) skin (warm, red, swollen) due to blockage of lymphatic drainage by cancerous invasion.

Answer 6

Inflammatory breast carcinoma (Invasive)

Question 7

characterized by crusty, scaly redness on the nipple and areola with oozing and bleeding.

Answer 7

Paget’s disease (manifestation of ductal carcinoma)

Question 8

Caused by cancerous cells obstructing lymphatic drainage after spreading to the dermal lymphatic spaces. High propensity to metastasize to the lymphatic system, (axillary lymphadenopathy) ​​​​​​​

Answer 8

Inflammatory Breast carcinoma (Invasive)

Question 9

small, firm, and mobile breast masses that occur due to proliferation of breast stroma and ducts.

Answer 9

Fibroadenomas

Question 10

Microscopic examination of Fibroadenoma shows ____ proliferation compressing the ducts to slits (look like septa).

Answer 10

stromal

Question 11

presents as an irregular breast mass with no associated nipple discharge after localized trauma or biopsy.

Answer 11

Fat necrosis

Question 12

Fat Necrosis microscopy may show adipocytes (white spots) undergoing necrosis with inflammation, including _____ and ____ cells.

Answer 12

lipid laden macrophages (look big, foamy, puffy, and light) Giant cells (multiple nuclei)

Question 13

Typically cause cyclic (comes/goes) breast pain no nipple discharge

Answer 13

Fibrocystic changes of the breast

Question 14

May show cysts (smooth, glassy pink globules encased) and areas of fibrous stroma (pink plain acellular sheet)

Answer 14

Fibrocystic changes of the breast

Question 15

Paget disease of the breast occurs due to the ductal spread of atypical malignant cells to the _____

Answer 15

nipple epidermis (Histo looks fucked and radical with large cells that have white clearings surrounding them)

Question 16

Patients may have: unilateral erythematous, intensely pruritic, ulcerative lesion over the nipple and areola. bloody nipple discharge

Answer 16

Paget disease of the breast

Question 17

characterized by epithelial and myoepithelial cells lining fibrovascular cores in a cyst wall or duct. (finger like papillary projections with stromal plain core that may have a few scattered nuclei here and there)

Answer 17

Intraductal papilloma (benign)

Question 18

Unilateral bloody (or clear) nipple WITHOUT a breast masses or skin changes. No enlarged axillary lymph nodes

Answer 18

Intraductal papilloma (benign)

Question 19

the most common cause of bloody nipple discharge

Answer 19

Intraductal papilloma (benign)

Question 20

benign tumor within the mammary duct

Answer 20

Intraductal papilloma (benign)

Question 21

Tamoxifen Raloxifene MOA

Answer 21

Selective Estrogen Receptor Modulators: Competitive inhibitor of estrogen binding Mixed agonist/antagonist action depending on tissue where the receptor is located

Question 22

_______ causes postmenopausal osteoporosis Prevention of breast cancer in high-risk patients

Answer 22

Raloxifene

Question 23

_______ is used for adjuvant treatment of breast cancer Prevention of breast cancer in high-risk patients

Answer 23

Tamoxifen

Question 24

Hot flashes Venous thromboembolism are adverse effects associated with:

Answer 24

Raloxifene Tamoxifen

Question 25

Endometrial hyperplasia & carcinoma is an adverse effect associated with:

Answer 25

Tamoxifen

Question 26

Tamoxifen has a favorable effect on serum lipids: decrease in _______ cholesterol no significant change in ______ Serum triglycerides may _____ in some patients.

Answer 26

total and LDL HDL increase

Question 27

most commonly occurs in lactating women and presents with pain, breast swelling, and erythema. Most patients also have systemic findings such as fever, malaise, and leukocytosis.

Answer 27

Mastitis (ie, breast infection) \*keep feeding baby as normal

Question 28

Histopathology demonstrates ducts distended by pleomorphic cells with prominent central necrosis withOUT extension beyond the ductal basement membrane.

Answer 28

Paget disease

Question 29

the most common hormonally active pituitary adenoma. These tumors can cause galactorrhea (milky discharge from bood) and amenorrhea in premenopausal women.

Answer 29

Prolactinomas \*Lactotrophs under negative regulation by Dopamine

Question 30

Immobile, firm breast mass (most commonly in the upper outer quadrant)

Answer 30

Invasive breast carcinoma

Question 31

Rupture of a silicone breast implant can lead to a foreign body REACTION of the breast with local inflammation (edema, induration), and ______ formation; can result in a palpable, tender mass.

Answer 31

granuloma

Question 32

a breast lesion characterized by a malignant clonal cell proliferation contained by the surrounding ductal basement membrane. The (basal) myoepithelial layer of the duct is preserved and uninvolved.

Answer 32

Ductal carcinoma in situ (DCIS)

Question 33

characterized by solid sheets of vesicular, pleomorphic, mitotically active cells with a significant lymphocytic & plasma cell infiltrate around and within the tumor and a pushing, noninfiltrating border.

Answer 33

Medullary carcinoma of breast \*well circumscribed can mimic fibroadenoma

Question 34

malignant cells spread from superficial DCIS into nipple skin without crossing the basement membrane.

Answer 34

Paget disease of the nipple

Question 35

Sclerosing adenosis is characterized by _____ proliferation and compression with surrounding fibrotic tissue and peripheral ductal \_\_\_. Common finding in fibrocystic change.

Answer 35

central acinar dilation

Question 36

Trastuzumab is a monoclonal antibody that blocks _______ to disrupt malignant cell signaling and encourage apoptosis.

Answer 36

human epidermal growth factor receptor-2 (HER2)

Question 37

HER2 helps preserve cardiomyocyte function, thus Trastuzumab can cause _______ that manifests as a decrease in myocardial _______ without cardiomyocyte destruction or \_\_\_\_\_\_\_.

Answer 37

Cardio toxicity myocardial contractility myocardial fibrosis.

Question 38

-mab that blocks human epidermal growth factor receptor-2 (HER2)

Answer 38

Trastuzumab

Question 39

Triple Negative for E, P, & HER2 indicates a ____ disease course

Answer 39

aggressive (Negative outcome)

Question 40

Estrogen Receptor positive (overexpression) breast cancer likely responds to what drug?

Answer 40

Tamoxifen (endometrial cancer risk)

Question 41

HER2/neu receptor positive (overexpression) breast cancer likely responds to what drug?

Answer 41

Trastuzumab (cardio toxic risk)

Question 42

Breast cancer often presents in post-menopausal women as a palpable hard mass in the _______ quadrant.

Answer 42

Upper Outer

Question 43

Invasive breast cancer can become fixed to the _____ muscle, deep fascia, Cooper ligament or skin (nipple retraction/ skin dimpling)

Answer 43

pectoral

Question 44

Invasive breast cancer usually arises in the ____ lobular unit

Answer 44

terminal duct

Question 45

African American women have an increased risk for what type of breast cancer hormone sensitivity?

Answer 45

Triple Negative

Question 46

\_\_\_\_ metastasis is the most important prognostic factor in early-stage breast cancer.

Answer 46

Axillary Lymph node

Question 47

Often seen as microcalcifications on mammography Usually does not produce a mass

Answer 47

DCIS (not past basement membrane)

Question 48

DCIS extension into lactiferous ducts

Answer 48

Paget's (eczma)

Question 49

Central Caseous necrosis and dystrophic calcifications

Answer 49

Comedocarcinoma (DCIS subtype)

Question 50

↓ E-cadherin expression No mass or calcifications incidental finding on biopsy

Answer 50

Lobular carcinoma in situ (LCIS) non-invasive

Question 51

Often presents with bilateral multiple lesions in the same location

Answer 51

Invasive Lobular Carcinoma

Question 52

Firm, Fibrous, Rock-hard mass with sharp margins and small, glandular, duct-like cells in desmoplastic stroma

Answer 52

Invasive Ductal Carcinoma

Question 53

Invasive breast carcinoma typically presents as an irregularly shaped, adherent breast mass, most commonly in the upper outer quadrant. Malignant infiltration of _____ of the breast can cause skin retractions.

Answer 53

suspensory ligaments

Question 54

Peau d'orange is an erythematous, itchy breast rash with skin texture changes that resemble an orange peel. It is caused by cancerous cells spreading and obstructing \_\_\_.

Answer 54

lymphatic drainage

Question 55

Intraductal papilloma is a benign tumor within the \_\_\_

Answer 55

mammary duct.